Reactions 1474, p29 - 19 Oct 2013 X S Meropenem/valproate interaction Absence seizures: case report A 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 and duration of treatment not stated]. She was admitted for management of cystic fibrosis and multidrug resistant pulmonary infection, and she began receiving IV meropenem [dosage not stated]. On day 2 of meropenem therapy, she experienced several brief episodes of eye fluttering and unresponsiveness. Her trough valproate serum concentration had decreased to 4.9 µg/mL. Meropenem was discontinued. The girl received an IV loading dose of valproate, and her valproate dose was increased to 1000 mg/day. She continued to experience brief absence seizures daily, until she started receiving levetiracetam bridge therapy. She was discharged, and her valproate concentration subsequently increased to 45.9 µg/mL. She remained seizure free following withdrawal of levetiracetam, and valproate was decreased to her previous dose of 750 mg/day. Author comment: "Meropenem is associated with clinically significant, rapid (<24 hour), severe reduction (90%) and persistent (2 weeks) reduction of serum valproate concentrations, potentially resulting in loss of previous seizure freedom." Taha FA, et al. Seizures from valproate-carbapenem interaction. Pediatric Neurology 49: 279-281, No. 4, Oct 2013. Available from: URL: http:// dx.doi.org/10.1016/j.pediatrneurol.2013.03.022 - USA 803094506 1 Reactions 19 Oct 2013 No. 1474 0114-9954/13/1474-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved

Meropenem/valproate interaction

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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