When do you consider using valproate to manage behavioral disturbances in patients with delirium?

Multiple studies have identified valproate as a potential option for the management of agitation in hyperactive delirium. This has particularly been investigated for patients in ICU settings with some studies finding positive outcomes such as reduction of the total number of concomitant psychoactive medications (Nuti et al., PMID 39648603), decrease in prevalence of agitation and delirium (Crowley et al., PMID 32273047; Cuartas et al., PMID 34409869).

Most common adverse effects noted in these studies included thrombocytopenia and hyperammonemia.

Some scenarios in which to consider the use of valproate can include:

• Patients with prolonged QTc,
• Patients whose medical co-morbodities preclude or limit the use of antipsychotics (such as movement...