Which of the following is recommended to be monitored in patients on Divalproex Sodium?

Divalproex sodium carries a well-documented risk of hepatotoxicity and dose-related thrombocytopenia/other cytopenias. Therefore, authoritative sources direct clinicians to obtain liver function tests (LFTs) and a complete blood count (CBC, including platelets) at baseline and at periodic intervals during therapy. These tests allow early detection of liver injury and hematologic toxicity, the two most clinically significant adverse effects requiring intervention or drug discontinuation.

B. Serum ammonia – checked only if encephalopathy or unexplained lethargy occurs; not recommended for routine periodic monitoring.
D. Pulmonary function – valproate does not impair lungs; no guideline advises routine PFTs.
E. Serum creatinine – nephrotoxicity is not characteristic of valproate; routine renal monitoring not listed in labeling or AHFS.

1. Depakote (divalproex sodium) Prescribing Information, AbbVie Inc., rev. Aug 2020: Section 5.1 (Hepatotoxicity) & Section 5.9 (Thrombocytopenia) – “Obtain baseline and periodic LFTs and CBC with platelet count.”

2. American Hospital Formulary Service (AHFS) Drug Information 2024, “Valproic Acid and Derivatives,” Monitoring Parameters subsection, pp 3420–3421 – recommends baseline/periodic liver function tests and CBC.

3. Patsalos PN et al. Therapeutic drug monitoring of antiepileptic drugs. Epilepsia. 2008;49(7):1242 (Table 2). DOI:10.1111/j.1528-1167.2008.01561.x – lists routine monitoring of LFTs and hematology for valproate.