hyperammonemia
3 interactions related to hyperammonemia
valproate + carnitine
Valproate (valproic acid) depletes carnitine by sequestering it as valproyl-carnitine for mitochondrial transport and by inhibiting renal tubular reabsorption, which can impair the urea cycle and contribute to hyperammonemia, hepatotoxicity, and encephalopathy.
valproate + aspirin
Aspirin (and other salicylates) displace valproate from plasma albumin binding sites and also inhibit valproate's beta-oxidation, leading to increases in the free (active) valproate fraction by up to fourfold. Even total valproate levels may not rise dramatically, masking the increase in pharmacologically active free drug and raising the risk of valproate toxicity (sedation, tremor, hyperammonemia, hepatotoxicity).
cbd + valproate
Concomitant CBD (Epidiolex) and valproate use produces a significantly higher rate of ALT/AST elevations than either drug alone - up to ~17% of patients in the combination group versus ~1-2% on valproate alone in pooled Epidiolex trial data. Postmarketing reports also describe hyperammonemia in patients on the combination.