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Valproate Interaction With Carbapenems: Review and Recommendations.
Osama Al-Quteimat1, Alla Laila1
1Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Hospital Pharmacy
|June 9, 2020
Summary
Carbapenem antibiotics can significantly lower valproic acid levels, increasing seizure risk. Healthcare providers should avoid this combination or closely monitor valproic acid levels and consider alternative antiepileptic drugs.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Neurology
Background:
- Valproic acid is a widely used antiepileptic medication.
- Combining valproate with carbapenem antibiotics can lead to a dangerous drug interaction.
- This interaction reduces serum valproate concentrations, risking uncontrolled seizures.
Purpose of the Study:
- To review literature on the valproate-carbapenem drug interaction.
- To establish therapeutic recommendations for concurrent use.
- To raise healthcare provider awareness of this interaction.
Main Methods:
- Literature review using Medline, PubMed, Ovid, Embase, and Cochrane Library.
- Keywords included valproate, carbapenem, and specific carbapenem agents.
- Manual search of referenced articles from January 1998 to November 2018.
Main Results:
- Case reports and clinical trials show carbapenems (meropenem, ertapenem, imipenem, doripenem) decrease valproate serum concentrations.
- This reduction can lead to subtherapeutic levels and seizures.
- Valproate levels typically normalize after carbapenem discontinuation.
Conclusions:
- Concurrent use of carbapenems and valproate derivatives should generally be avoided.
- Alternative antibiotics are preferred; if carbapenems are essential, consider additional antiepileptic agents.
- Therapeutic drug monitoring of valproate is crucial if the combination is unavoidable.
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