Meropenem/valproate interaction

Reactions 1474, p29 - 19 Oct 2013

X SMeropenem/valproate interaction

Absence seizures: case reportA 14-year-old girl experienced absence seizures due to an

interaction between valproate and meropenem.The girl, who had idiopathic generalised juvenile absence

epilepsy, was receiving valproate 750 mg/day [route andduration of treatment not stated]. She was admitted formanagement of cystic fibrosis and multidrug resistantpulmonary infection, and she began receiving IV meropenem[dosage not stated]. On day 2 of meropenem therapy, sheexperienced several brief episodes of eye fluttering andunresponsiveness. Her trough valproate serum concentrationhad decreased to 4.9 µg/mL.

Meropenem was discontinued. The girl received an IVloading dose of valproate, and her valproate dose wasincreased to 1000 mg/day. She continued to experience briefabsence seizures daily, until she started receivinglevetiracetam bridge therapy. She was discharged, and hervalproate concentration subsequently increased to45.9 µg/mL. She remained seizure free following withdrawal oflevetiracetam, and valproate was decreased to her previousdose of 750 mg/day.

Author comment: "Meropenem is associated withclinically significant, rapid (<24 hour), severe reduction (90%)and persistent (2 weeks) reduction of serum valproateconcentrations, potentially resulting in loss of previousseizure freedom."Taha FA, et al. Seizures from valproate-carbapenem interaction. PediatricNeurology 49: 279-281, No. 4, Oct 2013. Available from: URL: http://dx.doi.org/10.1016/j.pediatrneurol.2013.03.022 - USA 803094506

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Reactions 19 Oct 2013 No. 14740114-9954/13/1474-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved