scholarly journals Meropenem-induced Valproic Acid Elimination: A Case Report of Clinically Relevant Drug Interaction

2017 ◽  
Vol 118 (2-3) ◽  
pp. 105-109 ◽  
Author(s):  
Martin Šíma ◽  
Jan Hartinger ◽  
Jan Rulíšek ◽  
Robert Šachl ◽  
Ondřej Slanař
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Case Report ◽  
Serum Concentration ◽  
Dose Escalation ◽  
Treated Patient ◽  
Case Reports ◽  
Concomitant Administration ◽  
Serum Levels ◽  
Population Kinetic

We present two case reports of drug interaction between valproic acid and meropenem. In comparison with expected population-kinetic based serum levels, we observed 90.8 and 93.5% decrease in valproic acid serum levels during concomitant administration with meropenem. If carbapenems need to be administered to valproic acid treated patient, other anticonvulsant addition seems to be the appropriate as most probably the valproic acid dose escalation would not be sufficient to achieve therapeutic serum concentration.

scholarly journals Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Phenelzine and Morphine Drug-Drug Interaction? A Literature Review

2020 ◽  
pp. 089719002097075
Author(s):  
Ryan J. Beechinor ◽  
Rachel Tyson ◽  
Mary E. Roth
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Single Case ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Human Studies ◽  
Close Monitoring ◽  
Review Articles ◽  
Drug Drug Interaction

The objectives of this manuscript are to describe a case report of a patient whose phenelzine maintenance therapy was discontinued due to concern for a phenelzine-morphine drug interaction, to review the available literature regarding the potential for this drug-drug interaction, and provide recommendations for this clinical scenario. A PubMed/MEDLINE literature search was conducted and all publications determined to be relevant to this case report were included. Literature describing in vitro data, case reports/human studies, and review articles concerning the interaction between morphine and monoamine oxidase inhibitors (MAOIs) were included. A total of 14 publications pertinent to the potential phenelzine-morphine interaction were included in this review including 5 in vitro studies, 4 human studies, and 6 review articles detailing the drug interaction profile between opioids and antidepressants. Of these publications, only a single case report of a potential drug interaction between morphine and phenelzine was identified. The literature suggesting a drug interaction between morphine and phenelzine is limited. The combination of phenelzine and morphine, with close monitoring for signs and symptoms of serotonin syndrome, is reasonable for patients with appropriate indications for both agents.

scholarly journals Clozapine intoxication with severe adverse effects induced by an inflammatory and infectious process: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Emmanuel Bebawi ◽  
Leila Wakim ◽  
Maxime Doré
Keyword(s):  
Case Report ◽  
Inflammatory Process ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Serum Levels ◽  
Caucasian Woman ◽  
Severe Toxicity ◽  
Caffeine Consumption ◽  
Clozapine Dose ◽  
High Level

Abstract Background Clozapine intoxication can be life-threatening. Outside of the common drug–drug interactions, tobacco smoking, and caffeine consumption, infectious and inflammatory processes are important contributors to clozapine intoxication. Although this relationship has been reported previously, the literature is scant of proper research articles describing the presentation and management of this unpredictable interaction. Therefore, clinicians need to rely heavily on case reports describing clozapine intoxication caused by inflammation and/or infection. Case presentation A 64-year-old Caucasian woman known for schizophrenia was brought to the emergency department (ED) with severe signs and symptoms of clozapine intoxication (general deterioration, drowsiness, neutropenia, and ileus). She was on clozapine 700 mg daily amongst other medications. The clozapine dose was stable for over 3 years, and there were no recent changes in her medications. The initial culprit was determined to be an infectious/inflammatory process of gastrointestinal origin with contribution from dehydration and constipation. Clozapine and norclozapine serum concentrations confirmed the intoxication: 1315 ng/mL and 653 ng/mL, respectively. She drastically improved with clozapine dose reduction and antibiotic therapy. She remained stable for years with clozapine 600 mg daily with stable clozapine serum levels. Conclusion This case report illustrates the possibility of severe toxicity associated with an acute infectious and/or inflammatory process in patients on clozapine therapy. Clinicians must maintain a high level of suspicion in patients taking clozapine who develop and an infectious and/or inflammatory process. Constipation secondary to clozapine intoxication can exacerbate the initial intoxication process.

