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NEUROLOGY 1987;37:1392
© 1987 American Academy of Neurology

Clinical valproate toxicity induced by acetylsalicylic acid

Keith J. Goulden, MD, Joseph M. Dooley, MB, Peter R. Camfield, MD and Albert D. Fraser, PhD

Departments of Pediatrics (Drs. Goulden, Dooley, and Camfield) and Pathology (Dr. Fraser), Dalhousie University; the I.W.K. Hospital for Children, (Drs. Goulden, Dooley, and Camfield); and the Toxicology Laboratory (Dr. hr), Victoria General Hospital, Halifax, Nova Scotia, Canada.

We report three patients with serious clinical valproate (VPA) toxicity induced by interaction with acetylsalicylic acid (ASA). Two patients had a documented rise in VPA free level, and the third showed only clinical signs of toxicity. Symptoms resolved in all three when the ASA was stopped. This interaction has been previously documented under experimental conditions, and is due to displacement of VPA from plasma protein binding sites and a probable interference in metabolism. This is the first report of the clinical significance of this interaction.

Address correspondence and reprint requests to Dr. Dooley, I.W.K. Hospital for Children, 5850 University Avenue, Halifax, Nova Scotia B3J 3G9, Canada.

Received June 18, 1986. Accepted for publication in final form November 19, 1986.




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