UMEM Educational Pearls

Valproic Acid in Status Epilepticus

  • In previous pearls, we have discussed the treatment of status epilepticus (SE) with first-line (benzodiazepines) and second-line agents (phenytoin/fosphenytoin).
  • Refractory SE is defined as the failure to respond to both first- or second-line antiepileptic medications.
  • Valproic acid is listed in many algorithms as a third-line agent for treating SE.
  • Avoid valproic acid in refractory SE patients who have hepatic disease or dysfunction.
  • Although rare, valproic acid can cause a fatal hepatotoxicity in these patients. 


Pillow MT, Malani N. Best practices for seizure management in the emergency department.  ACEP News 2011; 30(1):14-16.