Severe hypokalemia due to a possible drug–drug interaction between vinblastine and antiretrovirals in a HIV-infected patient with Hodgkin’s lymphoma

2017 ◽  
Vol 28 (12) ◽  
pp. 1259-1262 ◽  
Author(s):  
Ezequiel Cordova ◽  
Laura Morganti ◽  
Andrea Odzak ◽  
Florencia Arcondo ◽  
Mariana Silva ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Renal Dysfunction ◽  
Hodgkin’S Lymphoma ◽  
Concomitant Administration ◽  
Serum Levels ◽  
Hodgkin's Lymphoma ◽  
Tubular Damage ◽  
Infected Woman ◽  
Proximal Tubular ◽  
Drug Drug Interaction

A 60-year-old HIV-1 infected woman on antiretroviral therapy (emtricitabine/tenofovir, and ritonavir-boosted atazanavir) developed Hodgkin’s lymphoma. The patient initiated ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) chemotherapy and presented with neutropenia and severe hypokalemia. Hypokalemia was considered as part of a proximal tubular renal dysfunction, and other causes of hypokalemia were excluded. Due to suspicion of drug-–drug interactions between antiretrovirals and vinblastine, ritonavir-boosted atazanavir was switched to dolutegravir and the patient continued emtricitabine/tenofovir. In the subsequent ABVD cycles, no neutropenia or hypokalemia were observed. Vinblastine is metabolized by the hepatic P450 cytochrome isoenzyme CYP3A4, therefore, concomitant administration with protease inhibitors may increase plasma levels of vinblastine. Vinblastine is also a substrate and inhibitor of multidrug resistance-associated protein 2 (MRP2) transporter in the proximal renal tubule. Inhibition of this renal transporter could increase tenofovir renal toxicity. Our hypothesis is that the hypokalemia could be a result of a tenofovir-mediated tubular damage triggered by the increased vinblastine serum levels secondary to a CYP3A4 inhibition by ritonavir. To the best of our knowledge, this is the first report of severe hypokalemia and proximal tubular renal dysfunction as a result of a possible drug–drug interaction between vinblastine, tenofovir and ritonavir-boosted atazanavir.

Lacosamide Lowers Valproate and Levetiracetam Levels

2017 ◽  
Vol 48 (03) ◽  
pp. 188-189 ◽  
Author(s):  
Bernhard Weschke ◽  
Angela Kaindl ◽  
Maria Tountopoulou
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Clinical Significance ◽  
Enzyme Induction ◽  
Serum Levels ◽  
Mechanisms Of Action ◽  
Metabolic Enzyme ◽  
First Time

AbstractLacosamide (LCM) due to no known drug interaction and the absence of metabolic enzyme induction is a good candidate for an add-on medication, especially in combination with lamotrigine, levetiracetam (LEV), oxcarbazepine, topiramate, and valproic acid (VPA). Here we report for the first time, to our knowledge, that LCM can lower VPA and LEV serum levels. At present, there are no known explicable mechanisms of action of LCM, which lowers VPA and LEV. Here observed drug interaction of LCM is of clinical significance, which might be useful for other colleagues in the field.

scholarly journals Valproate Interaction With Carbapenems: Review and Recommendations

2019 ◽  
Vol 55 (3) ◽  
pp. 181-187
Author(s):  
Osama Al-Quteimat ◽  
Alla Laila
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Serum Concentration ◽  
Health Care Providers ◽  
Cochrane Library ◽  
Therapeutic Drug ◽  
Potential Drug Interaction ◽  
Potential Drug ◽  
Care Providers ◽  
Carbapenem Antibiotic

