01.07.

2019 Imipenem and cilastatin: Drug information - UpToDate

Official reprint from UpToDate®

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Imipenem and cilastatin: Drug information

Copyright 1978-2019 Lexicomp, Inc. All rights reserved.

(For additional information see "Imipenem and cilastatin: Patient drug information" and see "Imipenem and cilastatin:
Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)

Special Alerts
Beta-Lactam Antibiotics Safety Alert September 2018

Health Canada has reviewed the risk of severe cutaneous adverse reactions (SCAR) with beta-
lactam antibiotics and concluded that there is a link between the use of beta-lactam antibiotics and
the risk of SCAR. Health Canada will be working with manufacturers to update the product safety
information of beta-lactam antibiotics (that do not already include SCAR) to inform health care
providers and patients about this potential risk.

More information is available at https://hpr-rps.hres.ca/reg-content/summary-safety-review-

detail.php?lang=en&linkID=SSR00209.

Brand Names: US
Primaxin I.V.

Brand Names: Canada

Imipenem and Cilastatin for Injection; Imipenem and Cilastatin for Injection, USP; Primaxin; RAN-
Imipenem-Cilastatin

Pharmacologic Category
Antibiotic, Carbapenem

Dosing: Adult
Doses based on imipenem content.

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Usual dosage range: IV:

Susceptible bacterial species: 500 mg every 6 hours or 1,000 mg every 8 hours

(maximum dose: 4,000 mg/day)

Intermediate susceptibility bacterial species: 1,000 mg every 6 hours (maximum dose:

4,000 mg/day)

Indication-specific dosing:

Burkholderia pseudomallei (melioidosis) (off-label use): IV: Initial: 20 mg/kg every 8

hours for at least 10 days (White 2003) or 25 mg/kg (up to 1 g) every 6 hours for at least 10
days (Currie 2003); continue parenteral therapy until clinical improvement then switch to oral
therapy if tolerated and/or appropriate. Additional data may be necessary to further define
the role of imipenem/cilastatin in this condition.

Intra-abdominal infections, complicated: IV: 500 mg every 6 hours or 1 g every 8 hours

for 4 to 7 days (provided source controlled). Note: Not recommended for mild to moderate,
community-acquired intra-abdominal infections due to risk of toxicity and the development of
resistant organisms (Solomkin 2010).

Neutropenic fever (off-label use): IV: 500 mg every 6 hours (Paul 2006)

Nontuberculous mycobacterial disease (off-label use): IV: M. abscessus skin, soft

tissue, or bone infections: 500 mg every 6 to 12 hours; use in combination with other
antibacterial agents (ATS/IDSA [Griffith 2007]).

Pneumonia, hospital acquired or ventilator-associated (off-label dose): IV: 500 mg

every 6 hours for 7 days; may consider shorter or longer duration depending on rate of
clinical improvement. When used as empiric therapy, use in combination with an agent
active against MRSA (unless coverage of MSSA only is appropriate) with or without an
additional antipseudomonal agent (dependent on patient and institution-specific risk factors).
Note: May need to decrease dose in patients weighing less than 70 kg to prevent seizures
(Kalil 2016).

Skin and soft tissue necrotizing infections (off-label use): IV: 1 g every 6 to 8 hours in
combination with an agent effective against MRSA (eg, vancomycin, linezolid, daptomycin)
for empiric therapy of polymicrobial [mixed] infections. Continue until further debridement is
not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours
(IDSA [Stevens 2014]).

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Surgical-site infection (intestinal or genitourinary tract surgery) (off-label use): IV: 500
mg every 6 hours (IDSA [Stevens 2014]).

Urinary tract infection, complicated (including pyelonephritis): IV: 500 mg every 6

hours for 10 to 14 days; when used for empiric therapy, use alone or in combination with
other appropriate agents. Note: Reserved for critically ill patients or patients with risk
factor(s) for multidrug-resistant (MDR) pathogens, including extended-spectrum beta-
lactamase (ESBL)–producing organisms (Hooton 2018).

Dosing: Renal Impairment: Adult

US labeling (estimation of renal function for the purpose of dosing adjustment should be done
using the Cockcroft-Gault formula):

Usual dosing regimen of 500 mg every 6 hours:

CrCl ≥90 mL/minute: No dosage adjustment necessary.

