Imipenem/Cilastatin Teva (Cilastatin Sodium, Imipenem Monohydrate)

• Imipenem/cilastatin is a carbapenem antibiotic used to treat serious bacterial infections affecting various organ systems.
• Complicated intra‑abdominal infections: achieves bacterial eradication and clinical cure in patients with mixed‑flora intra‑abdominal infections.
• Complicated urinary tract infections: provides rapid bacterial clearance and symptom resolution in complicated UTIs.
• Complicated skin and soft tissue infections: eliminates pathogenic bacteria and promotes healing of severe skin infections.
• Community‑acquired pneumonia: delivers broad‑spectrum coverage for typical and atypical pneumonia pathogens.
• Hospital‑acquired pneumonia: offers effective treatment against resistant organisms in nosocomial pneumonia.
• Septicemia: rapidly reduces bloodstream bacterial load and improves survival in systemic infections.

• 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 prolonging its antibacterial activity in the body.

Adverse reactions may range from mild to severe and should be monitored during therapy.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Vomiting: occasional emesis following infusion.
• Diarrhea: loose stools, often self‑limiting.
• Rash: erythematous skin eruption.
• Injection site phlebitis: pain or inflammation at the infusion site.
• Elevated liver enzymes: transient increase in hepatic transaminases.

Serious or Rare Side Effects

• Seizures: risk increases with high doses or renal impairment.
• Anaphylaxis: severe, potentially life‑threatening allergic reaction.
• Clostridioides difficile‑associated diarrhea: colitis due to disruption of normal flora.
• Neutropenia: marked reduction in neutrophil count.
• Thrombocytopenia: low platelet levels leading to bleeding risk.
• Renal toxicity: acute kidney injury in susceptible patients.

Careful assessment and monitoring are required to minimize risks associated with imipenem/cilastatin therapy.

• Assess renal function: adjust dosing in patients with impaired kidney function.
• Monitor for seizures: especially in patients with CNS disorders or high serum concentrations.
• Evaluate hypersensitivity: discontinue if signs of severe allergic reaction appear.
• Use caution in CNS disease: patients with a history of seizures may need alternative therapy.
• Adjust dose in renal impairment: follow renal dosing guidelines to avoid accumulation.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/cilastatin may interact with other medicines, requiring vigilance.

Major Interactions (Avoid)

• Valproic acid: concomitant use can lower valproate levels and precipitate seizures.
• Other carbapenems: concurrent use may increase toxicity without added benefit.
• Nephrotoxic agents (e.g., aminoglycosides): combined use can exacerbate renal impairment.

Moderate Interactions (Monitor Closely)

• Loop diuretics: monitor renal function and electrolytes.
• NSAIDs: watch for additive renal effects.
• Warfarin: observe INR for potential anticoagulation changes.
• Oral contraceptives: efficacy may be reduced; consider alternative contraception.
• Antacids containing magnesium or aluminum: although given IV, monitor for any unexpected electrolyte shifts.