Valproic acid has a black box warning for life-threatening pancreatitis, which can occur at any time during therapy in both children and adults. This is a rare but serious adverse effect that can progress rapidly and be fatal. Patients should be counseled to report any signs or symptoms of pancreatitis, such as severe abdominal pain, nausea, vomiting, or anorexia, to their healthcare provider immediately. The drug should be discontinued if pancreatitis is diagnosed.

A. Gingival hyperplasia is a classic and common side effect associated with phenytoin, not valproic acid.

C. Kidney stones (nephrolithiasis) are a known adverse effect of other antiepileptic drugs like topiramate and zonisamide.

D. Valproic acid is commonly associated with significant weight gain, which is often a reason for non-adherence.

E. Euphoria is not a recognized side effect of valproic acid; sedation and dizziness are more common CNS effects.

1. U.S. Food and Drug Administration (FDA). (2018). DEPAKOTE (divalproex sodium) delayed-release tablets

for oral use. Highlights of Prescribing Information. Section: WARNINGS AND PRECAUTIONS

5.2 Pancreatitis. Retrieved from the FDA database. (This official vendor documentation explicitly lists pancreatitis as a boxed warning).

2. Zaccara

G.

Franciotta

D.

& Perucca

E. (2007). Idiosyncratic adverse reactions to antiepileptic drugs. Epilepsia

48(7)

1223–1244. https://doi.org/10.1111/j.1528-1167.2007.01041.x (Table 2 on page 1228 lists pancreatitis as a rare

life-threatening idiosyncratic reaction to valproate).

3. McNamara

J. O. (2018). Pharmacotherapy of the Epilepsies. In L. L. Brunton

R. Hilal-Dandan

& B. C. Knollmann (Eds.)

Goodman & Gilman's: The Pharmacological Basis of Therapeutics (13th ed.). McGraw-Hill Education. Chapter 17

Section: Valproate

Subsection: Adverse Effects. (This standard academic textbook

used in university curricula

details pancreatitis as a serious idiosyncratic toxicity of valproate).