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Taking Benefit of a Drug-Drug Interplay: A Case of Valproic Acid Toxicity

Posted in News on 15th June 2018

June 14, 2018

A 45-year-old male was found unresponsive after ingesting 10 grams of extended-release divalproex sodium

A 45-year-old male was discovered unresponsive after ingesting 10 grams of extended-release divalproex sodium

In response to findings of a current case report, short-term administration of carbapenem antibiotics could also be useful within the remedy of valproic acid (VPA) overdose in sufferers with no historical past of seizure dysfunction.

The case report, printed in The Journal of Medical Pharmacy and Therapeutics, describes a 45-year-old male affected person who was discovered unresponsive after ingesting 10 grams of extended-release divalproex sodium. His previous medical historical past was vital for bipolar dysfunction. Laboratory evaluation confirmed elevated serum VPA concentrations (396.2mg/mL initially; 415mg/mL after 5.5 hours) in addition to a traditional serum ammonia degree (24mmol/L). The affected person was prescribed activated charcoal, 1 dose of intravenous levocarnitine, cefepime, and metronidazole.

The authors defined, “Given the priority for rising VPA concentrations and dangers of extra extreme toxicity, an interprofessional settlement was made to alter antibiotic remedy to short-term administration of meropenem as a remedy for aspiration pneumonia that may deliberately benefit from the interplay between VPA and carbapenem antibiotics.” 

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A major lower within the affected person’s serum VPA focus was noticed following the primary dose of meropenem in addition to over the subsequent 14 hours (to 36.5mg/mL). Moreover, the affected person was reported to develop into extra alert regardless of elevated serum ammonia ranges. After 5 days of hospitalization, the affected person acquired a complete of eight doses of meropenem (500mg each 6 hours administered intravenously) previous to being discharged to inpatient psychiatry.

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Administration of carbapenem antibiotics could also be useful for the remedy of poisonous ranges of VPA. The authors concluded, “The lower within the elimination half-life induced by this main drug-drug interplay could hasten enchancment in neurological restoration, decrease toxicity from VPA overdose and shorten size of hospital keep.” They added, “Nevertheless, this requires affirmation of security and efficacy in a well-designed examine previous to widespread implementation.”

Reference

Khobrani MA et al. Intentional use of carbapenem antibiotics for valproic acid toxicity: A case report. Journal of Medical Pharmacy and Therapeutics. 2018. 

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Antidepressants And Pregnancy: Are You Depressed? Read This Before Taking

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