• Sheryn Tan, Jeng Swen Ng, Charis Tang, Brandon Stretton, Joshua Kovoor, Aashray Gupta, Thomson Delloso, Tony Zhang, Rudy Goh, Shaddy El-Masri, Michelle Kiley, Ian Maddocks, Adil Harroud, Sybil Stacpoole, Gregory Crawford, and Stephen Bacchi.
• University of Adelaide, Adelaide, SA, Australia.
• Palliat Med. 2024 Apr 1; 38 (4): 492497492-497.

BackgroundSeizures are an important palliative symptom, the management of which can be complicated by patients' capacity to swallow oral medications. In this setting, and the wish to avoid intravenous access, subcutaneous infusions may be employed. Options for antiseizure medications that can be provided subcutaneously may be limited. Subcutaneous sodium valproate may be an additional management strategy.AimTo evaluate the published experience of subcutaneous valproate use in palliative care, namely with respect to effectiveness and tolerability.DesignA systematic review was registered (PROSPERO CRD42023453427), conducted and reported according to PRISMA reporting guidelines.Data SourcesThe databases PubMed, EMBASE and Scopus were searched for publications until August 11, 2023.ResultsThe searches returned 429 results, of which six fulfilled inclusion criteria. Case series were the most common study design, and most studies included <10 individuals who received subcutaneous sodium valproate. There were three studies that presented results on the utility of subcutaneous sodium valproate for seizure control, which described it to be an effective strategy. One study also described it as an effective treatment for neuropathic pain. The doses were often based on presumed 1:1 oral to subcutaneous conversion ratios. Only one study described a local site adverse reaction, which resolved with a change of administration site.ConclusionsThere are limited data on the use of subcutaneous sodium valproate in palliative care. However, palliative symptoms for which subcutaneous sodium valproate have been used successfully are seizures and neuropathic pain. The available data have described few adverse effects, supporting its use with an appropriate degree of caution.

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