Divalproex Sodium-Induced Eosinophilic Pleural Effusion

Abstract

Eosinophilic pleural effusion is defined as an effusion in which eosinophils constitute more than 10% of white blood cells. These effusions can be due to multiple causes with drugs being implicated as one of the etiological agents. We report a case of 48-year-old woman with seizure disorder on divalproex sodium (Depakote) who presented with dyspnea. A chest radiograph demonstrated right pleural effusion. Investigations showed peripheral blood eosinophilia with thoracocentesis revealing eosinophilic exudative pleural effusion. An extensive workup for other causes of eosinophilic pleural effusion was unrevealing. Withdrawal of Depakote resulted in resolution of the effusion.

Pleural Effusion Associated With Divalproex Sodium

“…Through literature research, we collected 18 published cases of valproic acid-associated pleural effusion, aging from 15 to 70 years. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Ten of the cases were male. Daily dosage differed among cases, from 250 to 2000 mg, the majority over 1000 mg.…”

“…Its mechanism of action is thought to be mediated via increasing the inhibitory action of gamma-aminobutyric acid 1 . The commonly observed side effects are tremors, dizziness, weight gain, nausea, hair loss and, and others 2–4 …”

Pericardial and Pleural Effusion with Valproic Acid use in a Patient with Bipolar Disorder

“…When diagnosed with drug-induced effusion, and if the patient's clinical condition permits, the patient can be expected to recover spontaneously. However, there is not enough evidence on whether to re-start the drug or not 4 . As PE in our case continued for three months, the drug was discontinued, and then the PE regressed.…”

“…It is also reported that pleural effusion (PE) may rarely occur due to the use of VPA 3 . In the literature, 13 cases of PE developing due to the use of VPA have been reported so far [1][2][3][4][5][6][7][8][9][10][11] . In an animal study investigating teratogenic effect of VPA, the development of drug-induced PE has also been reported 12 .…”

Drug-induced eosinophilic pleural effusion

“…Some drugs used in psychiatry and neurology are some of the most important, including valproic acid (and its derivatives) and dantrolene [5][6][7][8]. EPE was also reported as a complication of treatment with tazinidine, trimipramine and fluoxetine [9][10][11].…”