Imipenem/Cilastatine Acs Dobfar (Cilastatin, Imipenem Anhydrate)

Imipenem/Cilastatin is a broad‑spectrum carbapenem used to treat infections caused by susceptible bacteria.

• Complicated intra‑abdominal infections: eradicates mixed‑flora pathogens and improves clinical outcomes.
• Complicated urinary tract infections: clears resistant Gram‑negative organisms in the urinary system.
• Complicated skin and soft‑tissue infections: resolves deep‑seated infections caused by resistant bacteria.
• Hospital‑acquired bacterial pneumonia: provides coverage for multidrug‑resistant respiratory pathogens.
• Septicemia: rapidly reduces bacterial load in bloodstream infections.

• Imipenem binds to penicillin‑binding proteins, inhibiting the synthesis of bacterial cell walls and leading to cell lysis. Cilastatin co‑administered inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby extending its antibacterial activity in the body.

Adverse reactions may occur with any antimicrobial therapy.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Rash: erythematous skin eruption.
• Elevated liver enzymes: transient increase in hepatic transaminases.
• Injection site reactions: pain, erythema, or swelling.
• Headache: occasional mild headache.

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 severe diarrhea.
• Severe neutropenia: marked reduction in neutrophil count.
• Thrombocytopenia: low platelet levels leading to bleeding risk.
• Acute renal failure: sudden loss of kidney function.

Use Imipenem/Cilastatin with caution in specific clinical situations.

• Renal function: assess creatinine clearance before initiating therapy.
• Allergy: avoid in patients with known hypersensitivity to carbapenems or β‑lactams.
• Seizure risk: monitor patients with a history of CNS disorders.
• Drug interactions: review concomitant use of valproic acid and other interacting agents.
• Pregnancy: prescribe only when the potential benefit justifies the potential risk to the fetus.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Valproic acid: reduces serum levels of valproate, risking seizure breakthrough.
• Ganciclovir: decreased antiviral activity when co‑administered.
• Probenecid: may increase imipenem concentrations, heightening toxicity risk.

Moderate Interactions (Monitor Closely)

• Loop diuretics: additive nephrotoxic potential; monitor renal function.
• Aminoglycosides: increased risk of nephrotoxicity and ototoxicity; assess dosing and renal parameters.