Effect of carbapenem antibiotics on serum concentration of sodium valproate in older patients with epilepsy
10.3760/cma.j.issn.0254-9026.2025.01.008
- VernacularTitle:高龄老年癫痫患者碳青霉烯类抗生素对丙戊酸钠血药浓度的影响
- Author:
Huijing LIU
1
;
Yinhong LIU
;
Di CHEN
;
Fang LIU
;
Aizhen SHENG
;
Xinxin MA
Author Information
1. 北京医院神经内科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Publication Type:Journal Article
- Keywords:
Valproate;
Serum drug concentration;
Carbapenem;
Advanced age
- From:
Chinese Journal of Geriatrics
2025;44(1):46-50
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.
