Phenobarbital--valporic acid interaction.

The effect of subchronic valproate treatment on the single-dose kinetics of phenobarbital was investigated in 6 normal subjects. The study consisted of 2 drug treatments assigned through randomized crossover design. In one treatment subjects received a 60-mg dose of phenobarbital orally. In the other, subjects received 250 mg valproic acid orally twice daily for 14 consecutive days and a 60-mg dose of phenobarbital orally on day 4. Nineteen plasma samples (over 12 days) and two 48-hr urine samples were collected during each treatment. Plasma and urine phenobarbital levels were determined by gas chromatograph interfaced with mass spectrometer in a chemical ionization mode (GLC/CI/MS) and plasma valproic acid levels by GLC. Valproic acid induced several changes in the elimination parameters of phenobarbital: (1) phenobarbital half-life rose from 96 to 142 hr (p = 0.006); (2) plasma clearance fell from 4.2 to 3.0 ml/hr/kg (p = 0.009); (3) renal clearance was unchanged, and metabolic clearance fell from 3.3 to 2.0 mg/hg/kg (p = 0.006); and (4) the fraction of dose excreted unchanged rose from 0.22 to 0.33 (p = 0.015), and the fraction of dose metablized fell from 0.78 to 0.67 (p = 0.015). The findings indicate that valproic acid inhibits phenobarbital metabolism.

RCT Entities:   Population Interventions Outcomes