Imipenem/Cilastatina Hikma (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatin is a broad‑spectrum carbapenem used for serious bacterial infections in the following settings:

• Complicated intra‑abdominal infections: effective bacterial eradication in patients with intra‑abdominal sepsis.
• Complicated urinary tract infections: clears resistant uropathogens causing pyelonephritis and cystitis.
• Complicated skin and soft‑tissue infections: treats deep tissue infections caused by multidrug‑resistant organisms.
• Lower respiratory tract infections (community‑acquired and hospital‑acquired): resolves pneumonia caused by Gram‑negative and Gram‑positive bacteria.
• Febrile neutropenia: provides empiric coverage for high‑risk neutropenic patients.

• Imipenem binds to multiple 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.

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: severe allergic reaction requiring immediate medical attention.
• Clostridioides difficile colitis: antibiotic‑associated diarrhea.
• Stevens‑Johnson syndrome: rare mucocutaneous necrolysis.
• Severe neutropenia: marked reduction in white blood cells.
• Acute renal failure: abrupt loss of kidney function.

Before initiating therapy, consider the following precautions:

• Renal function assessment: adjust dose in patients with impaired kidney function.
• Allergy history: avoid in individuals with known carbapenem or beta‑lactam hypersensitivity.
• Seizure risk: monitor patients with a history of epilepsy or CNS disorders.
• Concomitant valproic acid: avoid due to reduced plasma levels and loss of seizure control.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk to the fetus or infant.
• Store at below 25°C: keep in the original container, protect from moisture and light.

Imipenem/Cilastatin may interact with several drugs:

Major Interactions (Avoid)

• Valproic acid: reduces valproate levels, increasing seizure risk.
• Renal dehydropeptidase inhibitors: may increase imipenem toxicity.
• Penicillins or other beta‑lactams: cross‑reactivity can trigger allergic reactions.
• Probenecid: can raise imipenem plasma concentrations.
• Monoamine oxidase inhibitors: not recommended due to unknown interaction risk.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance nephrotoxic potential.
• CNS depressants: additive risk of seizures.
• Anticoagulants (warfarin): monitor INR as imipenem may affect coagulation parameters.