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Valproic Acid Augmentation in Traumatic Brain Injury Related Agitation
Friday April 25, 2025 10:40am - 10:55am EDT
Athena H
  1. Title: Valproic Acid Augmentation in Traumatic Brain Injury Related Agitation
  2. Authors: Michelle Allsup, Peterson Worrell
  3. Background: Traumatic brain injuries (TBIs) are a prevalent issue with many patients experiencing cognitive/behavioral symptoms such as agitation, impulsiveness, and irritability. TBIs were defined as subdural hematoma, subarachnoid hematoma, skull fractures, and cerebral contusion given that it was caused by a traumatic event, such as a fall or motor vehicular collision. The purpose of this study is to identify if valproic acid (VPA) augmentation has a significant difference in these patients’ agitation.
  4. Methods: This retrospective, observational, cohort study included adult trauma patients admitted to the hospital diagnosed with TBI, and initiated on of VPA and/or quetiapine for agitation. Patients were excluded if they pregnant, incarcerated, and taking any of the following prior to admission – antipsychotics, mood stabilizers, or VPA. These patients were individually chart reviewed from July 31, 2024 to January 31, 2025. The primary outcome was the time to documented resolution, in days, of agitation and the length of time until dose reductions occurred. The secondary outcomes are the incidence of adverse drug reactions (ADR) and the incidence of valproic acid discontinuation due to an ADR or persistent ADRs. As needed medications were also evaluated prior to VPA initiation and after VPA initiation.
  5. Results: A total of 8 patients were included in this IRB-approved study. The included patients were then split amongst themselves to examine the before VPA initiation and after VPA initiation. The primary outcome of time to documented resolution of agitation in the pre-VPA time period was a median of 0 days and in the post-VPA time period was 1.5 days. The length of time until dose reductions occurred in the pre-VPA time period was 0 days with quetiapine and in the post-VPA time period was 3.5 days with quetiapine and 0 days with VPA. There were no documented adverse events and no discontinuations due to ADRs. There was a total of 36 doses of as needed medications (haloperidol or lorazepam) given 72 hours prior to VPA initiation and a total of 20 doses of as needed medications given 72 hours after VPA initiation.
  6. Conclusion: We observed that VPA may reduce agitation in patients post-TBI whose agitation was not controlled on quetiapine alone. We found that there were more frequent dose reductions of quetiapine on discharge. There was less use of as needed medications after VPA initiation than prior to VPA initiation. A larger sample size is needed to determine if valproic acid decreases agitation in TBI patients. This should be conducted in a multicenter, prospective, randomized controlled study. This will aid in fully evaluating the benefit of VPA for agitation in patients post-TBI.


Contact: Michelle Allsup at michelle.allsup@hcahealthcare.com with any questions.
Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
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Presenters
avatar for Michelle Allsup

Michelle Allsup

PGY-1 Pharmacy Resident at Memorial Health University Medical Center, michelle.r.allsup@gmail.com
PGY-1 pharmacy resident at Memorial Health University Medical Center in Savannah, Georgia. I am from St. Augustine, Florida. I graduated from Auburn University Harrison College of Pharmacy in May 2024. I graduated from Auburn University with a bachelors of science in biomedical sciences... Read More →
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MM
Friday April 25, 2025 10:40am - 10:55am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Memorial Health University Medical Center
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