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: achieves clinical cure and microbiological eradication.
• Complicated urinary tract infections: resolves infection and prevents recurrence.
• Skin and soft‑tissue infections: promotes rapid healing and bacterial clearance.
• Nosocomial pneumonia: improves respiratory function and reduces pathogen load.
• Febrile neutropenia: provides broad‑spectrum coverage to control infection in immunocompromised patients.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final steps of bacterial cell‑wall peptidoglycan synthesis, which leads to cell lysis. Cilastatin, co‑administered, blocks renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby extending 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.
• Vomiting: occasional episodes during infusion.
• Headache: transient and usually resolves.
• Rash: mild erythematous skin eruption.
• Elevated liver enzymes: transient increase in hepatic transaminases.

Serious or Rare Side Effects

• Seizures: especially in patients with CNS disorders or renal impairment.
• Anaphylaxis: acute, potentially life‑threatening hypersensitivity.
• Clostridioides difficile infection: severe colitis risk.
• Severe neutropenia: marked reduction in white blood cells.
• Renal dysfunction: acute kidney injury in susceptible individuals.
• Stevens‑Johnson syndrome: rare severe skin reaction.

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

• Renal function assessment: evaluate creatinine clearance before initiation.
• Seizure risk monitoring: observe patients with a history of CNS disease.
• Hypersensitivity evaluation: screen for known allergies to beta‑lactams.
• Caution in CNS disorders: adjust therapy in patients with epilepsy or brain injury.
• Dose adjustment in renal impairment: modify dosing according to renal function.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/Cilastatin may interact with several concomitant medications.

Major Interactions (Avoid)

• Valproic acid: increased risk of seizures.
• Ganciclovir: reduced antiviral efficacy.
• Probenecid: heightened nephrotoxicity.
• Other nephrotoxic agents (e.g., aminoglycosides): additive renal damage.
• Diuretics: may exacerbate renal clearance changes.

Moderate Interactions (Monitor Closely)

• Warfarin: potential alteration of INR.
• Oral contraceptives: reduced hormonal effectiveness.
• Other antibiotics (e.g., linezolid): possible antagonistic effects.
• Antacids: may affect infusion site irritation.
• Immunosuppressants: monitor for increased infection risk.