IMIPENEM/CILASTATIN
Please note Imipenem is not licensed for the treatment of tuberculosis in the UK.
Imipenem is not usually recommended for the treatment of MDRTB. When it is used, it should be counted as half a drug in a treatment regimen.
DOSAGE
[NOTE: Limited data on evidence for dosing in TB]
Adults (>50kg): 1g twice a day (intravenous). (Dose is based on the imipenem component).
Adults (<50kg): 15mg/kg twice a day (intravenous). (Dose is based on the imipenem component).
Children: Not used in patients aged <15 years (use meropenem).
In renal failure dose reduction may be necessary. Please discuss with a pharmacist.
PREPARATIONS
Parenteral: 500/500mg 250mg powder for solution for infusion.
DRUG LEVEL MONITORING
ADVERSE EFFECTS
COMMON:
Dermatological: Rash & urticaria (3%), injection site pain.
Gastrointestinal: Nausea, vomiting, diarrhoea.
Haematologic: Thrombophlebitis (3%), eosinophillia (4%).
Hepatic: Transient mild increases in LFTs.
Renal: Transient increases in urea and/or serum creatinine concentrations (<2%).
SERIOUS:
Immunological: Anaphylaxis.
Infections: Clostridium difficile-associated diarrhoea and colitis.
Haematologic: Pancytopaenia, neutropaenia, leucopaenia, thrombocytopaenia, thrombocytosis (rare): agranulocytosis.
Neurological: Seizures.
Renal (rare): Acute renal failure, oliguria/anuria, polyuria, urine discoloration.
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
Ganciclovir: Increased risk of convulsions.
Valproate: Reduced serum concentrations of valproate. Avoid concomitant use.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: Severe hypersensitivity to penicillins, carbapenems or cephalosporins.
Pregnancy.
Cautions:
TB Meningitis: Increased risk of seizures. Meropenem may be preferred.
CNS disease: Increased risk of seizures. Meropenem may be preferred.
Breast-feeding.
Renal impairment: Increased risk of seizures, reduce dose.
Liver disease: Monitor LFTs (risk of increase in transaminases, hepatic failure and fulminant hepatitis).
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time for tests is usually a few days to a week but this can be reduced by calling ahead and informing the laboratory in advance.
Imipenem is not usually recommended for the treatment of MDRTB. When it is used, it should be counted as half a drug in a treatment regimen.
DOSAGE
[NOTE: Limited data on evidence for dosing in TB]
Adults (>50kg): 1g twice a day (intravenous). (Dose is based on the imipenem component).
Adults (<50kg): 15mg/kg twice a day (intravenous). (Dose is based on the imipenem component).
Children: Not used in patients aged <15 years (use meropenem).
In renal failure dose reduction may be necessary. Please discuss with a pharmacist.
PREPARATIONS
Parenteral: 500/500mg 250mg powder for solution for infusion.
DRUG LEVEL MONITORING
- Drug levels need not be routinely measured.
ADVERSE EFFECTS
COMMON:
Dermatological: Rash & urticaria (3%), injection site pain.
Gastrointestinal: Nausea, vomiting, diarrhoea.
Haematologic: Thrombophlebitis (3%), eosinophillia (4%).
Hepatic: Transient mild increases in LFTs.
Renal: Transient increases in urea and/or serum creatinine concentrations (<2%).
SERIOUS:
Immunological: Anaphylaxis.
Infections: Clostridium difficile-associated diarrhoea and colitis.
Haematologic: Pancytopaenia, neutropaenia, leucopaenia, thrombocytopaenia, thrombocytosis (rare): agranulocytosis.
Neurological: Seizures.
Renal (rare): Acute renal failure, oliguria/anuria, polyuria, urine discoloration.
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
Ganciclovir: Increased risk of convulsions.
Valproate: Reduced serum concentrations of valproate. Avoid concomitant use.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: Severe hypersensitivity to penicillins, carbapenems or cephalosporins.
Pregnancy.
Cautions:
TB Meningitis: Increased risk of seizures. Meropenem may be preferred.
CNS disease: Increased risk of seizures. Meropenem may be preferred.
Breast-feeding.
Renal impairment: Increased risk of seizures, reduce dose.
Liver disease: Monitor LFTs (risk of increase in transaminases, hepatic failure and fulminant hepatitis).
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time for tests is usually a few days to a week but this can be reduced by calling ahead and informing the laboratory in advance.