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Carnitine deficiency during valproic acid treatment

J P Van Wouwe1

  • 1Department of Pediatrics, Drechtsteden Hospital Jacobus, Zwijndrecht, The Netherlands.

International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift Fur Vitamin- Und Ernahrungsforschung. Journal International De Vitaminologie Et De Nutrition
|January 1, 1995
PubMed
Summary

Prolonged valproic acid treatment can cause carnitine deficiency in children. Supplementing with carnitine is recommended if fatigue occurs, with effective symptom reversal observed within a week.

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Area of Science:

  • Biochemistry
  • Pediatric Neurology
  • Clinical Pharmacology

Background:

  • Valproic acid (VPA) is a widely used antiepileptic and mood-stabilizing drug.
  • Long-term VPA therapy is associated with potential adverse effects, including metabolic disturbances.
  • Secondary carnitine deficiency is a known complication of certain drug treatments.

Purpose of the Study:

  • To investigate the effect of prolonged valproic acid treatment on carnitine levels in children.
  • To assess the incidence of biochemical and clinical carnitine deficiency during VPA therapy.
  • To evaluate the efficacy of carnitine supplementation in children with VPA-induced carnitine deficiency.

Main Methods:

  • Paired plasma samples were collected from thirteen children before and after 9 months of continuous valproic acid treatment.

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  • Plasma free and total carnitine levels were measured.
  • Clinical symptoms, particularly fatigue, were monitored.

    • Main Results:

    • Mean plasma free carnitine decreased by 40% (p=0.0008) and total carnitine by 20% (p=0.016) after 9 months of VPA treatment.
    • The esterified/free carnitine ratio increased significantly (p=0.011).
    • Two out of thirteen children developed fatigue, while four others showed only biochemical evidence of carnitine deficiency.

    Conclusions:

    • Prolonged valproic acid treatment leads to significant secondary carnitine deficiency in children.
    • Carnitine supplementation (15 mg/kg) effectively reverses clinical symptoms like fatigue within a week.
    • Monitoring carnitine levels and considering supplementation is advised for children on long-term VPA therapy, especially if fatigue is present.