Imipenem/Cliastatin Fresenius Kabi (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/cilastatin is a broad‑spectrum carbapenem used for infections that involve the bacterial cell wall and require intravenous therapy.

• Complicated intra‑abdominal infections: achieves clinical cure and microbiological eradication.
• Complicated urinary tract infections: resolves infection and prevents recurrence.
• Skin and soft tissue infections: eliminates pathogenic bacteria and promotes healing.
• Febrile neutropenia: provides rapid bacterial coverage in immunocompromised patients.
• Community‑acquired pneumonia: treats severe pulmonary infection caused by susceptible organisms.
• Hospital‑acquired pneumonia: effective against resistant nosocomial pathogens.

• 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.

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

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Vomiting: occasional emesis during treatment.
• Diarrhea: may be self‑limiting or indicate colitis.
• Headache: transient cranial discomfort.
• Rash: erythematous skin eruption.
• Elevated liver enzymes: transient hepatic enzyme rise.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or high doses.
• Anaphylaxis: acute hypersensitivity requiring immediate intervention.
• Clostridioides difficile infection: severe colitis risk.
• Severe neutropenia: marked reduction in white blood cells.
• Renal toxicity: worsening kidney function in susceptible individuals.

Imipenem/cilastatin requires careful assessment before use to minimise risks.

• Renal function: adjust dose in patients with impaired clearance.
• History of seizures: avoid or monitor closely due to neurotoxicity potential.
• Hypersensitivity: discontinue if allergic reactions develop.
• Concomitant valproic acid: monitor for reduced seizure control.
• Pregnancy and lactation: use only if benefits outweigh potential risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Drug interactions can affect efficacy or safety and should be evaluated.

Major Interactions (Avoid)

• Valproic acid: reduces serum levels of valproate, risking breakthrough seizures.
• Other carbapenems: concurrent use may increase toxicity without added benefit.
• High‑dose sodium bicarbonate: may alter renal excretion of imipenem.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance nephrotoxic potential.
• Aminoglycosides: combined nephrotoxicity risk.
• NSAIDs: may affect renal function.
• Warfarin: monitor INR for possible anticoagulant effect changes.
• Oral contraceptives: possible reduction in efficacy, advise backup method.