Which serious risk is associated with valproic acid use, especially in children and those with liver disease?

• A. Hepatotoxicity and teratogenicity.
• B. Pancreatitis.
• C. Weight gain.
• D. Thrombocytopenia.

Answer: (A)

Valproic acid carries a serious risk of liver injury, including potentially fatal hepatotoxicity, which is especially concerning in young children and in people with preexisting liver disease. The risk is highest in early treatment and can occur even at therapeutic doses, so clinicians monitor liver function tests before starting therapy and regularly thereafter, and may avoid or discontinue valproate in patients with hepatic impairment or mitochondrial disorders. Teratogenicity is also a significant risk of valproate, particularly neural tube defects when used during pregnancy, but in the context of children and liver disease, the hepatotoxicity risk is the most relevant and defining concern. While pancreatitis, weight gain, and thrombocytopenia can occur, they do not carry the same level of risk emphasis for these populations.