Valproate-Induced Severe Adverse Effects in Patients with Mania: A Case Series

Abstract

Sodium valproate is widely used in the management of acute mania and bipolar disorder, but rare and serious adverse drug reactions may occur. We report a case series of three patients with bipolar affective disorder, current episode mania, who developed significant valproate-related adverse effects. A 22-year-old woman developed acute necrotising pancreatitis within two weeks of treatment initiation, confirmed biochemically and radiologically after exclusion of other causes. A 35-year-old woman developed progressive diffuse alopecia that resolved following valproate discontinuation. A 55-year-old man developed asymptomatic thrombocytopenia, with normalisation of platelet counts after drug withdrawal. In all cases, clinical and laboratory improvement occurred after cessation of valproate, and alternative mood stabilisers were successfully introduced. This case series highlights the spectrum of rare but clinically significant valproate-induced adverse effects and underscores the importance of vigilant monitoring, early recognition, and prompt intervention to prevent serious morbidity.