CrCl ≥60 to <90 mL/minute: 400 mg every 6 hours

CrCl ≥30 to <60 mL/minute: 300 mg every 6 hours

CrCl ≥15 to <30 mL/minute: 200 mg every 6 hours

CrCl <15 mL/minute: Do not administer imipenem and cilastatin unless hemodialysis is
instituted within 48 hours.

Usual dosing regimen of 1,000 mg every 8 hours:

CrCl ≥90 mL/minute: No dosage adjustment necessary.

CrCl ≥60 to <90 mL/minute: 500 mg every 6 hours

CrCl ≥30 to <60 mL/minute: 500 mg every 8 hours

CrCl ≥15 to <30 mL/minute: 500 mg every 12 hours

CrCl <15 mL/minute: Do not administer imipenem and cilastatin unless hemodialysis is
instituted within 48 hours.

Usual dosing regimen of 1,000 mg every 6 hours:

CrCl ≥90 mL/minute: No dosage adjustment necessary.

CrCl ≥60 to <90 mL/minute: 750 mg every 8 hours

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CrCl ≥30 to <60 mL/minute: 500 mg every 6 hours

CrCl ≥15 to <30 mL/minute: 500 mg every 12 hours

CrCl <15 mL/minute: Do not administer imipenem and cilastatin unless hemodialysis is
instituted within 48 hours.

Canadian labeling: Reduced IV dosage regimen based on creatinine clearance (mL/minute/1.73

m2) and body weight ≥70 kg (Note: The manufacturer labeling recommends further proportionate
dose reductions for patients <70 kg, but does not provide specific dosing recommendations):

Mild renal impairment (CrCl 31 to 70 mL/minute/1.73 m2):

Fully susceptible organisms: Maximum dosage: 500 mg every 8 hours

Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage:

500 mg every 6 hours

Moderate renal impairment (CrCl 21 to 30 mL/minute/1.73 m2):

Fully susceptible organisms: Maximum dosage: 500 mg every 12 hours

Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage:

500 mg every 8 hours

Severe renal impairment (CrCl 0 to 20 mL/minute/1.73 m2):

Fully susceptible organisms: Maximum dosage: 250 mg every 12 hours

Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage:

500 mg every 12 hours

Note: Patients with CrCl 6 to 20 mL/minute/1.73 m2 should receive 250 mg every 12 hours
or 3.5 mg/kg (whichever is lower) every 12 hours for most pathogens; seizure risk may
increase with higher dosing.

End-stage renal disease (ESRD) on intermittent hemodialysis (IHD): Use the dosing
recommendation (for US labeling) for patients with a CrCl ≥15 to <30 mL/minute; administer dose
after dialysis session and at intervals timed from the end of that dialysis session or 250 to 500
mg every 12 hours (Heintz 2009). Note: Dosing dependent on the assumption of 3 times/week,
complete IHD sessions.

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Continuous renal replacement therapy (CRRT) (Heintz 2009; Trotman 2005): Drug clearance is
highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate
dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to
drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The
following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2
L/hour and minimal residual renal function) and should not supersede clinical judgment:

CVVH: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 8
hours

CVVHD: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6 to
8 hours

CVVHDF: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6
hours

Note: Data suggest that 500 mg every 8 to 12 hours may provide sufficient time above MIC
to cover organisms with MIC values ≤2 mg/L; however, a higher dose of 500 mg every 6
hours is recommended for resistant organisms (particularly Pseudomonas spp) with MIC ≥4
mg/L or deep-seated infections (Fish 2005).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Imipenem and cilastatin: Pediatric drug information")
Note: Dosage recommendations are based on imipenem component.

General dosing, susceptible infection; severe infections (Red Book [AAP 2018]): Infants,
Children, and Adolescents: IV: 60 to 100 mg/kg/day divided every 6 hours; maximum daily dose:
4,000 mg/day

Burkholderia pseudomallei (melioidosis): Infants, Children, and Adolescents: IV: Initial: 60 to

100 mg/kg/day divided every 6 to 8 hours for at least 10 days; maximum daily dose: 4,000
mg/day; continue parenteral therapy until clinical improvement, then switch to oral therapy if
tolerated and/or appropriate (Currie 2003; White 2003)

Febrile neutropenia, empiric therapy: Limited data available: Children and Adolescents: IV: 60
mg/kg/day divided every 6 hours (Caselli 2012; Erbey 2009; Riikonen 1991); some centers use
doses as high as 100 mg/kg/day; maximum daily dose: 4,000 mg/day

