Imipenem/cilastatin (Ipm/Cln)

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    Update: January 2022

     

    Forms, strengths and route of administration

    • Powder for injection, in vial of 500 mg imipenem monohydrate/500 mg cilastatin sodium, to be reconstituted with 20 ml of 0.9% sodium chloride (25 mg imipenem/ml).
    • Each dose is to be diluted in 100 ml of 0.9% sodium chloride and to be administered by IV infusion:
      • over 30 minutes for doses ≤ 500 mg/500 mg
      • over 60 minutes for doses > 500 mg/500 mg
    • Use a deep line, preferably an implantable venous access device (Port-a-Cath).

    Dosage (expressed in imipenem)

    • Adolescent 15 years and over (and ≥ 30 kg) and adult: 1000 mg (2 vials) 2 times daily with 10 hours minimum between infusions
    • Maximum dose: 2000 mg daily
    • Renal insufficiency: 750 mg every 12 hours for CrCl 20-40 ml/minute; 500 mg every 12 hours for CrCl < 20 ml/minute

     

    Weight
    (kg)

    Daily dose
    (mg)

    Daily dose (ml) - IV infusion
    (500 mg/500 mg per vial)

    5-29

    Do not used in patients < 15 years and < 30 kg

     

    30-33

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

    34-40

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

    41-45

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

    46-50

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

    51-70

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

    > 70

    2000

    2 vials (40 ml) in 100 ml of 0.9% NaCl x 2

     

    Contra-indications, adverse effects, precautions

    • Do not administer to patients with hypersensitivity to carbapenems.
    • Administer with caution to patients with hypersensitivity to other betalactams (cross-hypersensitivity may occur).
    • May cause:
      • nausea, vomiting (the infusion rate may be slowed down in case of nausea), diarrhoea;
      • nervous sytem disorders: confusional state, seizures (most frequently in patients with history of seizures or renal impairment);
      • hypersensitivity reactions;
      • local reactions (phlebitis/thrombophlebitis).
    • For the management of adverse effects, see Appendix 17.
    • Avoid or monitor combination with: valproic acid (decreased plasma concentration of valproic acid and risk of seizures), oral or injectable ganciclovir (risk of seizures).
    • Pregnancy and breastfeeding: use only if the benefits outweigh the risks (safety not established).

    Monitoring

    • Symptomatic monitoring.

    Remarks

    • Administer clavulanic acid 60 minutes before each dose of imipenem/cilastatin.
    • Do not mix with Ringer lactate (incompatibility) but may be administered via Y-site.
    • Do not mix with other drugs in the infusion bag.

    Storage

     
    –  Below 25 °C
    • Once reconstituted, solution:
      • remains stable 4 hours at room temperature or 24 hours between 2 to 8 °C,
      • may darken from colourless to yellow (this does not indicate a loss of potency),
      • should be discarded if it becomes brown.
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