Imipenem/Cilastatin Aptapharma (Cilastatin, Imipenem)

Imipenem/Cilastatin is a broad‑spectrum carbapenem antibiotic used for serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides bactericidal activity against mixed aerobic and anaerobic pathogens.
• Complicated urinary tract infections: eradicates resistant Gram‑negative and Gram‑positive organisms.
• Skin and soft‑tissue infections: treats severe infections caused by susceptible bacteria.
• Nosocomial pneumonia: effective against hospital‑acquired respiratory pathogens.
• Septicemia: rapidly clears bloodstream infections caused by susceptible organisms.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, leading to cell lysis. Cilastatin concurrently inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem in the kidneys and thereby extending its antimicrobial activity in the body.

Adverse reactions may occur with any antimicrobial therapy. Monitoring for side effects is recommended.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Rash: erythematous skin eruption.
• Headache: transient and usually resolves.
• Elevated liver enzymes: mild transaminase increase.
• Injection site pain: discomfort at the infusion site.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or CNS disorders.
• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Clostridioides difficile colitis: antibiotic‑associated diarrhea.
• Severe renal impairment: worsening kidney function.
• Thrombocytopenia: low platelet count.
• Stevens‑Johnson syndrome: rare severe skin reaction.

Careful assessment and monitoring are essential when using this injectable antibiotic.

• Renal function assessment: adjust dosage in patients with impaired kidney function.
• Seizure risk: avoid in individuals with a history of seizures or CNS disorders.
• Hypersensitivity: do not use in patients with known allergy to beta‑lactams.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk, as safety data are limited.
• Concomitant nephrotoxic drugs: monitor renal function closely when combined with other nephrotoxic agents.
• Store at 2‑8 °C: keep refrigerated, protect from light, do not freeze or shake.

Drug interactions can affect efficacy and safety; review patient medication lists.

Major Interactions (Avoid)

• Valproic acid: reduces valproate levels, risking seizure breakthrough.
• Other carbapenems: concurrent use may increase toxicity without added benefit.
• Renal toxic agents (e.g., aminoglycosides): may exacerbate kidney injury.

Moderate Interactions (Monitor Closely)

• Diuretics: may alter renal clearance, requiring dose adjustment.
• Anticoagulants (warfarin): monitor INR for potential changes.
• Oral contraceptives: possible reduction in effectiveness, advise alternative contraception.