Decrease in the effectiveness of valproic acid against the background of antibacterial therapy with imipenem/cilastatin in pediatric practice: A case report

A clinical case of the co-medication of valproic acid and cilastatin/imipenem in a 17-year-old girl with generalized tonic-clonic seizures is described. As an antiepileptic therapy, the child was prescribed valproic acid, the concentration of which in the blood plasma was more than 80 μg/ml, and seizures were not observed during this therapy. At the same time, due to the developed pneumonia, the girl was imipenem/cilastatin prescribed. Co-medication of drugs led to a decrease in the concentration of valproic acid in the blood plasma less than 50 μg/ ml, relapse of epileptic seizures was noted. Correction of antiepileptic therapy with phenobarbital did not lead to the seizure control. The removal of imipenem/ cilastatin contributed to the increase in the concentration of valproic acid in blood plasma above 50 μg/ml, which corresponds to the recommended therapeutic range. Within two weeks after discontinuation of imipenem/cilastatin, the concentration of valproic acid reached values as close as possible to the values before the start of antibiotic therapy. The authors of the article concluded that it is necessary to conduct therapeutic drug monitoring in children receiving valproic acid and imipenem/ cilastatin (antibiotic of carbapenem group), based on the known mechanisms of pharmacokinetic interaction. © 2023, Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences. All rights reserved.

Authors
Strok A.B. , Chenkurov M.S. , Kostyleva M.N. , Umutkuzina D.А.
Publisher
Федеральное государственное бюджетное учреждение "Сибирское отделение медицинских наук"
Number of issue
6
Language
Russian
Pages
215-221
Status
Published
Volume
43
Year
2023
Organizations
  • 1 Russian Children’s Clinical Hospital–a Branch of the Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of Minzdrav of Russia, Moscow, Leninsky ave., 117, 119571, Russian Federation
  • 2 Federal State Autonomous Educational Institution of Higher Education «Peoples’ Friendship University of Russia named after Patrice Lumumba», Miklukho-Maklaya st., 6, Moscow, 117198, Russian Federation
  • 3 Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of Minzdrav of Russia, Ostrovityanova st., 1, Moscow, 117997, Russian Federation
Keywords
antiepileptic therapy; combination therapy; drug interaction; epilepsy; seizures; therapeutic drug monitoring; valproates
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