Imipenem + Cilastatina Venus Pharma (Cilastatin, Imipenem Anhydrate)

Imipenem/cilastatin is used to treat serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides bactericidal activity to resolve infection and reduce intra‑abdominal sepsis.
• Complicated urinary tract infections: eradicates susceptible uropathogens, improving clinical cure rates.
• Complicated skin and soft‑tissue infections: eliminates resistant Gram‑negative and Gram‑positive organisms, facilitating wound healing.
• Community‑acquired and hospital‑acquired bacterial pneumonia: achieves rapid bacterial clearance and improves respiratory function.
• Febrile neutropenia: offers broad‑spectrum coverage to control infection in immunocompromised patients.

• 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 maintaining therapeutic plasma concentrations. This synergy allows the drug to retain activity even against organisms that produce certain β‑lactamases.

Adverse reactions to imipenem/cilastatin may vary in frequency and severity.

Common Side Effects

• Nausea: mild gastrointestinal upset occurring in many patients.
• Diarrhea: loose stools that may be self‑limiting.
• Rash: skin erythema or mild pruritus.
• Elevated liver enzymes: transient increase in ALT/AST.

Serious or Rare Side Effects

• Seizures: central nervous system excitation, particularly in patients with renal impairment.
• Anaphylaxis: severe, potentially life‑threatening allergic reaction.
• Clostridioides difficile colitis: antibiotic‑associated severe diarrhea.

Clinicians should consider several precautions when prescribing imipenem/cilastatin.

• Renal function: adjust dose in patients with impaired kidney function to avoid accumulation.
• Seizure risk: monitor patients with a history of CNS disorders or those receiving high doses.
• Hypersensitivity: avoid use in individuals with known allergy to β‑lactam antibiotics.
• Concomitant valproic acid: anticipate reduced serum levels of valproate, which may require monitoring.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk, as safety data are limited.
• Store at 2‑8 °C: keep refrigerated, protect from light, do not freeze or shake the solution.

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

Major Interactions (Avoid)

• Valproic acid: co‑administration can markedly reduce valproate concentrations, risking loss of seizure control.
• Carbapenem‑inducing agents (e.g., rifampin): may increase hepatic metabolism, lowering imipenem levels.
• Probenecid: can raise imipenem plasma concentrations, increasing toxicity risk.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may enhance nephrotoxic potential; monitor renal function.
• Anticoagulants (e.g., warfarin): possible alteration of INR; check coagulation parameters.
• CNS depressants: additive central nervous system effects; observe for increased sedation or seizures.