Intentional use of carbapenem antibiotics for valproic acid toxicity: A case report

M A Khobrani, S W Dudley, Y C Huckleberry, B J Kopp, A D Biggs, R N E French, F M Shirazi, B L Erstad
Journal of Clinical Pharmacy and Therapeutics 2018, 43 (5): 723-725

WHAT IS KNOWN AND OBJECTIVE: The interaction between valproic acid (VPA) and carbapenem antibiotics is well described with previous reports suggesting a reduction in VPA half-life between 47% and 90%. As described in this case, this interaction might be beneficial in the setting of toxic VPA ingestion.

CASE DESCRIPTION: An intubated, unresponsive patient arrived via emergency medical services after toxic VPA ingestion. Meropenem was prescribed for a suspected pneumonia and to take advantage of the VPA interaction. We observed a 56% decline in half-life with short-term meropenem dosing and an improvement in mental status shortly after administration.

WHAT IS NEW AND CONCLUSION: Our findings suggest a potential role for short-term carbapenem therapy for VPA overdose.

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