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Imipenem/Cilastatin/Relebactam

    Brands

    DEA Class; Rx

    Common Brand Names; Recarbrio

    • Carbapenems

    Imipenem: Carbapenem; inhibits bacterial cell-wall synthesis by binding to penicillin-binding proteins resulting in bacterial cell lysis

    Cilastatin: Prevents renal metabolism of imipenem by competing with dehydropeptidase in the renal tubules

    Relebactam: Has no intrinsic antibacterial activity; protects imipenem from degradation by certain serine beta-lactamases such as sulfhydryl variable (SHV), temoneira (TEM), cefotaximase-Munich (CTX-M), E cloacae P99 (P99), Pseudomonas-derived cephalosporinase (PDC), and K pneumoniae

    Indicated for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP)

    Indicated for treatment of complicated urinary tract infections (cUTIs), including pyelonephritis, in individuals with limited or no other treatment options

    Indicated for treatment of complicated intra-abdominal infections (cIAIs) for individuals with limited or no other treatment options

    History of severe hypersensitivity to imipenem, cilastatin, or relebactam, or any other component

    • Diarrhea (6%)
    • Nausea (6%)
    • Headache (4%)
    • Vomiting (3%)
    • Increased ALT or AST (3%)
    • Phlebitis or infusion site reactions (2%)
    • Pyrexia (2%)
    • Hypertension (2%)
    • Anemia (1%)
    • Increased lipase (1%)
    • CNS adverse effects (1%)
    • Increased blood creatinine

    Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported in patients receiving therapy with beta-lactams; carefully assess allergy history for previous hypersensitivity to carbapenems, penicillins, cephalosporins, other beta-lactams, and other allergens

    Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents; if CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C difficile may need to be discontinued

    Prescribing antibiotics in the absence of a proven or strongly suspected bacterial infection or prophylactic indication is unlikely to provide benefit to the patient and increases risk of drug-resistant bacteria

    Data are insufficient in pregnant women to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes

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

    Adults

    1.25 g IV q6hr x 4-14 days

    Geriatric

    Substantially excreted by the kidney and risk of adverse reactions may be greater in patients with impaired renal function

    Because geriatric patients are more likely to have decreased renal function, care should be taken in dose selection; consider monitoring renal function

    No dosage adjustment is required based on age; dosage adjustment is based on renal function

    See Adult Dosing

    Pediatric

    <18 years: Safety and efficacy not established

    Imipenem/cilastatin/relebactam

    injection, powder for reconstitution

    • 500mg/500mg/250mg per vial (ie, 1.25g/vial)