Imipenem/Cilastatin Fresenius Kabi (Cilastatin Sodium, Imipenem Monohydrate)

• Imipenem/Cilastatin is a broad‑spectrum carbapenem used for severe bacterial infections across several organ systems.
• Complicated intra‑abdominal infection: provides rapid bacterial eradication to resolve intra‑abdominal sepsis.
• Complicated urinary tract infection: eliminates resistant uropathogens causing pyelonephritis and cystitis.
• Complicated skin and soft tissue infection: treats deep tissue infections where Gram‑negative and anaerobic coverage is needed.
• Hospital‑acquired and ventilator‑associated pneumonia: offers coverage against multidrug‑resistant respiratory pathogens.
• Severe sepsis and septic shock: delivers timely bactericidal activity to improve outcomes in systemic infection.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages 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 plasma half‑life and antibacterial activity.

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.
• Headache: transient and usually resolves without intervention.
• Infusion site phlebitis: local irritation at the IV site.
• Elevated liver enzymes: transient increase in transaminases.

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 colitis presenting with profuse diarrhea.
• Neutropenia or thrombocytopenia: significant drops in blood cell counts.
• Renal toxicity: worsening kidney function in susceptible individuals.

• Careful assessment and monitoring are required before and during therapy.
• Renal function: adjust dose in patients with impaired kidney function.
• Seizure risk: monitor patients with a history of seizures or CNS disorders.
• Allergy: avoid in individuals with known hypersensitivity to carbapenems.
• Drug interactions: review concomitant medications that may lower seizure threshold.
• Pregnancy and lactation: use only when the potential benefit justifies the potential risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Imipenem/Cilastatin may interact with several agents; awareness helps prevent adverse outcomes.

Major Interactions (Avoid)

• Valproic acid: may reduce imipenem plasma concentrations, compromising efficacy.
• Cisplatin: concurrent use can increase nephrotoxicity.
• Other carbapenems: redundant therapy may increase toxicity without added benefit.

Moderate Interactions (Monitor Closely)

• Loop diuretics: may exacerbate renal impairment.
• Phenobarbital: may lower seizure threshold when combined.
• Other nephrotoxic drugs (e.g., aminoglycosides): monitor renal function closely.