HOT TOPICS: Valproic Acid for Agitation in the Neurosurgical ICU

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, is joined by Andrew Webb, PharmD, to discuss the article "Valproic Acid for the Management of Agitation in Neurosurgical Intensive Care Unit Patients," published in Neurocritical Care. Their conversation examines the complex causes of delirium and agitation in the neurocritical care setting, including neurologic injury, medication effects, sleep disruption and frequent clinical interventions. They review nonpharmacologic approaches to delirium prevention, current sedation strategies and the potential role of valproic acid as an adjunct when agitation remains difficult to control. They also discuss findings from the retrospective study, in which valproic acid use was associated with reduced requirements for opioids, benzodiazepines and dexmedetomidine, along with fewer positive agitation scores and less use of physical restraints. Dr. Webb reviews the medication's multimodal effects, potential adverse events and drug interactions, and patient populations that may benefit from its use. He also emphasizes the need for careful monitoring, eventual deprescribing and prospective research to clarify valproic acid's role in neurocritical care. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.