CILAPEN
IMIPENEM WITH CILASTATIN · by BOSCH
Composition
IV Inj 250 mg/500 mg: Imipenem (as monohydrate), cilastatin (as sodium salt) in equal parts; powder in vials.
Indications & Dosage
Aerobic and anaerobic Gram-positive and Gram-negative infections, Hospital-acquired septicaemia: BY IV INF: Adult: 500 mg every 6 hours, alternatively 1 g every8 hours. Infection caused by Pseudomonas or other less sensitive organisms, Empirical treatment of infection in febrile patients with neutropenia, Life-threatening infection: BY IV INFU: Adult: 1 g every 6 hours. Lower respiratory tract, intra-abdominal, genitor-urinary, gynaecological, bone and joint, skin and soft tissue infections, Septicaemia, Prophylaxis of post-operative infections: BY IV INF: Adults: 250 mg-1 gm 6-8 hourly, depending on type and severity of infections. Prophylaxis: 1 gm on induction of anaesthesia then 1 gm three hr later. BY DEEP IM INJ:Adults: 500-750 mg 12 hourly depending on type and severity of infection; max 1.5 gm daily. Children above3 months: 15 mg/kg body weight every 6 hr. Max daily dose 2 gm. Gonococcal urethritis or cervicitis: BY DEEP IM INJ: Adults: 500 mg as a single dose.
Administration
Administer by IV intermittent infusion; final concentration should not exceed 5 mg/ml; in fluid-restricted patients, a final concentration of 7 mg/ml has been administered; dose < 500 mg may be infused over 15-30 min; dose > 500 mg should be infused over 40-60 min. Administer by deep IM injection into a large muscle mass (such as the gluteal muscles or lateral part of the thigh) with a 21-gauge 2-inch needle. Aspiration is necessary to avoid inadvertent injection into a blood vessel.
Compatibility
Stable in D5W, NS.
Stability
Store dry powder at less than 25C (77F). Recon-stituted solutions are stable for 4 hours at room temperature and for 24 hours when refrigerated. Do not freeze solutions.
Precautions
Penicillin hypersensitivity, GI disease (particularly colitis), CNS disorders, renal dysfunction, epilepsy
Interactions
Probenecid, ganciclovir.
Pregnancy
Avoid unless potential benefit outweighs risk.
Lactation
Caution advised, avoid
Side Effects
Diarrhoea, eosinophilia, nausea, rash, vomiting, confusion, dizziness, drowsiness, hallucinations, hypotension, leucopenia, myoclonicactivity, seizures, thrombocytopenia, thrombocytosis. Rare: Acute renal failure, anaphylactic reactions, antibiotic-associated colitis, encephalopathy, hearing loss, hepatitis, paraesthesia, polyuria, Stevens-Johnson syndrome, taste disturbances, tooth, tongue or urine discoloration, toxic epidermal necrolysis, tremor, neurotoxicity (at high dose, renalfailure, CNS disease)