Which of the following is a significant side effect of valproic acid?

Valproic acid, also known as valproate or divalproex sodium, is a medication commonly used to treat epilepsy, bipolar disorder, and to prevent migraines. A significant concern associated with valproic acid therapy is hepatotoxicity, which refers to liver damage or dysfunction. This side effect can range from mild and asymptomatic elevations in liver enzymes to severe liver failure, particularly in young children and in individuals with underlying liver disease.

Monitoring liver function tests is essential for patients on valproic acid to detect any signs of hepatotoxicity early on. Risk factors for developing liver toxicity include being under the age of two, using multiple anticonvulsants, and having a pre-existing liver condition.

The other potential side effects, such as arrhythmias, respiratory depression, and hypertension, are not well-documented as significant risks associated with valproic acid. While they can occur under very specific circumstances or in certain patients, they do not represent the major safety concern that hepatotoxicity does. This emphasis on liver health is crucial in the clinical management of patients being treated with valproic acid.