Why is liver function monitoring important with valproate therapy, and what major risk does it carry?

• A. Valproate therapy has no impact on the liver.
• B. Valproate can cause nephrotoxicity; monitor kidney function.
• C. Valproate can cause hepatotoxicity; monitor LFTs regularly due to risk of fulminant hepatitis.
• D. Valproate improves liver function; monitoring is optional.

Answer: (C)

Liver injury is a serious and unpredictable adverse effect of valproate, so regular liver function monitoring is essential. Valproate can cause hepatotoxicity that may progress to fulminant hepatitis, a rapid and potentially fatal liver failure. Because this risk can present quickly, especially in the early months of therapy or after dose changes, baseline liver tests and periodic monitoring help detect troubling changes early. Clinicians typically check enzymes such as AST and ALT, bilirubin, and sometimes coagulation parameters, and they reassess treatment if there are symptoms like nausea, vomiting, abdominal pain, jaundice, or unusual fatigue. If liver tests rise significantly or liver injury symptoms appear, stopping valproate is indicated. This is why the best answer emphasizes hepatotoxicity with regular LFT monitoring due to the risk of fulminant hepatitis.