Classes
DEA Class; Rx
Common Brand Names; Recarbrio
- Carbapenems
Description
Imipenem: Carbapenem; inhibits bacterial cell-wall synthesis by binding to penicillin-binding proteins resulting in bacterial cell lysis
Cilastatin: Prevents renal metabolism of imipenem by competing with dehydropeptidase in the renal tubules
Relebactam: Has no intrinsic antibacterial activity; protects imipenem from degradation by certain serine beta-lactamases such as sulfhydryl variable (SHV), temoneira (TEM), cefotaximase-Munich (CTX-M), E cloacae P99 (P99), Pseudomonas-derived cephalosporinase (PDC), and K pneumoniae
Indications
Indicated for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP)
Indicated for treatment of complicated urinary tract infections (cUTIs), including pyelonephritis, in individuals with limited or no other treatment options
Indicated for treatment of complicated intra-abdominal infections (cIAIs) for individuals with limited or no other treatment options
Contraindications
History of severe hypersensitivity to imipenem, cilastatin, or relebactam, or any other component
Adverse Effects
- Diarrhea (6%)
- Nausea (6%)
- Headache (4%)
- Vomiting (3%)
- Increased ALT or AST (3%)
- Phlebitis or infusion site reactions (2%)
- Pyrexia (2%)
- Hypertension (2%)
- Anemia (1%)
- Increased lipase (1%)
- CNS adverse effects (1%)
- Increased blood creatinine
Warnings
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported in patients receiving therapy with beta-lactams; carefully assess allergy history for previous hypersensitivity to carbapenems, penicillins, cephalosporins, other beta-lactams, and other allergens
Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents; if CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C difficile may need to be discontinued
Prescribing antibiotics in the absence of a proven or strongly suspected bacterial infection or prophylactic indication is unlikely to provide benefit to the patient and increases risk of drug-resistant bacteria
Pregnancy and Lactation
Data are insufficient in pregnant women to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes
There are insufficient data on the presence of imipenem/cilastatin and relebactam in human milk, and no data on the effects on the breastfed child, or the effects on milk production
Maximum Dosage
1.25 g IV q6hr x 4-14 days
Substantially excreted by the kidney and risk of adverse reactions may be greater in patients with impaired renal function
Because geriatric patients are more likely to have decreased renal function, care should be taken in dose selection; consider monitoring renal function
No dosage adjustment is required based on age; dosage adjustment is based on renal function
See Adult Dosing
Pediatric
<18 years: Safety and efficacy not established
How supplied
Imipenem/cilastatin/relebactam
injection, powder for reconstitution
- 500mg/500mg/250mg per vial (ie, 1.25g/vial)
