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

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

• Complicated intra‑abdominal infections: provides bacterial eradication in patients with severe abdominal sepsis.
• Complicated urinary tract infections: eliminates resistant uropathogens in hospitalized individuals.
• Lower respiratory tract infections (pneumonia): treats severe community‑acquired or hospital‑acquired pneumonia.
• Skin and soft tissue infections: resolves deep or necrotizing infections caused by Gram‑negative and Gram‑positive organisms.
• Febrile neutropenia: offers empiric coverage for high‑risk neutropenic patients with fever.

• Imipenem binds to penicillin‑binding proteins, inhibiting the synthesis of bacterial cell wall peptidoglycan and leading to cell lysis. Cilastatin, co‑administered, blocks renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby maintaining therapeutic concentrations in the urine and plasma.

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.
• 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: acute hypersensitivity reaction requiring immediate treatment.
• Clostridioides difficile infection: severe colitis risk.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: rare severe skin reactions.
• Severe neutropenia or thrombocytopenia: hematologic suppression.
• Acute renal failure: worsening kidney function in susceptible individuals.

Careful assessment and monitoring are required before and during therapy.

• Renal function: adjust dosage in patients with impaired kidney function.
• Allergy: avoid in individuals with known hypersensitivity to carbapenems or β‑lactam antibiotics.
• Seizure risk: monitor patients with a history of epilepsy or CNS disorders.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk to the fetus or infant.
• Concomitant nephrotoxic drugs: increase monitoring of renal parameters.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/Cilastatin may interact with several medicines; some require avoidance while others need close monitoring.

Major Interactions (Avoid)

• Valproic acid: may reduce serum valproate levels, risking loss of seizure control.
• Cisplatin: combined use can increase nephrotoxicity.
• Other carbapenems: additive toxicity and overlapping spectrum.

Moderate Interactions (Monitor Closely)

• Probenecid: can raise imipenem concentrations, requiring dose adjustment.
• Loop diuretics: may potentiate renal adverse effects.
• Warfarin: may alter INR, necessitating coagulation monitoring.