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Rapid administration of undiluted IV push valproic acid
Stephanie Rollins1, John J Radosevich1, Nora Sammani1
1Department of Pharmacy, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Journal of Neurology
|July 10, 2026
Summary
Rapid, undiluted intravenous push (IVP) administration of valproic acid (VPA) is safe and well-tolerated for seizure and headache management. This method proved effective across over 5500 doses, including high loading doses, supporting its use in time-sensitive situations.
Area of Science:
- Pharmacology
- Neurology
- Clinical Pharmacy
Background:
- Traditional intravenous (IV) infusion of valproic acid (VPA) can cause treatment delays.
- Rapid administration via IV push (IVP) may offer benefits, but safety data across various doses is limited.
Purpose of the Study:
- To evaluate the safety and tolerability of undiluted IVP VPA administration.
- To assess IVP VPA safety for doses up to 4000 mg.
Main Methods:
- Retrospective, observational, single-center cohort analysis.
- Included patients receiving at least 3 doses of IVP VPA between January 2020 and May 2025.
- Focused on safety and tolerability outcomes of rapid, undiluted VPA administration.
Main Results:
- 570 patients received 5546 doses of undiluted IVP VPA.
- Loading doses up to 3000 mg and maintenance doses of 500 mg were common.
- Only three adverse events were reported, with none classified as drug-related via the Naranjo scale.
Conclusions:
- Undiluted IVP VPA exhibits a favorable safety and tolerability profile.
- Supports the use of rapid VPA administration in clinical practice.
- Especially beneficial for time-sensitive indications like emergent seizures.
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