TY - JOUR T1 - A clinical pharmacist's intervention on interaction between meropenem and valproic acid in paediatric inpatient clinic: A case report AU - Memiş, Hasan AU - Çakır, Ahmet AU - Özdemir, Nesligül AU - Gün, Zeynep Ülkü PY - 2023 DA - April DO - 10.26650/IstanbulJPharm.2023.1202590 JF - İstanbul Journal of Pharmacy JO - iujp PB - Istanbul University WT - DergiPark SN - 2587-2087 SP - 92 EP - 94 VL - 53 IS - 1 LA - en AB - Background and Aims: Drug-drug interactions cause many complex drug events, especially adverse drug effects. It is known that drug interactions occur when meropenem and valproic acid are used together. It was aimed to back up existing research on the interaction of valproic acid.Methods: After an interaction had been suspected by the ward pharmacists, all of the patient’s drugs were assessed via Up- ToDate® and Micromedex® databases and the interaction management was shared with the physician in charge.Results: The patient’s serum valproic acid through level was in therapeutic range before meropenem administration. After the administration of meropenem, the patient's number of seizures increased and the serum trough level of valproic acid de- creased to 4.3 µg/ml. The valproic acid levels turned back to normal range after switching to a carbapenem antibiotic.Conclusion: Drug interactions are often encountered in paediatric patients and it is of critical importance in terms of seizure control. Because of the drug interaction between valproic acid and meropenem, one should avoid using these medications concomitantly. If that is impossible, daily serum valproic acid levels should be monitored with caution. Clinical pharmacists could increase the clinicians’ awareness about drug-drug interactions. KW - drug interactions KW - hospitalized child KW - meropenem KW - pharmacists KW - valproic acid CR - Al-Quteimat, O., & Laila, A. (2020). Valproate Interaction With Car- bapenems: Review and Recommendations. Hospital Pharmacy, 55(3), 181-187. doi:10.1177/0018578719831974 CR - Coves-Orts, F. J., Borras-Blasco, J., Navarro-Ruiz, A., Murcia-Lopez, A., & Palacios-Ortega, F. (2005). Acute seizures due to a probable interaction between valproic acid and meropenem. Annals of Pharmacotherapy, 39(3), 533-537. doi:10.1345/aph.1E358 CR - González, C., & Villena, R. (2012). Interacción entre merope- nem y ácido valproico: A propósito de dos casos pediátricos. Revista chilena de infectología, 29, 353-355. Retrieved from http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716- 10182012000300018&nrm=iso CR - Miranda Herrero, M. C., Alcaraz Romero, A. J., Escudero Vilaplana, V., Fernandez Lafever, S. N., Fernandez-Llamazares, C. M., Barredo Valderrama, E., . . . de Castro, P. (2015). Pharmacological interaction between valproic acid and carbapenem: what about levels in pe- diatrics? European Journal of Paediatric Neurology, 19(2), 155-161. doi:10.1016/j.ejpn.2014.12.010 CR - Nakamura, Y., Nakahira, K., & Mizutani, T. (2008). Decreased valproate level caused by VPA-glucuronidase inhibition by car- bapenem antibiotics. Drug Metabolism Letters, 2(4), 280-285. doi:10.2174/187231208786734049 CR - Naranjo, C. A., Busto, U., Sellers, E. M., Sandor, P., Ruiz, I., Roberts, E. A., . . . Greenblatt, D. J. (1981). A method for estimating the prob- ability of adverse drug reactions. Clinical Pharmacology & Thera- peutics, 30(2), 239-245. doi:10.1038/clpt.1981.154 CR - Okumura, L. M., Andreolio, C., Di Giorgio, C., Carvalho, P. R. A., & Piva, J. P. (2017). Meropenem-induced low valproate levels in a ce- rebral palsy child. The Brazilian Journal of Infectious Diseases, 21(4),491. doi:10.1016/j.bjid.2017.01.010 CR - Park, M. K., Lim, K. S., Kim, T. E., Han, H. K., Yi, S. J., Shin, K. H., . . .Yu, K. S. (2012). Reduced valproic acid serum concentrations due to drug interactions with carbapenem antibiotics: overview of 6 cases. Therapeutic Drug Monitoring, 34(5), 599-603. doi:10.1097/ FTD.0b013e318260f7b3 CR - Spriet, I., Goyens, J., Meersseman, W., Wilmer, A., Willems, L., & Van Paesschen, W. (2007). Interaction between valproate and me- ropenem: a retrospective study. Annals of Pharmacotherapy, 41(7), 1130-1136. doi:10.1345/aph.1K079 CR - Wu, C. C., Pai, T. Y., Hsiao, F. Y., Shen, L. J., & Wu, F. L. (2016). The Effect of Different Carbapenem Antibiotics (Ertapenem, Imipenem/ Cilastatin, and Meropenem) on Serum Valproic Acid Concentra- tions. Therapeutic Drug Monitoring, 38(5), 587-592. doi:10.1097/ FTD.0000000000000316 CR - Yamamura, N., Imura-Miyoshi, K., & Naganuma, H. (2000). Panipe- num, a carbapenem antibiotic, increases the level of hepatic UDP-glucuronic acid in rats. Drug Metabolism and Disposition, 28(12), 1484-1486. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/11095587 UR - https://doi.org/10.26650/IstanbulJPharm.2023.1202590 L1 - https://dergipark.org.tr/en/download/article-file/2764557 ER -