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Cilastatin/imipenem Disease Interactions

There are 5 disease interactions with cilastatin / imipenem.


Antibiotics (applies to cilastatin/imipenem) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.


  1. (2002) "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories
  2. (2002) "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome
  3. (2002) "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome
  4. (2002) "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn
  5. (2002) "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals
  6. (2002) "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals
  7. (2001) "Product Information. Amoxil (amoxicillin)." SmithKline Beecham
  8. (2001) "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals
  9. (2001) "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis
  10. (2001) "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn
  11. (2003) "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc
  12. (2004) "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals
  13. (2007) "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical
  14. (2009) "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc
  15. (2009) "Product Information. Vibativ (telavancin)." Theravance Inc
  16. (2010) "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals
  17. (2022) "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc
  18. (2014) "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc.
  19. (2014) "Product Information. Orbactiv (oritavancin)." The Medicines Company
  20. (2017) "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions
  21. (2017) "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc.
  22. (2022) "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC
  23. (2018) "Product Information. Zemdri (plazomicin)." Achaogen
  24. (2018) "Product Information. Seysara (sarecycline)." Allergan Inc
  25. (2018) "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc.
  26. (2018) "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc.
  27. (2019) "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc
  28. (2019) "Product Information. Biaxin (clarithromycin)." AbbVie US LLC, SUPPL-61
  29. (2021) "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group, LAB-0372-7.0
  30. (2018) "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals, SUPPL-74
  31. (2020) "Product Information. Priftin (rifapentine)." sanofi-aventis, SUPPL-18
  32. (2021) "Product Information. Xerava (eravacycline)." Tetraphase Pharmaceuticals, Inc
  33. (2023) "Product Information. Xacduro (durlobactam-sulbactam)." La Jolla Pharmaceutical
  34. (2024) "Product Information. Exblifep (cefepime-enmetazobactam)." Allecra Therapeutics
  35. (2021) "Product Information. Maxipime (cefepime)." Hospira Inc, SUPPL-46
View all 35 references

Carbapenems (applies to cilastatin/imipenem) renal dysfunction

Major Potential Hazard, High plausibility.

Carbapenems are primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from carbapenems, including seizures and other central nervous system disturbances, due to decreased drug clearance. Dosage adjustments should be considered, with modifications based on degree of renal impairment and severity of infection in accordance with the individual product package labeling. Renal function tests should be performed periodically during therapy.


  1. Drusano GL, Standiford HC, Bustamante C, et al. (1984) "Multiple-dose pharmacokinetics of imipenem-cilastatin." Antimicrob Agents Chemother, 26, p. 715-21
  2. Gibson TP, Demetriades JL, Bland JA (1985) "Imipenem/cilastatin: pharmacokinetic profile in renal insufficiency." Am J Med, 78, p. 54-61
  3. Rogers JD, Meisinger AP, Feber F, et al. (1985) "Pharmacokinetics of imipenem and cilastatin in volunteers." Rev Infect Dis, 7, s435-46
  4. Berman SJ, Sugihara JG, Nakamura JM, et al. (1985) "Multiple-dose study of imipenem/cilastatin in patients with end-stage renal disease undergoing long-term hemodialysis." Am J Med, 78, p. 113-6
  5. Somani P, Freimer EH, Gross ML, Higgins JT (1988) "Pharmacokinetics of imipenem-cilastatin in patients with renal insufficiency undergoing continuous ambulatory peritoneal dialysis." Antimicrob Agents Chemother, 32, p. 530-4
  6. Bax RP, Bastain W, Featherstone A, Wilkinson DM, Hutchison M, Haworth SJ (1989) "The pharmacokinetics of meropenem in volunteers." J Antimicrob Chemother, 24(suppl a, p. 311-20
  7. Ljungberg B, Nilsson-Ehle I (1992) "Pharmacokinetics of meropenem and its metabolite in young and elderly healthy men." Antimicrob Agents Chemother, 36, p. 1437-40
  8. Wise R, Logan M, Cooper M, Ashby JP, Andrews JM (1990) "Meropenem pharmacokinetics and penetration into an inflammatory exudate." Antimicrob Agents Chemother, 34, p. 1515-7
  9. Chimata M, Nagase M, Suzuki Y, Shimomura M, Kakuta S (1993) "Pharmacokinetics of meropenem in patients with various degrees of renal function, including patients with end-stage renal disease." Antimicrob Agents Chemother, 37, p. 229-33
  10. Leroy A, Fillastre JP, Borsa-Lebas F, Etienne I, Humbert G (1992) "Pharmacokinetics of meropenem (ICI 194,660) and its metabolite (ICI 213,689) in healthy subjects and in patients with renal impairment." Antimicrob Agents Chemother, 36, p. 2794-8
  11. Mouton JW, van den Anker JN (1995) "Meropenem clinical pharmacokinetics." Clin Pharmacokinet, 28, p. 275-86
  12. Leroy A, Fillastre JP, Etienne I, Borsa-Lebas F, Humbert G (1992) "Pharmacokinetics of meropenem in subjects with renal insufficiency." Eur J Clin Pharmacol, 42, p. 535-8
  13. Drusano GL, Hutchison M (1995) "The pharmacokinetics of meropenem." Scand J Infect Dis Suppl, 96, p. 11-6
  14. Christensson BA, Nilsson-Ehle I, Hutchison M, Haworth SJ, Oqvist B, Norrby SR (1992) "Pharmacokinetics of meropenem in subjects with various degrees of renal impairment." Antimicrob Agents Chemother, 36, p. 1532-7
  15. (2001) "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals
  16. Campise M (1998) "Neurological complication during imipenem/cilastatin therapy in uraemic patients." Nephrol Dialysis Transplant, 13, p. 1895-6
  17. (2001) "Product Information. Invanz (ertapenem)." Merck & Co., Inc
  18. (2007) "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical
View all 18 references

Carbapenems (applies to cilastatin/imipenem) CNS disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

The intravenous use of carbapenems has been associated with central nervous system adverse effects such as seizures (up to 1.5%) and, less frequently, somnolence, encephalopathy, myoclonus, tremor, paresthesia, confusion, agitation, depression, and hallucinations. Therapy with carbapenems, regardless of route of administration, should be administered cautiously in patients with or predisposed to seizures or other neurologic disturbances. The normally recommended dosages should not be exceeded in such patients. In those with a known seizure disorder, anticonvulsant therapy should be continued during carbapenem therapy.


  1. Semel JD, Allen N (1991) "Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole." South Med J, 84, p. 465-8
  2. Wang C, Calandra GB, Aziz MA, Brown KR (1985) "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis, 7, s528-36
  3. Calandra GB, Brown KR, Grad LC, et al. (1985) "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med, 78, p. 73-8
  4. Zazgornik J, Schein W, Heimberger K, et al. (1986) "Potentiation of neurotoxic side effects by coadministration of imipenem to cyclosporine therapy in a kidney transplant recipient: synergism of side effects or drug." Clin Nephrol, 26, p. 265-6
  5. Eng RH, Munsif AN, Yangco BG, et al. (1989) "Seizure propensity with imipenem." Arch Intern Med, 149, p. 1881-3
  6. Job ML, Dretler RH (1990) "Seizure activity with imipenem therapy: incidence and risk factors." DICP, 24, p. 467-9
  7. Duque A, Altimiras J, Garcia-Cases C, Vidal P (1991) "Vertigo caused by intravenous imipenem/cilastatin." DICP, 25, p. 1009
  8. Leo RJ, Ballow CH (1991) "Seizure activity associated with imipenem use: clinical case reports and review of the literature." DICP, 25, p. 351-4
  9. (2002) "Product Information. Primaxin (imipenem)." Merck & Co., Inc
  10. Lane M, Kania D, Rapp RP (1996) "Seizures related to use of imipenem-cilastatin." Am J Health Syst Pharm, 53, p. 1605-6
  11. (2001) "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals
  12. Guglielmo BJ, Jacobs RA (1996) "Impact of dosage-monitoring system on frequency of seizures associated with imipenem-cilastatin." Am J Health Syst Pharm, 53, p. 1097-8
  13. Frucht S, Eidelberg D (1997) "Imipenem-induced myoclonus." Mov Disord, 12, p. 621-2
  14. Campise M (1998) "Neurological complication during imipenem/cilastatin therapy in uraemic patients." Nephrol Dialysis Transplant, 13, p. 1895-6
  15. (2001) "Product Information. Invanz (ertapenem)." Merck & Co., Inc
  16. (2007) "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical
View all 16 references

Carbapenems (applies to cilastatin/imipenem) hemodialysis

Moderate Potential Hazard, High plausibility.

In patients undergoing hemodialysis, carbapenems are recommended only if the benefit outweighs the potential risk of seizures. Carbapenems are removed by hemodialysis and should be administered after dialysis to avoid premature removal of the drug. There is not enough information regarding the use of some carbapenems such as meropenem for injection in patients on dialysis.


  1. (2002) "Product Information. Primaxin (imipenem)." Merck & Co., Inc
  2. (2001) "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals
  3. Hashimoto S, Honda M, Yamaguchi M, Sekimoto M, Tanaka Y (1997) "Pharmacokinetics of imipenem and cilastatin during continuous venovenous hemodialysis in patients who are critically ill." Asaio J, 43, p. 84-8
  4. Thalhammer F, Schenk P, Burgmann H, ElMenyawi I, Hollenstein UM, Rosenkranz AR, SunderPlassmann G, Breyer S, Ratheiser K (1998) "Single-dose pharmacokinetics of meropenem during continuous venovenous hemofiltration." Antimicrob Agents Chemother, 42, p. 2417-20
  5. Krueger WA, Schroeder TH, Hutchison M, Hoffmann E, Dieterich HJ, Heininger A, Erley C, Wehrle A, Unertl K (1998) "Pharmacokinetics of meropenem in critically ill patients with acute renal failure treated by continuous hemodiafiltration." Antimicrob Agents Chemother, 42, p. 2421-4
  6. Meyer MM, Munar MY, Kohlhepp SJ, Bryant RE (1999) "Meropenem pharmacokinetics in a patient with multiorgan failure from meningococcemia undergoing continuous venovenous hemodiafiltration." Am J Kidney Dis, 33, p. 790-5
  7. Giles LJ, Jennings AC, Thomson AH, Creed G, Beale RJ, McLuckie A (2000) "Pharmacokinetics of meropenem in intensive care unit patients receiving continuous veno-venous hemofiltration or hemodiafiltration." Crit Care Med, 28, p. 632-7
  8. (2007) "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical
View all 8 references

Imipenem (applies to cilastatin/imipenem) sodium

Moderate Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Hypertension, Hypernatremia, Fluid Retention

The intramuscular and intravenous formulations of imipenem-cilastatin contain 32 mg (1.4 mEq) and 37.5 mg (1.6 mEq) of sodium, respectively, per each 500 mg of imipenem activity. The sodium content should be considered when these products are used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.


  1. (2002) "Product Information. Primaxin (imipenem)." Merck & Co., Inc

Cilastatin/imipenem drug interactions

There are 37 drug interactions with cilastatin / imipenem.

Cilastatin/imipenem alcohol/food interactions

There is 1 alcohol/food interaction with cilastatin / imipenem.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.