Imicilast (Cilastatin, Imipenem Anhydrate)

Imicilast is a carbapenem antibiotic indicated for serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides broad‑spectrum bacterial eradication to resolve infection.
• Complicated urinary tract infections: eliminates resistant uropathogens to restore urinary health.
• Skin and soft‑tissue infections: treats deep‑seated infections caused by Gram‑negative and Gram‑positive organisms.
• Nosocomial pneumonia: combats hospital‑acquired lung infections, including ventilator‑associated pneumonia.
• Meningitis: penetrates the cerebrospinal fluid to treat bacterial meningitis caused by susceptible strains.

• Imipenem inhibits bacterial cell‑wall synthesis by binding to penicillin‑binding proteins, disrupting peptidoglycan cross‑linking and leading to cell lysis. Cilastatin co‑administered with imipenem inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby prolonging its antibacterial activity in the body.

Adverse reactions may occur with any antimicrobial therapy.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Injection site pain: localized discomfort during administration.
• Elevated liver enzymes: transient increase in transaminases.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or CNS disorders.
• Severe allergic reactions: anaphylaxis, rash, or angioedema.
• Clostridioides difficile colitis: antibiotic‑associated colitis presenting with profuse diarrhea.
• Renal dysfunction: acute kidney injury in predisposed individuals.

Imicilast requires careful patient assessment and monitoring.

• Renal function: adjust dosing in patients with impaired renal clearance.
• Neurological status: monitor for seizures, particularly in those with a history of CNS disease.
• Allergies: avoid in patients with known hypersensitivity to carbapenems or β‑lactams.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk to the fetus or infant.
• Drug interactions: review concomitant medications for potential interactions.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imicilast may interact with other medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: increased risk of seizures when combined with carbapenems.
• Probenecid: may reduce renal clearance of imipenem, leading to higher plasma levels.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may potentiate nephrotoxic effects; monitor renal function.
• Anticoagulants (e.g., warfarin): possible alteration of INR; check coagulation parameters.
• Other nephrotoxic agents (e.g., aminoglycosides): increased risk of kidney injury; assess renal markers regularly.