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Imipenem/Cilastatin

    Brands

    DEA Class; Rx

    Common Brand Names; Invanz

    • Carbapenems

    Beta-lactam antibiotic derived from thienamycin. Cilastatin added to reduce renal metabolism of imipenem. Without cilastatin, imipenem is rapidly metabolized and causes toxicity to the proximal tubule. Cilastatin has no antibacterial activity. Imipenem is more efficient at penetrating through the bacterial cell wall, resistant to bacterial enzymes, and has affinity for all bacterial PBPs. Broader spectrum of activity than many other beta-lactam antibiotics. Used to treat severe or resistant infections, especially those that are nosocomial in origin.

    Indicated for the treatment of Lower Respiratory Tract, Skin/Skin Structure, & Gynecologic Infections.

    Indicated for Intra-abdominal Infections.

    Indicated for Pseudomonas Infections, Urinary Tract Infections.

    Hypersensitivity to imipenem or cilastatin

    • Phlebitis (2-5%)
    • Eosinophilia (4%)
    • Miscellaneous dermatologic effects (<3%)
    • Potentially false-positive Coombs test (2%)
    • Miscellaneous hematologic effects (<2%)
    • Transient increase in blood urea nitrogen (BUN) or serum creatinine (<2%)
    • Seizures (1.5%)
    • Nausea, diarrhea, vomiting (1-2%)
    • Abnormal urinalysis
    • Agitation
    • Anaphylaxis
    • Anemia
    • Confusion (acute)
    • Dizziness
    • Dyskinesia
    • Emergence of resistant strains of Pseudomonas aeruginosa
    • Fever
    • Hypersensitivity
    • Hypotension
    • Elevated liver function test (LFT) results
    • Increased prothrombin time (PT)
    • Neutropenia (including agranulocytosis)
    • Palpitations
    • Pruritus
    • Pseudomembranous colitis

    History of hypersensitivity to penicillins

    Use with caution in CNS disorders (eg., history of seizures); adjust dosage in renal impairment to avoid risk of seizures; carbapenem use has been associated with seizures

    Prolonged use increases risk of superinfections

    Use with caution in renal impairment; adjust dosage in moderate to severe renal dysfunction

    Carbapenem use may decrease serum levels of divalproex sodium or valproic acid

    Combination with aminoglycosides may thwart resistant P aeruginosa

    Not for use in children with CNS problems

    Clostridioides difficile associated diarrhea (CDAD) reported and may range in severity from mild diarrhea to fatal colitis; treatment with antibacterial agents alters normal flora of colon leading to overgrowth of C. difficile

    Available data from a small number of postmarketing cases in pregnancy are not sufficient to identify any drug-associated risks for major birth defects, miscarriage, or adverse maternal or fetal outcomes

    There are insufficient data on presence of imipenem/cilastatin in human milk, and no data on effects on breastfed child, or on milk production

    Adults

    4 g/day IV.

    Geriatric

    4 g/day IV.

    Adolescents

    100 mg/kg/day IV (Max: 4 g/day).

    Children

    12 years: 100 mg/kg/day IV (Max: 4 g/day).
    1 to 11 years: 100 mg/kg/day IV (Max: 4 g/day).

    Infants

    100 mg/kg/day IV.

    Neonates

    older than 7 days: 75 mg/kg/day IV.
    0 to 7 days: 50 mg/kg/day IV.

    Imipenem/cilastatin

    powder for injection

    • 250mg/250mg
    • 500mg/500mg