Introduction: Valproic acid is a commonly used antiepileptic drug. Combining valproate derivatives with carbapenem antibiotics is associated with a potential drug interaction that decreases serum concentration of valproate and may expose the patient to uncontrolled seizure risk from valproate subtherapeutic concentration. Raising awareness of this drug interaction among health care providers including emergency department physicians, neurologists, and pharmacists is highly needed. The aim of this article was to review the current literature about the potential drug interaction resulting from combining valproate derivatives with carbapenem antibiotics and to establish therapeutic recommendations regarding their use together. Methods: A review of the literature was conducted using Medline (through PubMed), Ovid, Embase, Cochrane library using the following keywords: valproate, valproic acid, carbapenem, ertapenem, doripenem, meropenem, imipenem, and valproate drug interaction. In addition, a manual search through major journals for articles referenced in PubMed was performed. Related publications from January 1998 till November 2018 were included in the initial search. Relevant publications were reviewed, and data regarding patients, type of carbapenem used, valproic acid dosing and level, interaction severity, and clinical outcome were summarized. Results and Discussion: Few clinical trials and multiple case reports have shown that carbapenem antibiotics including meropenem, ertapenem, imipenem, and doripenem can decrease the serum concentration of valproate derivatives leading to a subtherapeutic serum concentration and seizures in some patients. Valproic acid serum concentration may be significantly decreased with addition of a carbapenem antibiotic but generally return toward normal shortly after discontinuation of the carbapenem antibiotic. Conclusions: Generally, the concurrent use of carbapenem antibiotics with valproate derivatives should be avoided due to the potential of drug-drug interaction that results in subtherapeutic valproate serum concentration. Other antimicrobial agents should be considered as alternatives to carbapenems but if a concurrent carbapenem is necessary, using an additional antiepileptic agent is recommended. Therapeutic drug monitoring of valproate serum concentrations is warranted when a carbapenem-valproic acid combination therapy is unavoidable.

scholarly journals Valproic acid during pregnancy: Case report of a child with congenital malformations due to fetal valproate syndrome, and a high unbound serum level of valproic acid at birth

2017 ◽  
Vol 04 (01) ◽  
pp. 094-097 ◽  
Author(s):  
Shirley Sparla ◽  
Paul Hogeman ◽  
Maarten van Gemert ◽  
Eleonora Swart ◽  
Mirte Malingre
Keyword(s):  
Valproic Acid ◽  
Case Report ◽  
Serum Level ◽  
Real Time ◽  
Therapeutic Range ◽  
Congenital Malformations ◽  
Serum Levels ◽  
Postnatal Period ◽  
Total Serum ◽  
Fetal Valproate Syndrome

AbstractWe present a child in utero exposed to valproic acid with congenital malformations due to fetal valproate syndrome and with toxic effects. Directly postnatal, a high-unbound serum level of valproic acid was measured. The total serum level of valproic acid was in the therapeutic range. Measuring unbound serum levels during pregnancy and postnatal period in the child provides more information about real-time exposure than measuring total serum levels.

Drug Interaction Between Phenytoin and Valproic Acid in a Child With Refractory Epilepsy

2013 ◽  
Vol 27 (2) ◽  
pp. 214-216 ◽  
Author(s):  
Indira Valadê Carvalho ◽  
Renata Cavalcanti Carnevale ◽  
Marília Berlofa Visacri ◽  
Priscila Gava Mazzola ◽  
Rosiane de Fátima Lopes Ambrósio ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Serum Concentration ◽  
Refractory Epilepsy ◽  
Free Drug ◽  
Epilepsy Syndrome ◽  
Concomitant Treatment ◽  
Case Description ◽  
Phenytoin Toxicity

Introduction: There are no published reports on pediatric phenytoin toxicity, resulting from the drug interaction between phenytoin and valproic acid. Case description: A 12-year-old patient with refractory epilepsy syndrome presented with phenytoin toxicity, following a concomitant treatment with phenytoin, valproic acid, and lamotrigine. The phenytoin concentration detected in the capsules used by the patient was in accordance with the prescribed dose and was appropriate for the age and weight of the patient. However, a supratherapeutic phenytoin serum concentration was observed (21.92 µg phenytoin/mL of blood). Consequently, the phenytoin dose was reduced, and the patient was monitored; 24 hours later the patient did not present with any signs/symptoms of toxicity. Discussion: Despite the appropriate phenytoin concentration in the capsules, the patient presented with phenytoin toxicity. This toxicity likely resulted from the drug interaction between phenytoin and valproic acid that leads to phenytoin displacement from plasmatic proteins and inhibits phenytoin metabolism, thereby increasing the concentration of free drug in the serum.

scholarly journals Drug Interaction Between Valproic Acid and Meropenem: A Case Report

2015 ◽  
Vol 13 (1) ◽  
pp. 46-48
Author(s):  
Murat Yaşar Özkalkanlı ◽  
Fulya Yılmaz Duran ◽  
Günay Yıldız ◽  
Orhan Kılıç ◽  
Onur Okur
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Case Report
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