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Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 60 to 100

mg/kg/day divided every 6 hours; maximum dose: 500 mg (Solomkin 2010)

Non-tuberculosis mycobacterium, cystic fibrosis: Infants, Children, and Adolescents: IV: 15

to 20 mg/kg/dose every 12 hours; maximum dose: 1,000 mg/dose (USCFF/ECFS [Floto 2016])

Peritonitis (peritoneal dialysis): Infants, Children, and Adolescents: Intraperitoneal:

Continuous: Loading dose: 250 mg per liter of dialysate; maintenance dose: 50 mg per liter
(ISPD [Warady 2012])

Pulmonary exacerbation, cystic fibrosis: Infants, Children, and Adolescents: IV: 100
mg/kg/day divided every 6 hours; maximum daily dose: 4,000 mg/day; efficacy may be limited
due to rapid development of resistance (Döring 2000; Zobell 2012)

Dosing: Renal Impairment: Pediatric

Infants, Children, and Adolescents: IV:

Manufacturer's labeling: Patient weight <30 kg and impaired renal function (not defined):
Use not recommended

The following adjustments have been recommended (Aronoff 2007): Note: Renally adjusted
dose recommendations are based on doses of 60 to 100 mg/kg/day divided every 6 hours.

GFR 30 to 50 mL/minute/1.73 m2: Administer 7 to 13 mg/kg/dose every 8 hours

GFR 10 to 29 mL/minute/1.73 m2: Administer 7.5 to 12.5 mg/kg/dose every 12 hours

GFR <10 mL/minute/1.73 m2: Administer 7.5 to 12.5 mg/kg/dose every 24 hours

Intermittent hemodialysis (IHD): Dialysis: Moderately dialyzable (20% to 50%): 7.5 to

12.5 mg/kg/dose every 24 hours (administer after hemodialysis on dialysis days)

Peritoneal dialysis (PD): 7.5 to 12.5 mg/kg/dose every 24 hours

Continuous renal replacement therapy (CRRT): 7 to 13 mg/kg/dose every 8 hours

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Geriatric
Refer to adult dosing.

Dosage Forms: US
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Excipient information presented when available (limited, particularly for generics); consult specific
product labeling.

Injection, powder for reconstitution: Imipenem 250 mg and cilastatin 250 mg; imipenem 500 mg
and cilastatin 500 mg

Primaxin® I.V.: Imipenem 250 mg and cilastatin 250 mg [contains sodium 18.8 mg (0.8
mEq)] [DSC]; imipenem 500 mg and cilastatin 500 mg [contains sodium 37.5 mg (1.6 mEq)]

Generic Equivalent Available: US

Yes

Administration: Adult
IV: For IV infusion only; do not administer IV push. Infuse doses ≤500 mg over 20 to 30 minutes;
infuse doses >500 mg over 40 to 60 minutes. If nausea and/or vomiting occur during administration,
decrease the rate of IV infusion.

Administration: Pediatric

IV: Administer by IV intermittent infusion; doses ≤500 mg may be infused over 20 to 30 minutes;
doses >500 mg should be infused over 40 to 60 minutes. If nausea and/or vomiting occur during
administration, decrease the rate of IV infusion.

Use: Labeled Indications

Bacterial septicemia: Treatment of septicemia caused by Enterococcus faecalis,

Staphylococcus aureus (penicillinase-producing), Escherichia coli, Klebsiella species,
Pseudomonas aeruginosa, Serratia species, Enterobacter species, Bacteroides species
(including Bacteroides fragilis).

Bone and joint infections: Treatment of bone and joint infections caused by E. faecalis, S.
aureus (penicillinase-producing), Staphylococcus epidermidis, Enterobacter species, P.
aeruginosa.

Endocarditis: Treatment of endocarditis caused by S. aureus (penicillinase-producing).

Gynecologic infections: Treatment of gynecologic infections caused by E. faecalis; S. aureus

(penicillinase-producing), S. epidermidis, Streptococcus agalactiae (group B streptococci), E.
coli, Klebsiella species, Proteus species, Enterobacter species, Bifidobacterium species,
Bacteroides species (including B. fragilis), Gardnerella vaginalis; Peptococcus species,
Peptostreptococcus species, Cutibacterium species.

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Intra-abdominal infections: Treatment of intra-abdominal infections caused by E. faecalis, S.

aureus (penicillinase-producing), S. epidermidis, E. coli, Klebsiella species, Enterobacter
species, Proteus species, Morganella morganii, P. aeruginosa, Citrobacter species, Clostridium
species, Bacteroides species (including B. fragilis), Fusobacterium species, Peptococcus
species, Peptostreptococcus species, Eubacterium species, Cutibacterium species,
Bifidobacterium species.

