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The impact of ibuprofen on valproic acid plasma concentration in pediatric patients

Peng Gao1, Junyan Wang1, Liwen Zhang1

  • 1Department of Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

Xenobiotica; the Fate of Foreign Compounds in Biological Systems
|August 23, 2022
PubMed

Insights

Ibuprofen moderately reduces valproic acid (VPA) plasma concentrations in children, particularly within one week of administration. However, target VPA levels and required doses remained comparable, suggesting careful monitoring is key.

Area of Science:

  • Pharmacology
  • Pediatric Neurology
  • Clinical Pharmacy

Background:

  • Valproic acid (VPA) and ibuprofen are frequently co-administered in pediatric epilepsy management.
  • Previous case reports suggested ibuprofen may lower VPA plasma levels, but robust cohort data were lacking.

Observation:

  • This retrospective study analyzed 616 VPA trough concentration (C0) samples from 434 pediatric patients.
  • Ibuprofen administration was associated with a decrease in the VPA concentration to dose (C0/D) ratio by 7.5% in total samples and 30.6% in paired samples.

Findings:

  • The interaction between ibuprofen and VPA was significant within one week of the last ibuprofen dose.
  • Despite the observed decrease in C0/D ratio, no significant differences were found in achieving target VPA concentrations (50-100 mg/L) or VPA dose requirements.

Implications:

  • Ibuprofen exerts a moderate effect on VPA C0/D ratio in pediatric patients, necessitating monitoring within a week of co-administration.
  • Clinical outcomes regarding target concentration achievement and VPA dosage requirements were not significantly impacted, suggesting current therapeutic strategies remain viable with awareness of this interaction.

Keywords:
Ibuprofendrug-drug interactionpharmacokineticstrough concentrationvalproic acid

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