Interazioni tra farmaci
Cilastatin-imipenem + Divalproex
Gravità: Maggiore
Cilastatin-imipenem and Divalproex: major interaction.
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Sintesi
Carbapenems, including imipenem, cause a rapid and marked fall in serum valproate concentrations. This can lead to loss of seizure control, and the effect may persist for days after stopping the carbapenem. Increasing the valproate dose does not reliably overcome it.
Cosa significa questa interazione in parole semplici
Cilastatin-imipenem and Divalproex can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Perché avviene
Carbapenems inhibit acylpeptide hydrolase, reducing hydrolysis of valproate glucuronide back to valproate, and may also decrease valproate absorption and distribution into tissues.
Cosa fare
Avoid the combination and use a non-carbapenem antibiotic. If a carbapenem is essential, add alternative anticonvulsant coverage and monitor valproate levels and seizure activity.
Cosa chiedere al farmacista
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Altre interazioni di Cilastatin-imipenem
Domande frequenti
Can I take Cilastatin-imipenem with Divalproex?
MediHelp rates the interaction as major. Cilastatin-imipenem and Divalproex can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Carbapenems, including imipenem, cause a rapid and marked fall in serum valproate concentrations. This can lead to loss of seizure control, and the effect may persist for days after stopping the carbapenem. Increasing the valproate dose does not reliably overcome it.
How serious is the interaction between Cilastatin-imipenem and Divalproex?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and use a non-carbapenem antibiotic. If a carbapenem is essential, add alternative anticonvulsant coverage and monitor valproate levels and seizure activity.
What other medicines interact with Cilastatin-imipenem?
MediHelp also lists interactions of Cilastatin-imipenem with, for example, Ganciclovir, Valproic acid, Bcg intravesical live. The full list is on the Cilastatin-imipenem page.
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