Imipenem E Cilastatina Aurobindo (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/cilastatin is a broad‑spectrum carbapenem used for serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides rapid bacterial eradication and clinical improvement.
• Complicated urinary tract infections: eliminates resistant uropathogens and resolves infection.
• Lower respiratory tract infections: treats severe pneumonia caused by Gram‑negative and Gram‑positive organisms.
• Skin and soft tissue infections: clears deep tissue infections and necrotizing fasciitis.
• Septicemia: offers bactericidal activity in bloodstream infections.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, leading to cell lysis. Cilastatin, co‑administered, blocks renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby maintaining therapeutic plasma concentrations.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Headache: transient and usually resolves without intervention.
• Rash: erythematous skin eruption.
• Elevated liver enzymes: mild transaminase increase.
• Injection site pain: discomfort at the infusion site.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or high doses.
• Anaphylaxis: acute, potentially life‑threatening hypersensitivity.
• Clostridioides difficile colitis: severe diarrhea due to gut flora disruption.
• Renal impairment: acute kidney injury in susceptible individuals.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Thrombocytopenia: marked reduction in platelet count.

Careful assessment and monitoring are required before and during therapy.

• Renal function: adjust dose in patients with reduced creatinine clearance.
• Hepatic function: monitor liver enzymes in patients with pre‑existing liver disease.
• Hypersensitivity: avoid in individuals with known allergy to carbapenems or β‑lactams.
• Pregnancy: use only if benefits outweigh potential risks, as data are limited.
• Concomitant valproic acid: monitor seizure control, as imipenem may lower valproate levels.
• Storage at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/cilastatin can alter or be altered by other medicines.

Major Interactions (Avoid)

• Valproic acid: reduces serum valproate concentrations, increasing seizure risk.
• Probenecid: decreases renal clearance of imipenem, raising plasma levels.
• Renal dehydropeptidase inhibitors: may increase imipenem toxicity.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): may enhance nephrotoxic potential.
• Aminoglycosides: combined nephrotoxicity requires renal function monitoring.
• Oral contraceptives: possible reduction in efficacy, advise additional contraceptive measures.