Parenteral Manual

Imipenem + cilastatin sodium (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
PRIMAXIN®
Classification: 
Antibiotic
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Moderate to severe infections due to susceptible organisms.  Broad spectrum against most gram negative and gram positive organisms and anaerobes
Reconstitution and Stability: 
  • Reconstituted solution ranges in colour from colourless to yellow;  discard brown solutions
  • Reconstituted with D5W, NS or dextrose-saline stable 4 hrs room temp, 24 hrs refrigerated
  • DILUTE BEFORE USE   
  • Contents of 250 mg vial must be suspended and transferred to 50 mL minibag
  • Contents of 500 mg vial must be suspended and transferred to 100 mL minibag
  • Contents of 1000 mg vial must be suspended and transferred to 250 mL minibag  
  • Diluted (2.5 mg/mL) in D5W or NS stable 24 hrs refrigerated or room temperature
  • Reconstituted IM suspension in lidocaine HCl should be used within 1 hour after preparation

PROCEDURE: 

  • Transfer 10 mL from the minibag to the vial.  SHAKE WELL.  Return resulting 10 mL of suspension to the remaining minibag.  Repeat, using 10 mL of diluted suspension, to ensure transfer of the contents of the vial to the minibag.  This makes a 5 mg/mL solution.
  • If doses are not equal to the vial size, make a 5 mg/mL stock bag in D5W and draw up the required doses
Compatibility: 

- Solutions Compatible: D5W, NS, dextrose-saline combinations

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: TPN (amino acids/dextrose)

- Incompatible: azithromycin, amphotericin, fluconazole, idarubicin, lorazepam, milrinone, midazolam, sodium bicarbonate

 

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM

YES, into large muscle
Usual dilution: reconstitute IM powder with with lidocaine HCl 1% without epinephrine
IV Direct NO
IV Intermittent Infusion

YES  Large Volume Pump ONLY 
Usual dilution: 2.5-5 mg/mL

Infusion time: < 500 mg; 15-30 minutes
                          > 500 mg; 40-60 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:                       

  • 60-100 mg/kg/day IV ÷ Q 6H hours
  • Maximum 4 g/day

Adults:

  • Mild-moderate infections: 1-2 g/day IM/IV in 3-4 divided doses
  • Serious infections: 2-4 g/day IV ÷ Q 6 hours

DOSAGE ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 30-70 mL/min/1.73 m2; Give 50% of usual daily dose Q6H
  • CrCl 20-30 mL/min/1.73 m2; Give 63% of usual daily dose Q8H
  • CrCl < 20 mL/min/1.73 m2; Give 75% of usual daily dose Q12H
Potential hazards of parenteral administration: 
  • Nausea, vomiting: primarily associated with high doses or rapid infusion rate 
  • Diarrhea, pseudomembranous colitis
  • Neutropenia, eosinophilia
  • Seizures, confusion
  • Hypersensitivity: rash, pruritus, bronchospasm, anaphylaxis
  • Local reactions at injection site: inflammation
Notes: 
  • Monitor periodic renal, hepatic and hematologic function tests
  • Possible cross-sensitivity to penicillins
  • Imipenem is primarily excreted by the kidneys
  • Cilastatin is added to prevent renal metabolism but doesn't possess any intrinsic antimicrobial activity
  • May interfere with urinary glucose determination using Clinitest®  
  • Contains 3.2 mEq Sodium per 1 gram of imipenem  
  • IM formulation is not for IV use

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