IMIPENEM-CILASTATIN SODIUM 
(i-mi-pen'em sye-la-stat'in)
Primaxin
Classifications: antiinfective; beta-lactam antibiotic
Pregnancy Category: C
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250 mg, 500 mg, 750 mg vials
Fixed combination of imipenem, a beta-lactam antibiotic, and cilastatin. Action of imipenem: inhibition of mucopeptide synthesis
in bacterial cell walls leading to cell death. Cilastatin increases the serum half life of imipenem.
Acts synergistically with aminoglycoside antibiotics against some isolates of Pseudomonas aeruginosa. Infections resistant to cephalosporins, penicillins, and aminoglycosides have responded to treatment with this combination.
Treatment of serious infections caused by susceptible organisms in the urinary tract, lower respiratory tract, bones and joints,
skin and skin structures; also intraabdominal, gynecologic, and mixed infections; bacterial septicemia and endocarditis.
Hypersensitivity to any component of product, multiple allergens. Safe use in pregnancy (category C) is not established.
Lactation; patients with CNS disorders (e.g., seizures, brain lesions, history of recent head injury); renal impairment; patients
with history of penicillin allergies.
Serious Infections
Adult: IV 250–500 mg infused over 20–30 min q6–8h, up to 1 g infused over 40–60 min q6h IM 500 or 750 mg q12h
Child: IV 10–15 mg/kg q6h IM 15–25 mg/kg q12h
Neonate: IV 20–40 mg/kg/d divided q12–24h
Renal Impairment
Clcr 20–30 mL/min, dose q8–12h; <20 mL/min, dose q12h
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- Caution: IM and IV solutions are NOT interchangeable; do NOT give IM solution by IV, and do NOT give IV solution as IM.
Intramuscular
- Reconstitute powder for IM injection as follows: Add 2 mL or 3 mL of 1% lidocaine HCl solution without epinephrine, respectively,
to the 500 mg vial or the 750 mg vial. Agitate to form a suspension then withdraw and inject entire contents of the vial IM.
- Give IM suspension by deep injection into the gluteal muscle or lateral thigh.
- Use reconstituted IM injection within 1 h after preparation.
| Intravenous PREPARE: Intermittent: • Dilute each dose with 10 mL of D5W, NS, or other compatible infusion solution.• Agitate the solution until clear. Color should range from colorless to yellow.• Further dilute with 100 mL of same solution used for initial dilution.
ADMINISTER: Intermittent: Give each 500 mg or fraction thereof over 20–30 min. DO NOT give as a bolus dose. Nausea appears to be related to infusion rate, and if it presents during infusion, slow the rate (occurs
most frequently with 1-g doses).
INCOMPATIBILITIES Solution/additive:
Ringer's lactate, stable in dextrose-containing solutions for only 4 h. Y-site:
Azithromycin, milrinone.
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- Store according to manufacturer's recommendations; stability of IV solutions depends on diluent used for reconstitution.
- Most IV solutions retain potency for 4 h at 15°–30° C (59°–86° F) or for 24 h if refrigerated
at 4° C (39° F). Avoid freezing.
Body as a Whole: Hypersensitivity (rash, fever, chills, dyspnea, pruritus), weakness, oliguria/anuria, polyuria, polyarthralgia; phlebitis and pain at injection site, superinfections. CNS: Seizures, dizziness, confusion, somnolence, encephalopathy, myoclonus, tremors, paresthesia, headache. GI:
Nausea, vomiting, diarrhea, pseudomembranous colitis, hemorrhagic colitis, gastroenteritis, abdominal pain, glossitis, heartburn. Respiratory: Chest discomfort, hyperventilation, dyspnea. Skin: Rash, pruritus, urticaria, candidiasis, flushing, increased sweating, skin texture change, facial edema. Metabolic: Hyponatremia, hyperkalemia. Special Senses: Transient hearing loss; increased WBC, AST, ALT, alkaline phosphatase, BUN, LDH, creatinine; decreased Hgb, Hct, eosinophilia.
Drug:
Aztreonam,
cephalosporins,
penicillins may antagonize the antibacterial effects.
Distribution: Widely distributed; limited concentrations in CSF; crosses placenta; in breast milk. Elimination: 70% of dose excreted in urine within 10 h. Half-Life: 1 h.
Assessment & Drug Effects
- Determine previous hypersensitivity reaction to beta-lactam antibiotics (penicillins and cephalosporins) or to other allergens.
- Monitor for S&S of hypersensitivity (see Appendix F). Discontinue drug and notify physician if S&S occur.
- Monitor closely patients vulnerable to CNS adverse effects.
- Notify physician if focal tremors, myoclonus, or seizures occur; dosage adjustment may be needed.
- Monitor for S&S of superinfection (see Appendix F).
- Notify physician promptly to rule out pseudomembranous enterocolitis if severe diarrhea accompanied by abdominal pain and
fever occurs (see Appendix F).
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Note: Sodium content derived from drug is high; consider in patient on restricted sodium intake.
- Monitor renal, hematologic, and liver function periodically.
Patient & Family Education
- Notify physician immediately to report pruritus or symptoms of respiratory distress.
- Report pain or discomfort at IV infusion site.
- Report loose stools or diarrhea promptly.
- Do not breast feed while taking this drug without consulting physician.
1%)
Canadian drug name;