Imipenem/Cilastatina Kabi (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatina Kabi is a broad‑spectrum carbapenem used to treat serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides bacterial eradication in severe abdominal sepsis.
• Complicated urinary tract infections: eliminates resistant uropathogens causing kidney and bladder infections.
• Skin and soft tissue infections: combats deep‑seated cellulitis and necrotizing infections.
• Hospital‑acquired pneumonia: treats ventilator‑associated and other nosocomial lung infections.
• Septicemia: offers rapid bactericidal activity in bloodstream infections.

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

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

Common Side Effects

• Nausea
• Diarrhea
• Headache
• Rash
• Elevated liver enzymes
• Injection site pain

Serious or Rare Side Effects

• Seizures, especially in patients with CNS disorders
• Anaphylactic or severe hypersensitivity reactions
• Clostridioides difficile‑associated colitis
• Renal toxicity or impaired renal function
• Severe thrombocytopenia or neutropenia
• Hepatotoxicity with jaundice

Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor for potential complications.

• Renal function assessment: adjust therapy based on creatinine clearance.
• Seizure risk: avoid in patients with a history of epilepsy or CNS disorders.
• Hypersensitivity evaluation: discontinue if signs of severe allergic reaction appear.
• Concomitant nephrotoxic drugs: use with caution when combined with other renal‑impacting agents.
• Dose adjustment in renal impairment: follow renal dosing guidelines.
• Store at below 25°C: keep in the original packaging, protect from moisture and light.

Imipenem/cilastatin may interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: carbapenems can reduce serum valproate levels, risking seizure breakthrough.
• Concurrent nephrotoxic agents (e.g., aminoglycosides, amphotericin B): increase risk of renal impairment.
• Probenecid: may decrease renal clearance of imipenem, raising plasma concentrations.

Moderate Interactions (Monitor Closely)

• Diuretics: monitor electrolytes and renal function.
• Anticoagulants (warfarin): observe INR for potential changes.
• Other antibiotics: assess for additive toxicity, especially neurotoxicity.