从1例老年感染患者探讨碳青霉烯类药物与丙戊酸钠的药物相互作用

摘要

One 94-year-old female patient with diabetes mellitus, coronary heart disease and secondary epilepsy was admitted into hospital twice for pulmonary infection. After admission, she received the concomitant administration of carbapenems and sodium valproate (VPA). Clinical pharmacists paid more attention to the drug interaction between carbapenems and VPA, and monitored closely the serum concentration of VPA. During the concomitant administration of carbapenem antibiotics, the concentration of VPA markedly decreased, and the patient developed epilepsy in the second hospitalization. The concentration of VPA raised significantly and her epilepsy was controlled well after the cessation of meropenem. Notably, decrease of the VPA serum concentration caused by carbapenems can result in the failure of seizure control. Therefore, the VPA serum concentration should be monitored closely and the concomitant administration of VPA and carbapenems should be avoided in consideration of the drug interaction between carbapenems and VPA and increasing the risk of seizure recurrence.%　　1例94岁老年女性患者，既往合并糖尿病、冠心病、继发性癫痫，因肺部感染先后2次入院，入院后均合并使用碳青霉烯类药物和丙戊酸钠（sodium valproate, VPA）。临床药师重点关注碳青霉烯类药物与VPA的药物相互作用，密切监测VPA血药浓度，发现合并使用碳青霉烯类药物后，患者VPA血药浓度显著降低，并于第二次住院期间发作癫痫，停用美罗培南后VPA血药浓度显著回升，癫痫控制良好，提示碳青霉烯类药物可明显降低VPA的血药浓度。鉴于碳青霉烯类药物与VPA的显著不良相互作用，明显增加患者的癫痫再发风险，建议在用药过程中密切监测VPA血药浓度，避免联合应用碳青霉烯类药物与丙戊酸钠。