Valproic acid useful for managing agitation, delirium in intensive care

Valproic acid provides a reasonable and tolerable alternative in the management of agitation and delirium in critically ill patients, a study has found.

Researchers conducted a descriptive analysis involving 47 patients who received valproic acid for at least 3 days for the treatment of agitation and/or delirium in the cardiac, surgical or medical intensive care unit. Agitation and delirium prevalence were assessed during therapy for up to 7 days.

Common reasons for admission in the entire sample were burn or trauma, transplant, pneumonia, coronary artery disease, and heart failure. Prior to valproic acid therapy initiation, 15 patients had received benzodiazepines, 35 opioid agents, 38 antipsychotics and 18 dexmedetomidine.

The median starting total daily dose for valproic acid was 500 mg or 6.2 mg/kg, with the median duration of therapy being 8 days. Fourteen patients (30.4 percent) were discharged on valproic acid therapy.

Throughout treatment, there was a downward trend observed in the prevalence of agitation (from 47.8 percent at day 1 to 16.7 percent at day 7) and delirium (from 84.8 percent at day 1 to 63.3 percent at day 7). There was a parallel decrease in patient requirement for dexmedetomidine, benzodiazepines, antipsychotics and opioids.

No adverse effects associated with valproic acid were recorded.

The researchers called for additional prospective data to validate the use of the drug for the treatment of agitation and delirium in critically ill patients.