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Imipenem Cilastin

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Imipenem Cilastin, Imipenem-Cilastin, Imipenem, Primaxin

  • See Also
  1. Carbapenem
  2. Imipenem-Cilastin Relebactam
  • Indications
  1. See Carbapenem
  2. Avoid in Meningitis and other CNS Infections
  3. Avoid in MRSA Infections (not active)
  4. Complicated Infections
    1. Sepsis
    2. Pneumonia
    3. Endocarditis
    4. Intraabdominal Infections
    5. Bone and joint infections
    6. Pelvic or gynecologic infections
    7. Urinary Tract Infections
    8. Skin and Soft Tissue Infections
    9. Empiric Febrile Neutropenia coverage (not FDA approved)
  • Mechanism
  1. See Carbapenem
  2. Imipenem is typically combined with Cilastin (Primaxin)
    1. Imipenem alone is rapidly inactivated by renal DHP-1
    2. Cilastin is added to Imipenem to prolong its half life by slowing renal excretion
  • Dosing
  • Imipenem-Cilastin (Primaxin)
  1. Infuse over 20-30 minutes (over 40 to 60 minutes if dose >500 mg or Nausea occurs)
  2. Adult
    1. High dose (intermediately sensitive Bacteria)
      1. CrlCl >=90 ml/min: 1000 mg IV/IM every 6 hours
      2. CrCl 60-90 ml/min: 750 mg IV/IM every 8 hours
    2. Low dose (suscepible Bacteria, empiric Febrile Neutropenia coverage)
      1. CrlCl >=90 ml/min: 500 mg every 6 hours or 1000 mg every 8 hours IV/IM
      2. CrCl 60-90 ml/min: 500 mg IV/IM every 6 hours
  3. Child (3 months and older)
    1. Avoid in renal Impairment if weight <30 kg
    2. Dose: 15 to 25 mg/kg IV every 6 hours (maximum: 4 g/day)
  4. Infant (birth to 3 months)
    1. Avoid in renal Impairment
    2. Age <1 week: 25 mg/kg every 12 hours
    3. Age 1 to 4 weeks: 25 mg/kg every 8 hours
    4. Age 1 to 3 months: 25 mg/kg every 6 hours
  • Drug Interactions
  1. See Carbapenem
  • Adverse Effects
  1. See Carbapenem
  2. Gastrointestinal Effects (Diarrhea, Nausea or Vomiting)
    1. More common with Imipenem-Cilastin
  3. Seizures
    1. Highest risk of Seizures of the Carbapenems (as well as other beta lactamases)
    2. Higher risk in elderly, underlying CNS disorders or Epilepsy, impaired Renal Function or high doses
    3. Also seen with Imipenem-Cilastin (Primaxin) when combined with Ganciclovir
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • Resources
  1. Imipenem Cilastin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f41d8abd-7792-4918-1b93-bd83ea01955e
  • References
  1. LiverTox (2017), accessed online 1/2/2023
    1. https://www.ncbi.nlm.nih.gov/books/NBK548705/
  2. Hamilton (2020) Tarascon Pharmacopeia
  3. (2012) Presc Lett, Resource #231205, Comparison of CarbapenemAntibiotics
  4. Zhanel (2007) Drugs: 67(7): 1027-52 [PubMed]