Valproate is employed in the management of epilepsy and bipolar disorders.1 Anticonvulsant therapy has traditionally been guided by monitoring levels. However, valproate concentrations do not correlate well with therapeutic and toxic effects,2 with concentrations varying by up to 100%.3 Therefore, routine monitoring is not recommended but measurement may be used to determine compliance. A recent study compared outcomes in epileptic patients with and without valproate monitoring and found no significant differences.4 However, routine monitoring is still advocated by the American Psychiatric Association.5

Clinicians are often not aware of the specific indications for valproate measurement, resulting in …