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. 2009 Jan 6;100(1):28–36. doi: 10.1038/sj.bjc.6604817

Table 3. Toxicity of valproic acid (VPA)a.

        NCI – CTC grade
        1 2 3 4
VPA dose (mg kg−1 day−1) No. of patients Median duration (weeks) Toxicity (No. of patients) (No. of patients) (No. of patients) (No. of patients)
VPA alone
 10–30b 17 6 Leukocytosis 2      
      Thrombocytosis 1      
      Anemia 2   2  
      Nausea/vomiting 2      
      Abdominal pain   1 1  
      Asthenia   3    
      Erithema   1    
      Hepatic (ALP, LDH)   1    
      Amylase 3 1    
      Dyspnea (pleural eff.)       1
      Depr. consciousness 1      
               
 60–90c 11 6 Thrombocytopenia 1      
      Anemia 1 1 1 1d
      Asthenia 1      
      Constipation 1d      
      Sciatic pain   1    
      Infection   2d    
      Creatinine 1      
      Hematuria   1d    
      Hypoacusis 1d      
      Dyspnoea 1      
      Ataxia     1  
      Depr. consciousness 1d 1    
               
VPA in combination with chemoimmunotherapy
 30 3 3 Anemia   1    
      Asthenia   2    
      Hepatic (AST) 1      
      Tremors 1      
               
 60 12 14 Leukopenia 2 4    
      Neutropenia   2 3  
      Thrombocytopenia 3 1 4  
      Anemia 2 3 1 1
      Nausea/vomiting 6      
      Diarrhea 3 1    
      Asthenia   2    
      Ammonia 2      
      Hepatic (any) 3      
      Gastric pain 2      
      Fever 1 1    
      Hypocalcemia     1  
      Depr. consciousness 3 3 1 1
      Other neurologicale 2 6 2 1
      Cerebral hemorrhage       1
      Urinary incontinence   1 1  
               
 90 3 3 Leukopenia   1    
      Thrombocytopenia     1 1
      Anemia 1      
      Hepatic (AST) 1      
      Amylase 1      
      Headache   1    
a

On 28 assessable patients. Each patient is reported in each section of the table (VPA alone, and VPA in combination with chemoimmunotherapy) within the row corresponding to the highest dose level he received during the pertinent period of therapy. Some patients had dose reductions of VPA already during the induction phase, and others had dose escalation during the combination phase. All patients except one had some kind of toxicity.

b

Three patients at 10 mg kg−1 day−1, 14 patients at 30 mg kg−1 day−1.

c

10 patients at 60 mg kg−1 day−1, one patient at 90 mg kg−1 day−1.

d

90 mg kg−1 day−1, with bladder progression of disease.

e

Vertigo, hallucinations, headache, speech impairment, mood alteration, memory loss, paraesthesia, seizures, tremors, confusion.