Imipenem/Cilastatin Aptapharma (Cilastatin, Imipenem)

Imipenem/Cilastatin is a carbapenem antibiotic used to treat serious bacterial infections.

• Complicated intra‑abdominal infections: achieves bacterial eradication within the peritoneal cavity.
• Complicated urinary tract infections: clears resistant Gram‑negative pathogens from the urinary tract.
• Skin and soft tissue infections: resolves deep tissue infection caused by susceptible organisms.
• Lower respiratory tract infections: eliminates bacterial pathogens in severe pneumonia.
• Febrile neutropenia: provides broad‑spectrum coverage for high‑risk immunocompromised patients.

• Imipenem binds to penicillin‑binding proteins, inhibiting the synthesis of bacterial cell‑wall peptidoglycan, which leads to cell lysis. Cilastatin co‑administered with imipenem inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby extending its antibacterial activity in the body.

Adverse reactions may occur with any intravenous antibiotic and should be monitored.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Vomiting: occasional emesis following infusion.
• Diarrhea: may be watery or loose.
• Headache: transient cranial discomfort.
• Rash: mild erythematous skin eruption.
• Elevated liver enzymes: transient increase in hepatic transaminases.

Serious or Rare Side Effects

• Seizures: risk increases with high doses or renal impairment.
• Anaphylaxis: severe allergic reaction requiring immediate intervention.
• Clostridioides difficile colitis: antibiotic‑associated severe diarrhea.
• Severe neutropenia: marked reduction in white blood cells.
• Renal toxicity: potential worsening of kidney function.
• Stevens‑Johnson syndrome: rare but life‑threatening skin reaction.

Use of Imipenem/Cilastatin requires careful clinical assessment and monitoring.

• Renal function: assess creatinine clearance before initiation and adjust dose as needed.
• Neurological status: monitor for seizures, especially in patients with CNS disorders.
• Allergies: verify no history of hypersensitivity to β‑lactam antibiotics.
• Concomitant valproic acid: avoid due to reduced serum levels of the antiepileptic.
• Pregnancy and lactation: weigh potential benefits against unknown risks; use only if clearly indicated.
• Store at 2‑8°C: keep refrigerated, protect from light, do not freeze or shake the product.

Imipenem/Cilastatin may interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: significant reduction in valproate concentrations.
• Probenecid: may increase imipenem plasma levels, raising toxicity risk.
• Renal tubular secretion inhibitors (e.g., cimetidine): can elevate imipenem exposure.

Moderate Interactions (Monitor Closely)

• Loop diuretics: potential additive nephrotoxicity.
• NSAIDs: may increase risk of renal impairment.
• Other nephrotoxic agents: monitor renal function closely when co‑administered.