Lower respiratory tract infections: Treatment of lower respiratory tract infections caused by S.
aureus (penicillinase-producing), E. coli, Klebsiella species, Enterobacter species, Haemophilus
influenzae, Haemophilus parainfluenzae, Acinetobacter species, Serratia marcescens.

Skin and skin structure infections: Treatment of skin and skin structure infections caused by
E. faecalis, S. aureus (penicillinase-producing), S. epidermidis, E. coli, Klebsiella species,
Enterobacter species, Proteus vulgaris, Providencia rettgeri, M. morganii, P. aeruginosa, Serratia
species, Citrobacter species, Acinetobacter species, Bacteroides species (including B. fragilis),
Fusobacterium species, Peptococcus species, Peptostreptococcus species.

Urinary tract infections (complicated and uncomplicated): Treatment of uncomplicated and

complicated urinary tract infections caused by E. faecalis, S. aureus (penicillinase-producing), E.
coli, Klebsiella species, Enterobacter species, P. vulgaris, Providencia rettgeri, M. morganii, P.
aeruginosa.

Limitations of use: Not indicated in patients with meningitis because safety and efficacy have not
been established; not recommend in pediatric patients with CNS infections because of the risk of
seizures.

Use: Off-Label: Adult

Burkholderia pseudomallei (melioidosis); Neutropenic fever; Nontuberculous mycobacterial disease;

Skin and soft tissue necrotizing infections; Surgical-site infection

Medication Safety Issues

Sound-alike/look-alike issues:

Imipenem may be confused with ertapenem, meropenem

Primaxin may be confused with Premarin, Primacor

Adverse Reactions

>10%
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Hematologic & oncologic: Decreased hematocrit (infants and children 3 months to 12 years:
18%; neonates and infants <3 months: 2%), decreased hemoglobin (infants and children 3
months to 12 years: 15%), eosinophilia (neonates, infants, and children to 12 years: 9% to
13%), thrombocythemia (infants and children 3 months to 12 years: 13%; neonates and
infants <3 months: 4%)

Hepatic: Increased serum AST (infants and children 3 months to 12 years: 18%; neonates
and infants <3 months: 6%), increased serum ALT (infants and children 3 months to 12
years: 11%; neonates and infants <3 months: 3%)

1% to 10%:

Cardiovascular: Phlebitis (2% to 3%), tachycardia (neonates and infants ≤3 months: 2%;
adults <1%)

Central nervous system: Seizure (neonates and infants ≤3 months: 6%; adults <1%)

Dermatologic: Skin rash (≤2%)

Gastrointestinal: Diarrhea (neonates, infants, and children to 12 years: 3% to 4%; adults

2%), nausea (2%), oral candidiasis (neonates and infants ≤3 months: 2%), vomiting (≤1% to
2%), gastroenteritis (≤1%)

Genitourinary: Proteinuria (infants and children 3 months to 12 years: 8%), urine

discoloration (≤1%), oliguria (neonates and infants ≤3 months: 2%; adults <1%)

Hematologic & oncologic: Neutropenia (infants and children 3 months to 12 years: 3%;
adults <1%), decreased platelet count (neonates and infants <3 months: 2%), increased
hematocrit (neonates and infants <3 months: 1%)

Hepatic: Increased serum alkaline phosphatase (neonates and infants <3 months: 3%),
increased serum bilirubin (neonates and infants <3 months: 3%), decreased serum bilirubin
(neonates and infants <3 months: 1%)

Local: Irritation at injection site (infants, children, and adolescents 3 months to 16 years: 1%)

Renal: Increased serum creatinine (neonates and infants <3 months: 5%)

