Sk. Akula et al., VALPROIC ACID INCREASES CEREBROSPINAL-FLUID ZIDOVUDINE LEVELS IN A PATIENT WITH AIDS, The American journal of the medical sciences, 313(4), 1997, pp. 244-246
Valproic acid is an anticonvulsant drug known to inhibit the glucuroni
dation of zidovudine (AZT) in human liver microsomes. Zidovudine is me
tabolized by glucuronidation to the inactive 5'-glucuronide with a sho
rt plasma half-life (1.0 +/- 0.2 hour), This case presentation confirm
s that valproic acid inhibits glucuronidation in vivo, and this is the
first documented observation of increased cerebrospinal fluid levels
of zidovudine because of an interaction with valproic acid in a patien
t with acquired immune deficiency syndrome (AIDS), The peak plasma AZT
level for the control period was 119 ng/mL, which increased almost 3-
fold to 344 ng/mL with valproic acid (1.5 g/day), The plasma AZT troug
h was 47 ng/mL, which also increased almost 3-fold to 124 ng/mL with v
alproic acid, The molar ratio of plasma 5'-glucuronide/AZT at the peak
was reduced from 1.77 (control) to 1.07 with valproic acid, The 5'-gl
ucuronide/AZT ratio at the trough was reduced markedly from 5.0 (contr
ol) to 0.93 with valproic acid, suggesting in vivo inhibition of glucu
ronidation, Cerebrospinal AZT levels, drawn 30 minutes after peak plas
ma levels, increased from 27 ng/mL for the control to 47 ng/mL with va
lproic acid, which paralleled the change in peak plasma concentrations
, This interaction with valproic acid may contribute to higher AZT lev
els in the brains of patients with human immunodeficiency virus-relate
d (HIV) encephalopathy.