社團法人臺灣臨床藥學會

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【原著】Ertapenem 併用Valproic Acid 於腦瘤病人產生癲癇案例報告
Report of Ertapenem Antibiotics Decreasing Valproic Acid Plasma Concentration in Brain Tumor Patient
Valproic acid、Ertapenem、藥物交互作用、Valproic Acid, Entrapenem, Drug Interaction
張瓊云Chiung-Yun Chang 、湯念湖Ni-Hu Tang* 、劉文雄Wen-Shyong Liou
1臺中榮民總醫院藥學部
抗癲癇藥物Valproic acid (VPA) 代謝途徑多元,包括N-glucuronidation、mitochondrial β-oxidation 和CYP microsomal oxidation,因此VPA 較有可能與其他藥物產生交互作用造成病患藥物濃度不穩定,使得病情變化。使用VPA 治療過程中,因發生中度至重度感染,例如感染性肺炎,需使用Carbapenem 類抗生素治療,例如imipenem、meropenem、doripenem 或ertapenem;已有多篇文獻報告,VPA 因併用Carbapenem 類抗生素,經由數種不同的機轉,降低VPA 血中藥物濃度而導致癲癇復發。但因ertapenem 較晚上市,國內案例較少,也未見腦瘤患者的ertapenem 併用VPA 案例。本文報導一位75 歲腦瘤患者使用VPA 後因為病情需要處方ertapenem 後引起癲癇的的案例。希望經過這一個案例的討論,可以提醒醫療人員於治療過程中需小心藥物併用,如VPA 併用ertapenem,可能引起不良反應。
 
Valproic acid (VPA) is metabolized via a variety of pathways, such as N-glucuronidation, mitochondrial β-oxiation and CYP microsomal oxidation. Hence, valproic acid is more likely to cause drug-drug interaction in comparison with other drugs. Several reports indicate possible interactions between VPA and carbapenem,such as imipenem, meropenem doripenem or ertapenem. The concurrent administration of VPA and carbapenems decrease VPA plasma concentration and develop seizure is well documented. Due to its time on market, ertapenem-induced seizures are rarely reported, especially in brain tumor patients. A 75-yearold female with brain tumor history requiring continous VPA administration experienced seizure following intravenous infusion of ertapenem. In reviewing this case, we hope to bring attention to clinician who could use more caution when co-administrate VPA and ertapenem.
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