A Review of Valproic Acid–Induced Carnitine Deficiency and Replacement

Abstract

Objective:

To review valproic acid–induced carnitine deficiency and subsequent carnitine replacement.

Data Sources:

Articles indexed in MEDLINE from 1966 to May 2000, as well as other published works and standard references.

Data Extraction:

Studies investigating clinical epidemiologic and pathologic evidence of the role of valproic acid–induced carnitine deficiency and double-blind clinical trials evaluating the effectiveness of carnitine replacement with anticonvulsant therapy are presented.

Data Synthesis:

Clinical epidemiologic and pathologic studies provide evidence of valproic acid–induced carnitine deficiency. There is no clear consensus for providing carnitine supplementation to all patients taking valproic acid — It is only indicated for children with valproic acid–induced hepatotoxicity and those with valproic acid overdose.

Conclusions:

There is evidence that implicates valproic acid in inducing carnitine deficiency. Patients should be evaluated clinically for signs and symptoms of carnitine deficiency before beginning supplementation. Currently, carnitine supplementation should be reserved for children with valproic acid–induced hepatotoxicity and valproic acid overdose until the results of further clinical studies are available.

Get full access to this article

View all access options for this article.

References

Raskind

El-Chaar

. The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 2000; 34: 630–8.

Eadie

Tyrer

. Anticonvulsant therapy: pharmacologic basis and practice. 3rd ed. New York: Churchill Livingstone, 1989.

Drugs for psychiatric disorders. Med Lett Drug Ther 1997;39: 33–40.

Bernad

. Neurotoxicology: a clinical source book. Charlottesville, VA: Lexis Law Publishers, 1998.

Pons

DeVivo

. Primary and secondary carnitine deficiency syndromes. J Child Neurol 1995; 10 (suppl 2): S8–24.

Schmidt-Sommerfield

Werner

Penn

Carnitine plasma concentrations in 353 metabolically healthy children. Eur J Pediatr 1988; 147: 356–60.

McCurdy

. Carnitine deficiency. Pediatrics 1995; 96: 1174–5.

Baynes

Dominiczak

Medical biochemistry. New York: Mosby, 1999.

Engel

Franzini-Armstrong

Myology: basic and clinical. 2nd ed. New York: McGraw-Hill, 1994.

10.

Kelley

. The role of carnitine supplementation in valproic acid therapy. Pediatrics 1994; 93 (6 pt 1): 891–2.

11.

Freeman

Vining

Cost

Singhi

Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994; 93 (6 pt 1): 893–5.