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  • 6000 in those on viagra suppliers canada polytherapy. Other studies have confirmed polytherapy as a risk factor but found that there was little difference in risk between younger and older children. Although VPA hepatotoxicity may occur at any age, data collected between 1977 and 1985 indicated that the risk of fatal hepatotoxicity was highest in children less than 2 years of age receiving concurrent anticonvulsant therapy in whom the incidence was estimated to be approximately 1:540 (52,84).

    Comparative estimates of risk for older children aged 6–6 years were 1:9,000 in those on monotherapy and 1. 514 Leeder and Pirmohamed C. This represents a 13-fold increase in risk relative to children of the same age on VPA monotherapy.

    The risk of fatal hepatotoxicity was essentially unchanged in children less than 3 years of age on polytherapy between 1986 and 1992 despite a trend toward decreasing use of VPA in very young children—0.8% of the studied population from 1986 to 1991 compared to 1.5% in the earlier studies. Susceptibility Factors A series of three retrospective studies of VPA-associated hepatotoxicity in the United States delineated patient age less than 5 years, polytherapy with enzyme-inducing antiepileptic medications, developmental delay, and coincident metabolic disorders as important risk factors for developing this adverse event.

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