Imipenem/Cilastatina Aurovitas (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/cilastatin is used for a range of severe bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides rapid bacterial eradication to resolve intra‑abdominal sepsis.
• Complicated urinary tract infections: offers effective clearance of resistant uropathogens in the urinary tract.
• Skin and soft‑tissue infections: eliminates causative bacteria to promote healing of deep tissue infections.
• Community‑acquired and hospital‑acquired pneumonia: delivers broad‑spectrum activity to treat pulmonary infections.
• Meningitis: penetrates the cerebrospinal fluid to treat bacterial meningitis.
• Febrile neutropenia: offers empiric coverage for neutropenic patients at risk of bloodstream infection.

• Imipenem binds to bacterial penicillin‑binding proteins, inhibiting the transpeptidation step of cell‑wall synthesis and leading to bacterial lysis. Cilastatin, a renal dehydropeptidase I inhibitor, prevents enzymatic degradation of imipenem in the kidneys, thereby maintaining therapeutic concentrations and extending the antibiotic’s activity. This combined action results in a time‑dependent bactericidal effect against a wide spectrum of Gram‑positive, Gram‑negative and anaerobic organisms, including many multidrug‑resistant strains.

Like all antibiotics, Imipenem/cilastatin may cause adverse reactions, ranging from mild to severe.

Common Side Effects

• Nausea
• Diarrhea
• Rash

Serious or Rare Side Effects

• Seizures, particularly in patients with renal dysfunction or CNS disease
• Anaphylactic reactions
• Clostridioides difficile‑associated colitis

Careful assessment and monitoring are required when using Imipenem/cilastatin.

• Renal function assessment: evaluate creatinine clearance and adjust dose in renal impairment.
• Seizure risk: monitor patients with a history of seizures or CNS disorders.
• Allergy history: avoid in individuals with known hypersensitivity to carbapenems or β‑lactams.
• Pregnancy and lactation: use only when the potential benefit justifies the potential risk to the fetus or infant.
• Concomitant medications: review for drugs that may lower seizure threshold or affect renal clearance.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Valproic acid: co‑administration can markedly reduce valproate levels, risking seizure breakthrough.
• Probenecid: may increase imipenem concentrations and heighten nephrotoxicity.
• Other carbapenems: concurrent use can lead to additive toxicity without therapeutic benefit.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance renal clearance of imipenem, requiring dose consideration.
• Aminoglycosides: combined nephrotoxic potential warrants renal function monitoring.
• NSAIDs: can affect renal perfusion and increase risk of renal impairment.