<1%, postmarketing and/or case reports: Abdominal pain, acute renal failure, agitation,
agranulocytosis, anaphylaxis, angioedema, back pain (thoracic spinal), basophilia, bilirubinuria,
bone marrow depression, brain disease, candidiasis, casts in urine, change in prothrombin time,
chest discomfort, Clostridioides (formerly Clostridium) difficile-associated diarrhea, confusion,
cyanosis, decreased serum sodium, dental discoloration, dizziness, drowsiness, drug fever,
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dysgeusia, dyskinesia, dyspnea, erythema at injection site, erythema multiforme, fever, flushing,
glossitis, hallucination, headache, hearing loss, heartburn, hematuria, hemolytic anemia,
hemorrhagic colitis, hepatic failure, hepatitis (including fulminant onset), hyperchloremia,
hyperhidrosis, hypersensitivity, hyperventilation, hypotension, increased blood urea nitrogen,
increased lactate dehydrogenase, increased monocytes, increased serum potassium, increased
urinary urobilinogen, induration at injection site, injection site infection, jaundice, leukocytosis,
leukocyturia, leukopenia, lymphocytosis, myoclonus, neutropenia, pain at injection site,
palpitations, pancytopenia, paresthesia, polyarthralgia, polyuria, positive direct Coombs' test,
pruritus, pruritus vulvae, pseudomembranous colitis, pseudomonas infection (resistant P.
aeruginosa), psychiatric disturbances, sialorrhea, skin changes (texture), sore throat, Stevens-
Johnson syndrome, thrombocytopenia, tinnitus, tongue changes (papillar hypertrophy), tongue
discoloration, toxic epidermal necrolysis, tremor, urticaria, vertigo, weakness

Contraindications

Hypersensitivity to imipenem/cilastatin or any component of the formulation

Documentation of allergenic cross-reactivity for carbapenems, penicillins, and cephalosporins is

limited. However, because of similarities in chemical structure and/or pharmacologic actions, the
possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: Carbapenems have been associated with CNS adverse effects, including
confusional states and seizures (myoclonic); use caution with CNS disorders (eg, brain
lesions and history of seizures) and adjust dose in renal impairment to avoid drug
accumulation, which may increase seizure risk. However, there have been reports of
adverse CNS effects in patients who had no recognized or documented underlying CNS
disorder or compromised renal function.

• Hypersensitivity reactions: Serious hypersensitivity/anaphylactic reactions have been

reported, including fatalities; may be more common in patients with a history of sensitivity to
multiple allergens. Patients with a history of penicillin hypersensitivity may experience
severe hypersensitivity reactions when treated with other beta-lactams; carefully inquire
about previous hypersensitivity reactions to penicillins, cephalosporins, other beta-lactams,
and other allergens. Serious anaphylactic reactions require immediate discontinuation and
supportive care as clinically indicated.

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• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C.

difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been
observed >2 months postantibiotic treatment.

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment
required in patients with moderate to severe renal dysfunction. Increased seizure risk has
been reported in patients with significant renal dysfunction. Do not use in patients with CrCl
≤15 mL/minute unless hemodialysis is instituted within 48 hours. For patients on
hemodialysis, use is recommended only when the benefit outweighs the potential risk of
seizures.

Concurrent drug therapy issues:

• Valproic acid and derivatives: Carbapenems, including imipenem, may decrease the serum
concentration of divalproex sodium/valproic acid increasing the risk of breakthrough
seizures. Concurrent use of carbapenem antibiotics with divalproex sodium/valproic acid is
generally not recommended. Alternative antimicrobial agents should be considered, but if a
concurrent carbapenem is necessary, consider additional antiseizure medication.

• Drug-drug interactions: Additional potentially significant interactions may exist, requiring

dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy.
Consult drug interactions database for more detailed information.

Special populations:

• Pediatric: Not recommended in pediatric CNS infections due to seizure potential. Not
recommended in pediatric patients <30 kg with impaired renal function (no data available).

Metabolism/Transport Effects
None known.

Drug Interactions
(For additional information: Launch drug interactions program)

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X:
Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine
(Immunization). Risk C: Monitor therapy

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Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine.
Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days
following the use of oral or parenteral antibiotics. Risk X: Avoid combination

CycloSPORINE (Systemic): May enhance the neurotoxic effect of Imipenem. Imipenem may
decrease the serum concentration of CycloSPORINE (Systemic). Imipenem may increase the
serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy

Ganciclovir-Valganciclovir: May enhance the adverse/toxic effect of Imipenem. Specifically, the

risk of seizures may be increased. Management: Avoid concomitant use of these agents unless
the prospective benefits of therapy outweigh the risks. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and
Estriol. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Imipenem. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate.
Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in
patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy
modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live
attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid
vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents.
Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial
agents. Risk D: Consider therapy modification

Valproate Products: Carbapenems may decrease the serum concentration of Valproate Products.
Management: Concurrent use of carbapenem antibiotics with valproic acid is generally not
recommended. Alternative antimicrobial agents should be considered, but if a concurrent
carbapenem is necessary, consider additional anti-seizure medication. Risk D: Consider therapy
modification

Pregnancy Implications

Imipenem and cilastatin cross the placenta (Cho 1988; Heikkilä 1992)

Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of

imipenem/cilastatin may be altered (Heikkilä 1992).

