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Wang Z, Liu B, Sun Q, Dong S, Kuang Y, Dong Y, He F, Gai S, Yang P

In one study, the clearance of free valproate was decreased by 50% in 7 patients with cirrhosis and by 16% in 4 patients with acute hepatitis, compared with 6 healthy subjects

The former pathway is catalyzed primarily by NADP + -dependent isocitrate dehydrogenase (mNADP-IDH, aka IDPm, EC 1.1.1.42) and by malic enzyme (NADP-ME, EC 1.1.1.40) [132]