🌟 ABX Pearl of the Day: drug interaction carbapenems + valproic acid
💡 Q: I’d like to start meropenem for an ESBL E. coli infection in my patient who is also on valproic acid (VPA). What should I be aware of?
#IDsky #Medsky #MedEd #PharmSky #SkyRX
💡 Q: I’d like to start meropenem for an ESBL E. coli infection in my patient who is also on valproic acid (VPA). What should I be aware of?
#IDsky #Medsky #MedEd #PharmSky #SkyRX
Comments
⚠️ Concomitant use typically leads to a rapid (< 24 hours) and significant reduction in serum VPA concentrations, resulting in subtherapeutic levels (< 50 mcg/mL), which may increase seizure risk. [1,2]
🚫VPA levels can remain reduced for over 14 days after discontinuation of meropenem, regardless of VPA dose. [2]
⚙️Probable mechanism: Inhibition of the hydrolysis of valproic acid's glucuronide metabolite back to valproic acid. [4]
1. Chen I-L et al. J Crit Care Apr, 2021; 62:151-156.
2. Haroutiunian S et al, J Clin Pharmacol Nov, 2009; 49(11):1363-1369.
3. Wu CC et al, Ther Drug Monit. 2016 Oct;38(5):587-92. DOI: 10.1097/FTD.0000000000000316.
4. Micromedex