No pharmaceutical opinion available for this interaction.
Lopinavir / ritonavir may increase the metabolism (UGT) and decrease the plasma concentration of Valproic acid (valproate, divalproex).
3A4 (major), 13 identified metabolites, 5 of these metabolites are linked to the metabolism of ritonavir, transporters: MRP1, MRP2, OATP1A2, OATP1B1, P-gp
2C19 (strong), 1A2, 2C9 (moderate) UGT (moderate)
3A4 and 2D6 (strong), transporters: BCRP, MRP2, OATP1A2, OATP1B1, OATP1B3, OATP2B1, P-gp
UGT (50%), mitochondrial β-oxidation (40%), minor CYP-dependent oxidation pathway (<10%)
UGT, 2C9, 2C19
Possible decrease of clinical efficacy.
Monitor for treatment response.
Adjust dosage if necessary.
|+ 38% *|
Ref #1623 : * Refers to lopinavir.
There were no significant differences in lopinavir Cmin (6.81 vs 10.7 ng/ml) or Cmax (12.4 vs 16.5 ng/ml) when given with valproic acid. Valproic acid trough not significantly
Ref #1940 : A case report of a 30 year old man with valproic acid concentrations decreased (- 48%) 21 days after starting lopinavir/ritonavir; valproic acid dosage was doubled and levels re-stabilized.