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Valproic acid estimation by enzyme immunoassay.

A A Elyas, V D Goldberg, N Ratnaraj

    Annals of Clinical Biochemistry
    |November 1, 1980
    PubMed
    Summary
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    Enzyme immunoassay (EMIT) accurately measures valproic acid in patients on long-term therapy. Anticoagulants like EDTA or fluoride/oxalate can cause falsely high valproic acid readings compared to serum analysis.

    Area of Science:

    • Clinical Chemistry
    • Pharmacology
    • Analytical Chemistry

    Background:

    • Sodium valproate (Epilim) is a common antiepileptic drug requiring therapeutic drug monitoring.
    • Accurate measurement of valproic acid is crucial for optimizing patient outcomes and minimizing toxicity.
    • Evaluating analytical methods and pre-analytical variables is essential for reliable drug level determination.

    Purpose of the Study:

    • To compare the accuracy and precision of enzyme immunoassay (EMIT) with gas-liquid chromatography (GLC) for valproic acid analysis.
    • To critically assess the impact of common anticoagulants on valproic acid measurements.
    • To validate EMIT as a reliable method for therapeutic drug monitoring of valproic acid.

    Main Methods:

    • Analysis of patient blood samples using both EMIT and GLC methods.

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  • Specificity, accuracy, and precision studies of the EMIT valproic acid reagent.
  • Evaluation of anticoagulant effects (EDTA, fluoride/oxalate) on valproic acid levels compared to serum.

    • Main Results:

    • EMIT demonstrated high specificity for valproic acid.
    • A strong correlation was observed between EMIT and GLC results across a broad concentration range.
    • EMIT assay showed good accuracy and precision within the therapeutic range of valproic acid.
    • EDTA and fluoride/oxalate anticoagulants led to a bias towards higher valproic acid results compared to serum.

    Conclusions:

    • EMIT is a specific, accurate, and precise method for quantifying valproic acid in patients on long-term therapy.
    • The presence of EDTA or fluoride/oxalate anticoagulants in blood samples can interfere with valproic acid measurement, leading to falsely elevated levels.
    • Careful consideration of anticoagulant choice is necessary when performing valproic acid analysis, with serum preferred over anticoagulated plasma for accurate results.