Decreased valproate level caused by VPA-glucuronidase inhibition by carbapenem antibiotics.

The serum concentration of valproic acid (VPA) in epilepsy patients decreased in the administration of carbapenem antibiotics (CP), such as meropenem, panipenem, biapenem or imipenem, to a sub-therapeutic level. The liver is the key organ for the decrease of VPA concentration by CP, because it has been reported that no decrease of the VPA level by CP was found in hepatectomized rats. This effect was also shown with monkey and rat liver slices. In this report, we show the results of in vitro inhibition of VPA-glucuronidase in human liver microsomes and cytosol by CP. We found the highest metabolic activity of VPA-glucuronide in human liver cytosol. The level in liver cytosol was 149 pmol/min/mg protein. The level in human liver microsomes (HLM) was one-fifth of that in cytosol and the level in serum was negligible. We found that this hydrolysis depends on VPA-glucuronidase in cytosol, because digestion was inhibited by D-saccharic acid 1,4-lactonemonohydrate of a specific inhibitor of beta-glucuronidase, but not by phenylmethylsulfonylfluoride of an esterase inhibitor. We also found the inhibition of VPA-glucuronidase in cytosol by CP, and the maximum inhibition was found with panipenem (IC(50) = 3 microM). We also found inhibition of VPA-glucuronidase in HLM by meropenem. These results showed that the inhibition in liver slices depended on the inhibition of VPA-glucuronidase by CP. We considered that the inhibition of VPA-glucuronidase by CP in cytosol is a key factor to decrease the plasma VPA level.