Valproate may interfere with mitochondrial beta oxidation of long-chain fatty acids and may be associated with a significant decrease in serum free carnitine levels^1,2

• 48% (20/42) of patients treated with levocarnitine survived, while 10% (5/50) of patients treated only with aggressive care survived³
• Early intervention with intravenous rather than enteral levocarnitine was associated with the greatest hepatic survival³

References: 1. Coulter DL: Carnitine, valproate, and toxicity. J Child Neurol 1991;6:7-14. 2. Melegh B, et al: Carnitine-dependent changes of metabolic fuel consumption during long-term treatment with valproic acid.
J Pediatr 1994;125:317-321. 3. Bohan TP, et al: Effect of L-carnitine treatment for valproate-induced hepatotoxicity. Neurology 2001;56:1405-1409.