Lee Sang-Guk, Kim Jeong-Ho, Joo Jin Yang, Kwon Oh Hun
Department of Laboratory Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Lab Med. 2007 Oct;27(5):338-43. doi: 10.3343/kjlm.2007.27.5.338.
Valproic acid (VPA) is a commonly prescribed anticonvulsant drug for the treatment of various forms of epilepsy. Concomitant administration of VPA and carbapenem antibiotics such as panipenem/ betamipron and meropenem has been reported to decrease the serum level of VPA. We observed seven cases which showed a decrease in serum levels of VPA due to concomitant use of VPA and carbapenem from January 2002 to October 2006 in a 750-bed university hospital, the average decrease of 70.4% was observed. Carbapenem antibiotics administrated concomitantly with VPA were panipenem (1 case), meropenem (3 cases), and imipenem (2 cases), and in one other case imipenem and meropenem were used sequentially. We found the VPA serum levels were significantly decreased with meropenem (n=4) more than with other carbapenem antibiotics (n=4, 89.3% vs. 51.5% decrease, P=0.03). Clinicians should be aware of this potential interaction, pay attention to the failure of seizure control due to decreased serum VPA levels with concomitant use of carbapenem antibiotics, and monitor VPA serum levels for those cases.
丙戊酸(VPA)是一种常用于治疗各种癫痫的抗惊厥药物。据报道,同时服用VPA和碳青霉烯类抗生素(如帕尼培南/倍他米隆和美罗培南)会降低VPA的血清水平。在一家拥有750张床位的大学医院,我们观察了2002年1月至2006年10月期间因同时使用VPA和碳青霉烯类药物导致VPA血清水平下降的7例病例,观察到平均下降了70.4%。与VPA同时使用的碳青霉烯类抗生素有帕尼培南(1例)、美罗培南(3例)和亚胺培南(2例),另外1例先后使用了亚胺培南和美罗培南。我们发现,与其他碳青霉烯类抗生素(n = 4)相比,美罗培南(n = 4)使VPA血清水平显著下降(下降89.3%对51.5%,P = 0.03)。临床医生应意识到这种潜在的相互作用,注意因同时使用碳青霉烯类抗生素导致血清VPA水平下降而引起的癫痫控制失败,并对这些病例监测VPA血清水平。