Which over-the-counter medication is contraindicated when taking valproic acid?

• A. Ibuprofen
• B. Aspirin
• C. Acetaminophen
• D. Naproxen

Answer: (B)

Valproic acid has a higher risk of bleeding and potential toxicity when combined with certain OTC meds. Aspirin is a salicylate that both inhibits platelet function and can displace valproic acid from albumin, increasing the amount of free (active) valproate in the blood. This combination raises the risk of serious bleeding and valproate toxicity, making aspirin contraindicated with valproic acid.

Acetaminophen is generally safe to use with valproic acid at typical doses. Ibuprofen and naproxen also carry bleeding and GI/renal risks, but they don’t have the same specific interaction that makes aspirin contraindicated; they can be used with caution, though monitoring is wise.