Valproate hepatotoxicity: two new cases, a summary of others, and recommendations

There are two types of hepatotoxicity associated with valproate therapy--dose-related and idiosyncratic. The former may cause alterations in liver function as determined by laboratory examinations and is not associated with death. Idiosyncratic hepatotoxicity is rare, usually irreversible, and not predictable on the basis of laboratory monitoring. Two new cases are reported along with a selected, brief literature review and the authors' suggestions for the use of valproate.