高龄老年癫痫患者碳青霉烯类抗生素对丙戊酸钠血药浓度的影响  

Effect of carbapenem antibiotics on serum concentration of sodium valproate in older patients with epilepsy

作　　者：刘慧菁 刘银红[1] 陈頔[2] 刘芳[1] 盛爱珍[1] 马欣昕[1] Liu Huijing;Liu Yinhong;Chen Di;Liu Fang;Sheng Aizhen;Ma Xinxin(Neurology Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Pharmacy Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院神经内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院药学部、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2025年第1期46-50,共5页Chinese Journal of Geriatrics

摘　　要：目的分析碳青霉烯类抗生素对高龄老年癫痫患者丙戊酸钠(valproate,VPA)血药浓度的影响,探讨碳青霉稀类抗生素和VPA的药物相互作用及可能的解决方案。方法回顾性纳入北京医院老年医学部2017年1月至2022年12月曾联合使用VPA及碳青霉烯类抗生素的80岁以上的癫痫住院患者。收集患者的基本信息、癫痫相关信息、感染用药相关信息、VPA血药浓度变化、临床处理方法及临床转归。结果共纳入12例患者进行分析,联合使用VPA及碳青霉烯类抗生素时的患者年龄为(92.0±7.0)岁,基础VPA用量为1000(650,1250)mg,基础VPA血药浓度为56.59(38.00,61.73)mg/L。9例(75%)患者在联合用药期间出现癫痫再发。10例患者增加了VPA的剂量,增加522(200,892)mg,VPA增加剂量持续时间为8(7,9)d。联合用药后所有患者的VPA血药浓度均较基线下降,最低VPA血药浓度较基线下降幅度达(71.90±15.69)%。碳青霉烯类抗生素使用时VPA血药浓度明显低于基线血药浓度及停药后血药浓度[12.30(10.49,22.47)mg/L比56.59(38.00,61.73)mg/L比43.74(41.48,73.14)mg/L,Z=-3.059、-2.803,P=0.002、0.005]。结论针对高龄老年癫痫患者,碳青霉烯类抗生素明显降低VPA血药浓度,且明显增加癫痫发生率。通过加用VPA剂量不一定能提高VPA血药浓度。临床上建议尽量避免两者之间的合用。Objective To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy,while also exploring the potential drug interactions between carbapenem antibiotics and VPA,as well as possible solutions.MethodsThis retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022,as well as older hospitalized patients with epilepsy.Data collected encompassed patients'demographic information,details related to epilepsy,information on infection medications,changes in VPA blood concentration,clinical management,and clinical outcomes.ResultsA total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1000 mg(range:650 to 1250 mg),and the baseline VPA serum concentration was 56.59 mg/L(range:38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy,representing 75%of the total cohort.The VPA dosage was increased in 10 patients,with a mean increase of 522 mg(range:200 to 892 mg),and the duration of this dosage increase was 8 days(range:7 to 9 days).All patients exhibited a decrease in VPA serum concentration,with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations,measuring 12.30 mg/L(range:10.49 to 22.47 mg/L)compared to 56.59 mg/L(range:38.00 to 61.73 mg/L)(Z=-3.059,P=0.002)and 43.74 mg/L(range:41.48 to 73.14 mg/L)(Z=-2.803,P=0.005).ConclusionsCarbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration;therefore,we recommend avoiding the concomitant use of VPA and carba

关 键 词：丙戊酸钠 血药浓度 碳青霉烯 高龄 

分 类 号：R742.1[医药卫生—神经病学与精神病学]