cilastatin sodium + imipenem monohydrate + relebactam monohydrate at a glance
Medicine class
Carbapenem antibacterial combined with enzyme inhibitors
How it is given
Intravenous infusion administered by a healthcare professional
Who may receive it
Licensed for adults and children from birth, with important evidence limitations in some younger or renally impaired children
Key assessment
Kidney function must be assessed and monitored because all three components are cleared mainly through the kidneys
What is cilastatin sodium + imipenem monohydrate + relebactam monohydrate used for?
Its licensed uses are:
Hospital-acquired pneumonia, including ventilator-associated pneumonia.
Bacteraemia associated with, or suspected to be associated with, hospital-acquired or ventilator-associated pneumonia.
Infections caused by aerobic Gram-negative organisms when treatment options are limited; specialist infectious-diseases input is recommended.
How does cilastatin sodium + imipenem monohydrate + relebactam monohydrate work?
Imipenem stops bacteria constructing their cell walls. Cilastatin blocks the kidney enzyme that would otherwise break down imipenem. Relebactam inhibits selected class A and class C beta-lactamases, helping protect imipenem from bacterial destruction. It does not inhibit metallo-beta-lactamases or class D carbapenemases.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 500 mg + 500 mg + 250 mg
How to take cilastatin sodium + imipenem monohydrate + relebactam monohydrate
Trained staff reconstitute, dilute and administer this preparation into a vein. It must not be swallowed or injected directly from the vial.
Tell the clinical team about previous serious reactions to penicillins, cephalosporins, monobactams or carbapenems.
Tell staff about kidney disease, dialysis, seizures, brain disorders, liver disease and all current medicines.
Food does not affect administration because treatment is intravenous.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate side effects
Common or expected effects
- Diarrhoea, nausea or vomiting
- Rash
- Inflammation of a vein
- Raised liver enzymes
- Raised eosinophil count
Get urgent medical advice
- Severe allergic reaction or blistering skin reaction
- Seizure, confusion, hallucinations or involuntary jerking movements
- Severe or persistent diarrhoea suggesting Clostridioides difficile-associated colitis
- Signs of serious liver injury, such as jaundice
- Markedly reduced urine output or other signs of acute kidney injury
- Severe blood-cell disorders, which may cause fever, infection, bruising or unusual bleeding
cilastatin sodium + imipenem monohydrate + relebactam monohydrate in pregnancy
Human pregnancy evidence for the complete combination is inadequate, and potential fetal risk is uncertain. It should be considered only when the expected clinical benefit justifies that uncertainty, following specialist or prescriber assessment.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate while breastfeeding
Small quantities of imipenem and cilastatin enter breast milk; whether relebactam enters human milk is unknown. The prescriber should weigh the benefit of breastfeeding against the need for treatment because risk to the infant cannot be excluded.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate interactions
Important interactions include:
Valproic acid or divalproex sodium
Carbapenems can rapidly lower valproate concentrations and increase the risk of breakthrough seizures; combined use is not recommended.
Ganciclovir
Generalised seizures have occurred with imipenem/cilastatin. Concurrent use should be reserved for situations where expected benefit outweighs risk.
Warfarin and other oral anticoagulants
Antibacterials may increase anticoagulant effects, so INR monitoring may be needed during and shortly after combined use.
Common questions about cilastatin sodium + imipenem monohydrate + relebactam monohydrate
Answers are fully visible for fast scanning and source review.
What is this treatment used for?
It treats hospital-acquired pneumonia, associated bacteraemia and selected aerobic Gram-negative infections where treatment options are limited.
Is it a carbapenem?
Imipenem is the carbapenem antibacterial; cilastatin and relebactam are enzyme inhibitors that support and protect its activity.
Can it be taken by mouth?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.