Valproate Monitoring — RACP Adult Medicine MCQ

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EasyClinical PharmacologyValproate MonitoringRACP Adult Medicine

A 55-year-old man on sodium valproate 1500 mg daily for epilepsy develops a tremor, weight gain, and hair loss. His ammonia is mildly elevated at 65 µmol/L. What is the most important laboratory test to perform regularly?

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Correct answer: C — Lipid profile

Sodium valproate requires regular monitoring of FBC (thrombocytopaenia, leucopaenia – dose-related) and LFTs (hepatotoxicity – can be fatal, especially in children <2 years). Valproate-induced hepatotoxicity can be idiosyncratic (rare, severe) or dose-related (common, mild elevations). Other important side effects include weight gain (up to 20% of patients), tremor (dose-related), hair loss/thinning (reversible), hyperammonaemia (can occur without liver dysfunction), pancreatitis, and teratogenicity (highest of all AEDs – 10% major malformation rate; avoided in women of childbearing potential unless essential). POLG mutation testing is recommended before starting valproate if mitochondrial disease is suspected.

Reference: AMH – 2025 – Sodium Valproate; eTG – 2025 – Neurology; TGA – 2024 – Valproate Safety