Imipenem/Cilastatina Kabi (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatin is a carbapenem antibiotic used to treat severe bacterial infections across several organ systems.

• Complicated intra‑abdominal infections: achieves bacterial eradication in the peritoneal cavity and reduces infection‑related mortality.
• Complicated urinary tract infections: provides rapid bacterial clearance and improves clinical cure rates.
• Nosocomial pneumonia: delivers broad‑spectrum coverage against resistant Gram‑negative and Gram‑positive pathogens.

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

Adverse reactions may occur with any antimicrobial therapy and should be monitored.

Common Side Effects

• Nausea: mild gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Headache: transient and usually resolves.
• Infusion site reactions: erythema or phlebitis at the injection site.

Serious or Rare Side Effects

• Seizures: especially in patients with pre‑existing CNS disorders or renal impairment.
• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Clostridioides difficile‑associated diarrhea: can be life‑threatening.
• Renal impairment: acute kidney injury in susceptible individuals.

Careful assessment and monitoring are required before and during therapy.

• Renal function: adjust dose in patients with impaired renal function.
• Seizure risk: monitor patients with a history of seizures or CNS disorders.
• Allergy: avoid in individuals with known hypersensitivity to β‑lactam antibiotics.
• Pregnancy: use only if the potential benefit justifies the potential risk to the fetus.
• Drug interactions: review concomitant medications that may lower the seizure threshold.
• 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: may reduce plasma valproate levels, increasing seizure risk.
• Ganciclovir: carbapenems can diminish antiviral efficacy.
• CNS stimulants: additive risk of seizures.

Moderate Interactions (Monitor Closely)

• Diuretics: may heighten nephrotoxicity.
• Probenecid: can increase imipenem plasma concentrations.
• Other β‑lactam antibiotics: potential for additive toxicity.