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Overdosage with valproate may result in somnolence, heart block, hypotension and circulatory collapse/shock, and deep coma. Fatalities have been reported; however, patients have recovered from valproate levels as high as 2,120 mcg/mL.
The presence of sodium content in the valproate formulations may lead to hypernatremia when taken in overdose.
In case of valproate overdose resulting in hyperammonemia, carnitine can be given through IV route to attempt to normalize ammonia levels.
In overdose situations, the fraction of drug not bound to protein is high and hemodialysis or tandem hemodialysis plus hemoperfusion may result in significant removal of drug. The benefit of gastric lavage or emesis will vary with the time since ingestion. General supportive measures should be applied with particular attention to the maintenance of adequate urinary output.
Naloxone has been reported to reverse the CNS depressant effects of valproate overdosage. Because naloxone could theoretically also reverse the antiepileptic effects of valproate, it should be used with caution in patients with epilepsy.
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