Highest reported clearance of valproate by hemodialysis in massive overdose

Valproic acid (VPA) is a commonly prescribed anti-epileptic used therapeutically for a range of conditions including bipolar disorder and migraines. It is a small molecule with a low volume of distribution (0.22  L/kg). At therapeutic levels, protein binding of valproic acid is high (90 to 95%) [1]. However, in overdose protein binding becomes saturated and the percentage of free valproic acid increases substantially. At valproic acid levels of 1000 mg/L, protein binding has been shown to decrease to 15 %.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research