Intentional use of carbapenem antibiotics for valproic acid toxicity: A case report

Khobrani, Moteb; Dudley, Steve; Huckleberry, Yvonne; Kopp, Brian J.; Biggs, Adam; French, Richard H.; Shirazi, Farshad; Erstad, Brian L.

doi:10.1111/jcpt.12705

Cited by 16 publications

(15 citation statements)

References 15 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meropenem was administered at different doses and frequencies (500 mg every 6 hours daily to 2000 mg every 8 hours). 10–13 In all cases, enhanced clearance of VPA was directly observed after meropenem initiation. In most cases, VPA levels were within the therapeutic concentration within 24 hours after administration of the first dose.…”

Section: Tdm Consultantmentioning

confidence: 88%

“…Khobrani et al 11 performed an intrapatient comparison of VPA overdose by the same patient. They showed that the half-life of VPA decreased by 56% compared with treatment with and without meropenem.…”

Section: Tdm Consultantmentioning

confidence: 99%

“…Four case reports have been published using meropenem (or another carbapenem antibiotic) for VPA overdose. [10][11][12][13] A summary of these interventions is shown in Table 2. Meropenem was administered at different doses and frequencies (500 mg every 6 hours daily to 2000 mg every 8 hours).…”

Section: Tdm Consultantmentioning

confidence: 99%

“…They showed that the half-life of VPA decreased by 56% compared with treatment with and without meropenem. 11…”

Section: Tdm Consultantmentioning

confidence: 99%

See 3 more Smart Citations

Meropenem to Treat Valproic Acid Intoxication

Smolders

Heine

Natsch

et al. 2022

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

This therapeutic drug monitoring (TDM) grand round describes a patient with serious valproic acid intoxication. A total valproic acid level of 844 mg/L and an unbound valproic acid level of 604 mg/L were observed. Meropenem was administered to enhance the clearance of valproic acid. This off-label usage of meropenem is based on the drug-drug interaction between carbapenems and valproic acid, which reduced the level of valproic acid within 24 hours after administration.

show abstract

Section: Tdm Consultantmentioning

confidence: 88%

Section: Tdm Consultantmentioning

confidence: 99%

Section: Tdm Consultantmentioning

confidence: 99%

“…They showed that the half-life of VPA decreased by 56% compared with treatment with and without meropenem. 11…”

Section: Tdm Consultantmentioning

confidence: 99%

See 2 more Smart Citations

Meropenem to Treat Valproic Acid Intoxication

Smolders

Heine

Natsch

et al. 2022

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

show abstract

“…He received a total of 8 doses of meropenem (500 mg every 6 hours). 35 In another case report, VPA toxicity was treated by supportive care, 1 dose of intravenous (IV) ertapenem (1 g), activated charcoal, and levocarnitine. Ertapenem was chosen due to its long half-life among other carbapenems.…”

Section: Intentional Use Of Vpa-carbapenem Interactionmentioning

confidence: 99%

Valproate Interaction With Carbapenems: Review and Recommendations

Al-Quteimat¹,

Laila²

2019

Hosp Pharm

View full text Add to dashboard Cite

Introduction: Valproic acid is a commonly used antiepileptic drug. Combining valproate derivatives with carbapenem antibiotics is associated with a potential drug interaction that decreases serum concentration of valproate and may expose the patient to uncontrolled seizure risk from valproate subtherapeutic concentration. Raising awareness of this drug interaction among health care providers including emergency department physicians, neurologists, and pharmacists is highly needed. The aim of this article was to review the current literature about the potential drug interaction resulting from combining valproate derivatives with carbapenem antibiotics and to establish therapeutic recommendations regarding their use together. Methods: A review of the literature was conducted using Medline (through PubMed), Ovid, Embase, Cochrane library using the following keywords: valproate, valproic acid, carbapenem, ertapenem, doripenem, meropenem, imipenem, and valproate drug interaction. In addition, a manual search through major journals for articles referenced in PubMed was performed. Related publications from January 1998 till November 2018 were included in the initial search. Relevant publications were reviewed, and data regarding patients, type of carbapenem used, valproic acid dosing and level, interaction severity, and clinical outcome were summarized. Results and Discussion: Few clinical trials and multiple case reports have shown that carbapenem antibiotics including meropenem, ertapenem, imipenem, and doripenem can decrease the serum concentration of valproate derivatives leading to a subtherapeutic serum concentration and seizures in some patients. Valproic acid serum concentration may be significantly decreased with addition of a carbapenem antibiotic but generally return toward normal shortly after discontinuation of the carbapenem antibiotic. Conclusions: Generally, the concurrent use of carbapenem antibiotics with valproate derivatives should be avoided due to the potential of drug-drug interaction that results in subtherapeutic valproate serum concentration. Other antimicrobial agents should be considered as alternatives to carbapenems but if a concurrent carbapenem is necessary, using an additional antiepileptic agent is recommended. Therapeutic drug monitoring of valproate serum concentrations is warranted when a carbapenem-valproic acid combination therapy is unavoidable.

show abstract

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

Feldman,

Leonard

2024

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Reviewed by Julianne Yeary, Pharm.D., BCCCP; and Monica Owen, Pharm.D., BCPS, BCCCP LEARNING OBJECTIVES 1. Classify prescription drug overdose by patient presentations.2. Evaluate the causative agents of a drug overdose based on history and clinical findings of presentation.3. Develop a treatment paradigm that may be applied in all prescription drug overdoses.4. Assess the relevance of each therapeutic target in drug overdose in a specific drug overdose scenario.5. Devise a plan for treatment of anticholinergic, sodium channel blocker, tricyclic antidepressant, bupropion, digoxin, sulfonylurea, alpha-2 agonist, iron, valproic acid, clonidine, and salicylate overdose.6. Justify the use of specific antidotes in overdose.Target audience for this application-based activity: Pharmacotherapy specialists and advanced level clinical pharmacists whose practice involves the direct care and management of critically ill patients in the ICU and emergency department.

show abstract

Intentional use of carbapenem antibiotics for valproic acid toxicity: A case report

Abstract: Our findings suggest a potential role for short-term carbapenem therapy for VPA overdose.

Cited by 16 publications

References 15 publications

Meropenem to Treat Valproic Acid Intoxication

Meropenem to Treat Valproic Acid Intoxication

Valproate Interaction With Carbapenems: Review and Recommendations

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

Contact Info

Product

Resources

About