Contraindicated in:

• Hypersensitivity
• Hepatic impairment
• Known/suspected urea cycle disorders (may result in fatal hyperammonemic encephalopathy).

Use Cautiously in:

• All patients (may ↑ risk of suicidal thoughts/behaviors)
• Bleeding disorders
• History of liver disease
• Organic brain disease
• Bone marrow depression
• Renal impairment
• Women of childbearing potential
• Geri: ↑ risk of adverse effects
• OB: Use during pregnancy is linked to congenital anomalies, neural tube defects, clotting abnormalities, and hepatic dysfunction in the neonate as well as impaired cognitive development as the child matures. Use with extreme caution. Lactation: Pass into breast milk. Consider discontinuing nursing when valproates are administered to the nursing mother
• Pedi: Children, especially <2 yr (at ↑ risk for potentially fatal hepatotoxicity).