Ibuprofen Valproate

Plasma levels of valproate may also be Increased by felbamate, chlorpromazine, fluoxetine, fluvoxamine, topiramate, cimetidine, erythromycin, and ibuprofen... 

Acute hepatocellular necrosis. This reaction varies from a transient disturbance of liver function tests to acute hepatitis. It can be induced by several drugs including general anaesthetics (halothane), antiepileptics (carbamazepine, phenytoin, sodium valproate, phenobarbital), antidepressants (MAO inhibitors), antiinflammatory drugs (indomethacin, ibuprofen), antimicrobials (isoniazid, sulphonamides, nitrofurantoin) and cardiovascular drugs (methyldopa, hydralazine). 

Valproate toxicity developed in three patients given large and repeated doses of aspirin. Increased levels of free valproate were found in S children within hours of them taking aspirin. Con-versefy, a slightly reduced valproate level was reported in one patient who took ibuprofen. Modestly altered protein binding has been shown when sodium valproate was given with diflunisal or naproxen, but this appears unlikely to be clinically important... 

A 15-year-old boy was found to have a subtherapeutic valproate level (43 micrograms/rriL) 3 days after starting to take ibuprofen 600 mg every 6 hours for post-fracture analgesia. The ibuprofen was stopped, and after one week the valproate levels were within the therapeutic range (60 micrograms/mLV The general importance of this isolated case is unknown. More study is needed. 

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