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Recently, interest has developed in the use of carbapenem antibiotics as an adjunctive therapy in patients with severe VPA poisoning. Carbapenems inhibit acylpeptide hydrolase, the enzyme responsible for reconstituting VPA from VPA\u2010glucuronide, and transiently promote distribution of VPA into erythrocytes. In patients receiving VPA therapeutically, carbapenems lower VPA concentrations abruptly, dramatically, and for a sustained period. This article discusses the possibility of exploiting this pharmacokinetic drug\u2013drug interaction in patients with or at risk of severe VPA poisoning.<\/jats:p>","DOI":"10.1111\/bcp.16376","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T11:21:01Z","timestamp":1736940061000},"page":"648-653","source":"Crossref","is-referenced-by-count":7,"title":["Carbapenems in the management of valproic acid overdose"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0368-4212","authenticated-orcid":false,"given":"David N.","family":"Juurlink","sequence":"first","affiliation":[{"name":"Departments of Medicine, Pediatrics, and Health Policy, Management and Evaluation University of Toronto  Toronto Canada"},{"name":"The Ontario Poison Centre  Toronto Canada"},{"name":"Sunnybrook Research Institute  Toronto 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