Imipenem/Cilastatin Steriscience (Cilastatin, Imipenem)

Imipenem/cilastatin is a carbapenem antibiotic used to treat serious infections caused by susceptible bacteria.

• Complicated intra‑abdominal infections: provides rapid bacterial clearance and supports clinical recovery.
• Complicated urinary tract infections: eradicates pathogens and reduces risk of progression.
• Hospital‑acquired pneumonia: effective against resistant organisms in ventilated patients.
• Ventilator‑associated pneumonia: improves outcomes in intensive‑care settings.
• Severe sepsis and septic shock: contributes to hemodynamic stabilization by controlling infection.
• Skin and soft tissue infections: treats deep‑seated infections caused by Gram‑negative and Gram‑positive bacteria.

• Imipenem binds to penicillin‑binding proteins, inhibiting the synthesis of bacterial cell walls and leading to cell lysis. Cilastatin, co‑administered, blocks renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby extending its plasma concentration and antibacterial activity.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Vomiting: occasional emesis after infusion.
• Rash: erythematous skin reactions.
• Headache: transient headache during therapy.
• Elevated liver enzymes: mild transaminase increases.

Serious or Rare Side Effects

• Seizures: risk increased in patients with CNS disorders or renal impairment.
• Anaphylaxis: severe hypersensitivity reaction requiring immediate medical attention.
• Clostridioides difficile infection: possible colitis due to alteration of gut flora.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: rare severe skin reactions.
• Renal toxicity: acute kidney injury in susceptible individuals.
• Neutropenia: marked reduction in neutrophil count.

Imipenem/cilastatin requires careful patient assessment before use.

• Renal function: adjust dosing in patients with impaired renal function to avoid accumulation.
• Seizure risk: monitor patients with a history of seizures or central nervous system disorders.
• Allergy: avoid in individuals with known hypersensitivity to carbapenems or β‑lactam antibiotics.
• Pregnancy: use only if the potential benefit justifies the potential risk to the fetus.
• Drug interactions: review concomitant medications for possible interactions that may affect safety or efficacy.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/cilastatin may interact with several medications.

Major Interactions (Avoid)

• Valproic acid: may reduce serum valproate levels, increasing seizure risk.
• Cisplatin: combined use can exacerbate nephrotoxicity.
• Other nephrotoxic agents: heightened risk of renal impairment.
• Probenecid: can increase imipenem concentrations, raising toxicity potential.
• Ineffective against carbapenem‑resistant organisms: avoid use when resistance is documented.

Moderate Interactions (Monitor Closely)

• Loop diuretics: monitor renal function and electrolytes.
• Aminoglycosides: watch for additive nephrotoxic effects.
• Warfarin: periodic INR monitoring is advised.