cilastatin sodium + imipenem monohydrate + relebactam monohydrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate: clinical details
Prescribing considerations
- Obtain appropriate microbiology samples and review susceptibility, infection site and local antimicrobial guidance.
- For infections with limited treatment options, involve a clinician experienced in managing infectious diseases.
- Assess renal function before treatment and monitor it when impaired or fluctuating.
- Consider limited activity against MRSA, MRSE and Enterococcus faecium, and the lack of relebactam inhibition of metallo-beta-lactamases and class D carbapenemases.
- Clinical evidence is limited in immunocompromised and neutropenic patients.
Contraindications and cautions
- Hypersensitivity to imipenem, cilastatin, relebactam or an excipient.
- Hypersensitivity to another carbapenem.
- Previous severe hypersensitivity, including anaphylaxis or a severe skin reaction, to another beta-lactam antibacterial.
Monitoring
- Renal function, including changes during acute illness or dialysis.
- Liver function, particularly with pre-existing liver disease.
- Neurological status, especially with renal impairment, CNS disease or seizure history.
- Diarrhoea during and after treatment for possible Clostridioides difficile infection.
- Clinical response, culture results and emergence of non-susceptible organisms.
- INR when used with an oral anticoagulant.
Clinical pharmacology
Imipenem is a bactericidal carbapenem; cilastatin inhibits renal dehydropeptidase-I and preserves imipenem exposure; relebactam inhibits selected class A and class C beta-lactamases. All three components are eliminated predominantly through the kidneys.
Formulation and product differences
- Available as a fixed-ratio, single-use powder for intravenous infusion.
- Requires aseptic reconstitution and further dilution; the constituted suspension must not be administered directly.
- Sodium chloride infusion fluid is standard; glucose infusion fluid may be used in specified exceptional circumstances.
- Contains sodium, which may matter for patients on a controlled-sodium diet.
- Physically incompatible with propofol in the stated infusion fluids.
cilastatin sodium + imipenem monohydrate + relebactam monohydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 500 mg + 500 mg + 250 mg
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.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.