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Imipenem is not one of the preferred antibiotics for the management of cystic fibrosis in pregnant
females; however, it may be used when a safer alternative is not available (Panchaud 2016).

Breast-Feeding Considerations

Imipenem is present in breast milk (Ito 1988; Chung 2002).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk
of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the
mother.

Imipenem is not one of the preferred antibiotics used for the management of cystic fibrosis in
lactating females; however, when a safer alternative is not available, imipenem is the preferred
carbapenem antibiotic. Due to poor oral bioavailability, exposure to a breastfed infant is expected
to be limited (Panchaud 2016).

Dietary Considerations
Some products may contain sodium.

Monitoring Parameters
Periodic renal, hepatic, and hematologic function tests; monitor for signs of anaphylaxis during first
dose

Mechanism of Action
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins
(PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell
walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall
autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Cilastatin
prevents renal metabolism of imipenem by competitive inhibition of dehydropeptidase along the brush
border of the renal tubules.

Pharmacodynamics and Pharmacokinetics

Protein binding: Imipenem: ~20%; cilastatin: ~40%

Metabolism: Imipenem is metabolized in the kidney by dehydropeptidase I; cilastatin prevents

imipenem metabolism by this enzyme.

Half-life elimination: IV: Both drugs: Prolonged with renal impairment:

Neonates: Imipenem: 1.7 to 2.4 hours; Cilastatin: 3.9 to 6.3 hours (Freij 1985)

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Infants and Children: Imipenem: 1.2 hours (Blumer 1996)

Adults: ~60 minutes

Excretion: Both drugs: Urine (~70% as unchanged drug)

Pricing: US

Solution (reconstituted) (Imipenem-Cilastatin Intravenous)

250 mg (per each): $5.99 - $15.00

500 mg (per each): $11.65 - $30.00

Solution (reconstituted) (Primaxin IV Intravenous)

500-500 mg (per each): $39.18

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as
reference price only. A range is provided when more than one manufacturer's AWP price is available
and uses the low and high price reported by the manufacturers to determine the range. The pricing
data should be used for benchmarking purposes only, and as such should not be used alone to set or
adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price
for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or
nature, whether express or implied, and assumes no liability with respect to accuracy of price or price
range data published in its solutions. In no event shall Medi-Span be liable for special, indirect,
incidental, or consequential damages arising from use of price or price range data. Pricing data is
updated monthly.

Brand Names: International

Amanam (LB); Anipen (PH); Arzobema (MX); Bacquire (ZW); Bacqure (TH); Bidinam (VN); Bionam
(TH); Cilanem (BH, JO, LB); Cilapenem (KR); Cispenam (BD); Imcitin (TH); Imenam (TW); Imicila
Alvogen (TH); Imiclast (ID); Iminem (BD); Iminen (MX); Imipen (PH); Imivex (PH); Inem (BD, CL, PY);
Junte (CN); Minem (TH); Nemcis (VN); Nimedine (MT); Pelascap (ID); Pelastin IV (ID); Penam (PH);
Plastin (PH); Premax (JO); Prepenem (HK, KR, PH, TH); Primax (BD); Primaxin (AU, GB, GR, MT,
NZ); Primaxin IV (BB, BM, BS, BZ, GY, JM, SR, TT); Sianem (TH); Supernem (TW); Supranem (EG);
Talispenem (VN); Tenacid (IT); Tienam (AE, BD, BE, BG, BR, CH, CL, CN, CO, CR, CY, CZ, DK, DO,
EC, EE, EG, ES, ET, FI, FR, GT, HK, HN, HR, ID, IE, IL, IN, IT, JO, JP, KW, LB, LT, LU, LV, MX, MY,
NI, NL, NO, PA, PE, PH, PK, PL, PT, RO, RU, SA, SE, SG, SK, SV, TH, TR, TW, UA, VN); Tiesilan
(CO, EC); Timipen (ID); Tipem (KR); Vexpinem (PH); Xerxes (ID); Zienam (AR, AT, DE, PY, UY, VE)

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For country abbreviations used in Lexicomp (show table)

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