The measurement of ammonia blood levels in patients taking valproic acid: Looking for problems where they do not exist?

Ada V. Chicharro, Alejandro J. de Marinis, Andres M. Kanner

Research output: Contribution to journalArticle

48 Scopus citations


Hyperammonemia (HA) commonly occurs with the use of valproic acid (VPA); while it has no clinical significance in most cases, the Physician Desk Reference recommends its discontinuation in the presence of HA. The purpose of this study is to review the literature in order to estimate the prevalence and magnitude of HA in VPA treated patients, to establish any association with hepatotoxicity and encephalopathy and to identify any factors associated with its occurrence. A search of MEDLINE and Cochrane Database of Systematic Reviews, between 1980 and 2005 was performed. Out of 183 studies, 24 met our inclusion criteria. The prevalence of HA in the prospective studies ranged between 70% and 100%, while in cross-sectional studies it varied between 16% and 100%. Ammonia (NH3) blood levels increased by a two-fold average relative to the baseline levels. There was no association between HA and clinical symptoms. Concomitant administration of other antiepileptic drugs (AEDs) was the factor most frequently associated with HA.

Original languageEnglish (US)
Pages (from-to)361-366
Number of pages6
JournalEpilepsy and Behavior
Issue number3
StatePublished - Nov 1 2007
Externally publishedYes



  • Antiepileptic drugs
  • Encephalopathy
  • Epilepsy
  • Hepatic failure
  • Valproic acid

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

Cite this