Interaction between valproic acid and carbapenem antibiotics

OBJECTIVE To discuss the drug interaction between carbapenem antibiotics and valprate based on the clinical finding that concurrently use of meropenem could significantly decrease the serum concentration of valproic acid.METHODS Researches about the interaction between carbapenen antibiotics and valproic acid or related case reports were indexed from the China CNKI and/ or wanfang data and the Pubmed data base.RESULTS No related study or case report was included in the China database.35 case reports about the combination use of carbapenem antibiotics with valproic acid,which could cause remarkable decrease of plasma concentration of free valproic acid and even could induce epilepsy,were searched from the Pubmed database.It was confirmed that carbpenem antibiotics interfered the absorption,distribution and metabolism of valproic acid,inhibiting the absorption of valproic acid,increasing erythrocyte distribution from plasma;and suppressing the valproic acid glucuronide hydrolase and reducing serum free valproic acid.CONCLUSION Concurrently use of carbpenem antibiotics and valproic acid should be avoided and this adverse drug interaction outcome can not be relieved by adjusting valproic acid oral dose.If it is necessary to use carbpenem antibiotics,other AEDs such as phentoin sodium or carbamazepine should be considered.