Valproate Hepatotoxicity – Stop Drug — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersValproate Hepatotoxicity – Stop DrugSCE Neurology

A 30-year-old woman with epilepsy on valproate develops elevated liver enzymes (ALT 250, AST 200). She has nausea and abdominal pain. She has been on valproate for 3 years. What is the most important action?

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Correct answer: C — Stop valproate — hepatotoxicity is a serious adverse effect that can progress to fatal hepatic failure; alternative AED should be started

Valproate-induced hepatotoxicity can range from asymptomatic transient LFT elevation (common and often benign) to fatal hepatic failure (rare but potentially life-threatening, more common in children <2 years, polytherapy, and metabolic disorders). Symptomatic hepatotoxicity (elevated LFTs WITH nausea, abdominal pain, vomiting, jaundice, or coagulopathy) requires immediate valproate cessation and liver function monitoring. An alternative AED should be started. Risk factors include young age, polytherapy, and mitochondrial disorders (particularly POLG mutations — where valproate is contraindicated). A: Symptomatic hepatotoxicity requires drug cessation. C: Would worsen toxicity. D: Symptomatic elevation is not benign. E: Drug cessation is the priority.

Reference: BNF – Valproate Hepatotoxicity Warning; NICE NG217