Before prescribing valproic acid, the NP should check for which contraindication in a patient with a mood disorder?

Valproic acid, also known as divalproex sodium, is primarily metabolized in the liver, and one of its significant contraindications is liver disease. Patients with liver impairment are at an increased risk for hepatotoxicity due to decreased metabolism and clearance of the drug. Since studies have shown that patients with existing liver dysfunction can experience elevated serum levels of valproic acid that can lead to toxicity, it is essential to assess liver function before initiating treatment.

While cirrhosis is a specific form of liver disease and pancreatitis can also be a potential adverse effect of valproic acid treatment, the most critical contraindication to be checked prior to prescription remains the general state of liver health. Chronic kidney disease does not have the same level of direct contraindication concerning valproic acid as liver disease does, although caution may still be warranted in the case of significant renal impairment. This emphasizes the importance of monitoring liver function in patients before considering valproic acid as a therapeutic option.