Meds Flashcards
Valproate (and some other AEDs like carbamazepine) labs and what to do about them
Check these labs:
- Liver panel (ALT, AST, ALP, Bilirubin, Albumin, Total protein)
- CBC with WBC differential and platelet count
- hCG
- Valproate level
Check the above labs at baseline, monthly for the 1st several months, then every 6 months to 24 months
Good level is 50 to 120 mcg/mL
If hepatic enzymes elevate, it’s usually in the 1st 6 months, and more common in children. AST/ALT will return to normal after stopping the meds, unless there’s an underlying cause.
If the AST/ALT is elevated more than 2-3 times the normal amount, discontinue valproate.
The patient should contact you if they have liver symptoms, like abdominal pain, nausea, vomiting, and jaundice.
Liver failure is very rare, if it does happen it’s in children younger than 10, developmentally disabled, or major seizure disorder.
The most common hematologic complications are thrombocytopenia and neutropenia.
Consider discontinuing the drug if there’s bone marrow depression.
Patient should contact you for signs of hematologic dysfunction (easy bleeding/bruising, slow healing, high fever).
Carbamazepine, special considerations about an adverse reaction
Rarely can cause SJS.
The risk is increased to 5% in asians and south asians. Screen these patients for a certain allele (genetic testing) before starting an asian person on carbamazepine.
