A Case of Delirium and Subsequent Pancytopenia Associated With the Oral Loading of Valproic Acid

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Sir: Some studies have shown that the oral loading of valproic acid or divalproex sodium is most likely safe and leads to more rapid antimanic effects than standard titration of these agents.1–4 Although there are some case reports of delirium5,6 or pancytopenia7–12 associated with valproic acid, as far as we know, serial acute adverse effects such as delirium and pancytopenia resulting from the oral loading of valproic acid have not yet been reported. We present a case in which manic symptoms were relieved rapidly with the oral loading of valproic acid, but delirium and subsequent pancytopenia developed as acute, severe adverse effects.​

J Clin Psychiatry 2005;66(6):801-802