Introduction: Administration of valproic acid (VPA) is often urgent and in large doses, though there is limited evidence surrounding the safety of this medication being administered via intravenous push (IVP). This study aims to determine if there is a difference in safety outcomes between high doses of VPA (greater than 1000 mg) administered via IVP compared to intravenous piggyback (IVPB). Methods: Single-center retrospective analysis of patients receiving ≥1000mg valproate via IVP or IVPB from January-July 2025. Primary efficacy endpoint assessed time from order verification to administration. Primary composite safety endpoint included hypotension, bradycardia, sedation, and infusion site reaction. Statistical analysis used chi-square and t-tests with significance set at p< 0.05. Results: Overall analysis included 106 patients (53 IVP, 53 IVPB). Baseline demographics were similar between each group. Status epilepticus was the indication for 18 patients (17.0%). Average dose of 2141.5 ± 747.8 mg for IVPB and 2178.8 ± 772.9 mg for IVP. Primary safety outcomes showed no significant difference between groups IVP: 14 patients (26.4%) vs IVPB: 12 patients (22.6%), p=0.6516. No infusion site reactions were reported. Average time from order verification to administration time was significantly shorter in the IVP group compared to the IVPB group 42.7 ± 94.6 minutes vs 79.4 ± 97.7 minutes, respectively; p=0.009. Conclusions: High-dose IVP valproate demonstrates equivalent safety to IVPB with significantly reduced administration time. IVP delivery represents a safe alternative that may optimize emergency management of seizure disorders requiring rapid valproate loading.
Woodruff et al. (Sun,) studied this question.