In addition, they tend to potentiate cognition problems in an already compromised patient. In addition, manufacturers product information was reviewed. Literature Review Lantz and Marin 13 published a comprehensive review of the pharmacotherapy used in the treatment of agitation in dementia. Recent literature citing the use of VPA for selected psychiatric disturbances is summarized in Table 1. Steady-state VPA levels should be obtained after any dosage change.
Most patients achieve steady-state concentrations after three days of the same dosing regimen.
Monitoring for sedation, confusion, and ataxia should be done routinely. If nausea occurs, VPA should be administered with food, given in divided doses, or divalproex preparation substituted, and if necessary the dosage should be reduced. In the event of tremors, the dosage should be reduced or given once daily. It may be necessary to consider adding propranolol. Drug interactions with valproate include some of the anti-epileptic drugs such as carbamazepine, lamotrigine, phenytoin, and phenobarbital.