Imipenem/Cilastatin Aptapharma (Cilastatin, Imipenem)

Imipenem/Cilastatin is a carbapenem antibiotic used to treat severe bacterial infections by inhibiting cell‑wall synthesis.

• Complicated intra‑abdominal infections: provides broad‑spectrum coverage to eradicate Gram‑negative, Gram‑positive and anaerobic pathogens.
• Complicated urinary tract infections: eliminates resistant Enterobacteriaceae and other uropathogens.
• Skin and soft tissue infections: treats mixed bacterial infections including MRSA‑susceptible strains.
• Nosocomial pneumonia: offers potent activity against hospital‑acquired respiratory pathogens.
• Septicemia: delivers rapid bactericidal effect in systemic bloodstream infections.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, leading to cell lysis. Cilastatin, co‑administered, inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby increasing its plasma concentration and renal excretion stability.

Adverse reactions may occur with any antimicrobial therapy and should be monitored.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Vomiting: occasional episodes after infusion.
• Rash: erythematous skin eruptions.
• Injection site phlebitis: pain or redness at IV site.
• Elevated liver enzymes: transient hepatic enzyme rise.

Serious or Rare Side Effects

• Seizures: risk increases with high doses or renal impairment.
• Anaphylaxis: severe allergic reaction requiring immediate intervention.
• Clostridioides difficile‑associated diarrhea: possible colitis.
• Thrombophlebitis: clot formation in veins.
• Renal toxicity: worsening kidney function in susceptible patients.

Careful assessment and monitoring are required before and during therapy.

• Renal function assessment: adjust dosing in patients with impaired renal clearance.
• History of seizures: monitor for neurotoxicity and consider alternative agents.
• β‑lactam allergy: evaluate risk of cross‑reactivity before initiating.
• Concurrent nephrotoxic drugs: use with caution to avoid additive kidney injury.
• Pregnancy and lactation: safety not established; weigh benefits against potential risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/Cilastatin may interact with several medications; monitoring is advised.

Major Interactions (Avoid)

• Valproic acid: carbapenems reduce serum valproate levels, increasing seizure risk.
• Nephrotoxic agents (e.g., aminoglycosides, vancomycin): may exacerbate renal impairment.
• CNS depressants: potential additive neurotoxic effects.

Moderate Interactions (Monitor Closely)

• Diuretics: monitor electrolytes and renal function.
• Warfarin: may alter INR, requiring coagulation monitoring.
• Oral contraceptives: possible reduction in efficacy, advise alternative contraception.