Imipenem Cilastatine Viatris (Cilastatin, Imipenem)

• Imipenem/cilastatin is employed for serious bacterial infections across several organ systems.
• Complicated intra‑abdominal infections: eradicates mixed aerobic and anaerobic pathogens to resolve infection.
• Complicated urinary tract infections: eliminates resistant uropathogens and restores urinary sterility.
• Complicated skin and soft‑tissue infections: provides rapid bacterial clearance in deep tissue involvement.
• Hospital‑acquired or community‑acquired bacterial pneumonia: treats severe pulmonary infections caused by resistant organisms.
• Febrile neutropenia: offers broad coverage for high‑risk immunocompromised patients.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, which leads to cell lysis. Cilastatin concurrently inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby extending its plasma concentration and antibacterial activity.

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.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or CNS disorders.
• Anaphylaxis: acute hypersensitivity reaction requiring immediate medical attention.
• Clostridioides difficile‑associated colitis: severe diarrhea due to gut flora disruption.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Thrombocytopenia: marked reduction in platelet count.

• Use imipenem/cilastatin with careful clinical monitoring.
• Renal function: adjust dosing in patients with impaired renal clearance.
• Seizure risk: avoid or monitor in individuals with a history of seizures or CNS disease.
• Allergy: do not administer to patients with known hypersensitivity to carbapenems.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk.
• Drug interactions: review concomitant medications for possible interactions.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/cilastatin may interact with several co‑administered drugs.

Major Interactions (Avoid)

• Valproic acid: concomitant use can lower valproate levels and precipitate seizures.
• Ganciclovir: carbapenems may reduce antiviral efficacy.
• Other nephrotoxic agents: increased risk of renal injury.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance electrolyte disturbances.
• Aminoglycosides: monitor renal function and drug levels.
• NSAIDs: increased risk of nephrotoxicity.
• Probenecid: may alter renal excretion of imipenem.