Decrease in serum valproic acid levels during treatment with ertapenem

Fen-fen Liao; Yaw-Bin Huang; Chi-Yu Chen
August 2010
American Journal of Health-System Pharmacy;8/1/2010, Vol. 67 Issue 15, p1260
Academic Journal
Case Study
Purpose. A possible interaction between valproic acid and ertapenem resulting in reduced serum valproic acid levels in two patients is reported. Summary. In the first case, a 47-year-old woman was brought to the emergency department (ED) with fever, pain, redness, swelling, and local heat in the tissue around her tracheostomy tube and left foot. One month prior she was hospitalized with pneumonia and had a generalized tonic- clonic seizure. She was given teicoplanin and amoxicillin-clavulanate potassium as empirical therapy for cellulitis. On day 3, the patient developed a fever. Amoxicillin-clavulanate potassium was discontinued and replaced by i.v. ertapenem. On day 5, due to a suspected drug-induced fever, carbamazepine was discontinued, and oral valproate sodium was initiated. On day 16, the patient was afebrile, so ertapenem was discontinued. Her serum valproic acid concentration was <1 mg/L, but seizures did not recur. Three days after ertapenem was discontinued, her serum valproic acid concentration increased to 33.6 mg/L. In the second case, a 72-year-old woman was brought to the ED after a sudden loss of consciousness and convulsive seizure. The patient was diagnosed with status epilepticus and admitted to the intensive care unit. A urine culture revealed Pseudomonas aeruginosa, and she was given cefpirome and valproate sodium. On day 15, cefpirome was replaced with ertapenem. On day 21, she had a seizure, and her serum valproic acid levels was found to be <1 mg/L. Ertapenem was discontinued after 14 days. Her serum valproic acid levels continued to increase until discharge onday 42. Conclusion. After initiation of ertapenem, decreased serum valproic acid levels were observed in two patients.


Related Articles

  • Treating Newly Diagnosed Epilepsy: The Canadian Choice. Burneo, J. G.; McLachlan, R. S. // Canadian Journal of Neurological Sciences;May2007, Vol. 34 Issue 2, p230 

    Background: Choosing an antiepileptic medication to treat a patient with epilepsy can be a complicated process during which the treating physician must base her or his decision on efficacy and safety of each of many available drugs. The lack of comparative studies between medications is one of...

  • Interaction of Delta Sleep-inducing Peptide and Valproate on Metaphit Audiogenic Seizure Model in Rats. Olivera Stanojlović; Dragan Hrnčić; Aleksandra RaÅ¡ić; Helena Lončar-Stevanović; Dragan Djuric; Veselinka Å uÅ¡ić // Cellular & Molecular Neurobiology;Nov2007, Vol. 27 Issue 7, p923 

    Abstract  Effects of valproate (VPA), a conventional antiepileptic drug and natural delta sleep-inducing peptide (DSIP) on metaphit (1-[1-(3-isothiocyanatophenyl)-cyclohexyl]-piperidine)-induced audiogenic reflex epilepsy were studied. For the purpose of the study, valproate in...

  • Levetiracetam in Idiopathic Generalised Epilepsy and Porphyria Cutanea Tarda. Bilo, Leonilda; Meo, Roberta; Fulvia de Leva, Maria // Clinical Drug Investigation;2006, Vol. 26 Issue 6, p357 

    We report the case of a 50-year-old male patient with idiopathic generalised epilepsy and porphyria cutanea tarda. Valproic acid and phenobarbital monotherapy controlled seizures but exacerbated porphyric symptomatology, while clobazam, clonazepam and lamotrigine monotherapy were well tolerated...

  • Drug Treatment of Epilepsy in Elderly People: Focus on Valproic Acid. Stephen, L.J. // Drugs & Aging;2003, Vol. 20 Issue 2, p141 

    Despite old age being the commonest time of life to develop epilepsy, relatively little is known about the condition in later years. Antiepileptic drugs (AEDs) are the mainstay of treatment and valproic acid (VPA) has been prescribed for older patients with seizures for over 35 years. VPA is...

  • Which is Better, the Older or the Newer Antiepileptic Drugs? Harden, Cynthia L. // Neurology Alert;May2007, Vol. 25 Issue 9, p66 

    THESE 2 LARGE CLINICAL TRIALS CARRIED OUT IN the United Kingdom aim to answer an important question for physicians treating epilepsy, that is, which is better, the older or the newer antiepileptic drugs (AEDs)? For that purpose, in these studies, the "standard" AED deemed to be appropriate...

  • Influence of Conventional Antiepileptic Drugs on Thyroid Function Tests in Epileptic Children. Gomaa, Mohamed; Wasel, Yasser; Elewa, Ahmed Mohamed // Egyptian Journal of Neurology, Psychiatry & Neurosurgery;Jan2012, Vol. 49 Issue 1, p23 

    Background: Antiepileptic drugs (AED) adverse effects are frequently encountered, careful monitoring for evaluation of adverse effects during AED administration should done as a routine in epilepsy practice. Objective: To determine the changes in thyroid function tests in male children who were...

  • Effect of antiepileptic drug polytherapy on urinary pH in children and young adults. Go, Tohshin // Child's Nervous System;Feb2009, Vol. 25 Issue 2, p237 

    The relationship between antiepileptic drugs (AEDs) polytherapy and urinary pH was studied to demonstrate the effect and difference of AED polytherapy compared to monotherapy. A total of 271 urine samples from patients receiving AED polytherapy aged from 7 months to 35 years were enrolled. Two...

  • VALPROIC ACID.  // Complete Guide to Prescription & Nonprescription Drugs 2012;2012, p826 

    The article presents information on valproic acid, an anticonvulsant drug, including its dosage, usage, adverse reactions, side effects, precautions when administering, and possible interaction with other drugs.

  • Primum Non Nocere: A Case of Valproate Encephalopathy. Hüseyin KOZAK, Hasan; UCA, Ali Ulvi // Epilepsi: Journal of the Turkish Epilepsi Society;2014, Vol. 20 Issue 2, p98 

    Valproic acid (VPA) is a traditional antiepileptic which is used in the treatment of some types of epileptic seizures. Encephalopathy is a side effect of VPA which leads to rare but serious results and hyperammoniemia may be accompanied by one of these statements. It is specified that...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics