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Merrem (meropenem) Disease Interactions

There are 5 disease interactions with Merrem (meropenem):

Major

Antibiotics (applies to Merrem) 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.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  4. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  5. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  6. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  7. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  8. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  9. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  10. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  11. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  12. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  13. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  14. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  15. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  16. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  17. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  18. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  19. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  20. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  21. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  22. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  23. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  24. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  25. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  26. "Multum Information Services, Inc. Expert Review Panel"
  27. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  28. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  29. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  30. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  31. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
  32. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  33. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  34. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  35. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  36. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  37. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  38. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  39. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  40. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  41. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  42. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  43. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  44. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  45. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  46. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  47. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
View all 47 references
Major

Carbapenems (applies to Merrem) 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.

References

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

Carbapenems (applies to Merrem) 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.

References

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

Carbapenems (applies to Merrem) 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.

References

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

Meropenem (applies to Merrem) sodium

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

Parenteral meropenem is formulated with sodium carbonate to adjust the pH of the reconstituted solution and contains 90.2 mg (3.92 mEq) of sodium per each gram of meropenem activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

References

  1. "Product Information. Merrem (meropenem)." Zeneca Pharmaceuticals, Wilmington, DE.

Merrem (meropenem) drug interactions

There are 29 drug interactions with Merrem (meropenem)

Merrem (meropenem) alcohol/food interactions

There is 1 alcohol/food interaction with Merrem (meropenem)

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.