Pivampicillin Valproate

Melegh B, Kerner J, Jaszai V, Bieber L. Differential excretion of xenobiotic acylesters of carnitine due to administration of pivampicillin and valproate. Biochem Med Metabol Biol 1990 43 30-8. 

An isolated report describes hyperammonaemic encephalopathy in an elderly patient during treatment with valproate and pivmecillinam. The manufacturers of both pivmecillinam and pivampicillin advise the avoidance of concurrent valproate because of the increased risk of carnitine deficiency. 

The authors of the report advise caution if pivmecillinam is added to treatment with valproate. Although this appears to be the only report of an adverse effect due to the combined effects of pivmecillinam and valproate on carnitine levels, the manufacturers advise the avoidance of both pivampicillin or pivmecillinam with valproic acid or valproate or other medication liberating pivalic acid. " ... 

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