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Drug Interactions between cilastatin / imipenem / relebactam and ganciclovir

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ganciclovir imipenem

Applies to: ganciclovir and cilastatin / imipenem / relebactam

GENERALLY AVOID: Generalized seizures have occurred in patients concomitantly receiving ganciclovir with products containing imipenem-cilastatin. The mechanism has not been described, but these agents are individually epileptogenic and may have additive effects on seizure threshold during coadministration.

MANAGEMENT: The manufacturers recommend that concomitant use of ganciclovir or its prodrug, valganciclovir, with imipenem-cilastatin be avoided unless the potential benefits outweigh the risks. Patients receiving this combination should be closely monitored for tremors, mental status changes, and seizures.

References (5)
  1. (2002) "Product Information. Cytovene (ganciclovir)." Genentech
  2. (2002) "Product Information. Primaxin (imipenem)." Merck & Co., Inc
  3. (2003) "Product Information. Primaxin (imipenem-cilastatin)." Merck & Co., Inc
  4. (2019) "Product Information. Recarbrio (imipenem/cilastatin/relebactam)." Merck & Co., Inc
  5. (2020) "Product Information. Recarbrio (imipenem/cilastatin/relebactam)." Merck Sharp & Dohme LLC, SUPPL-2

Drug and food interactions

Moderate

ganciclovir food

Applies to: ganciclovir

ADJUST DOSING INTERVAL: Food delays but enhances the oral absorption and bioavailability of ganciclovir capsules, possibly due to prolongation of gastrointestinal transit time. In 20 HIV- and CMV-seropositive subjects, ganciclovir dosing (1000 mg every 8 hours) following a standardized high-fat breakfast increased the mean steady-state peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of ganciclovir by an average of 15% and 22%, respectively, compared to dosing after an overnight fast. The time to reach peak plasma concentration (Tmax) was prolonged from 1.8 to 3 hours. In another study of 15 such patients, administration of ganciclovir (2000 mg) within 30 minutes following a high-fat breakfast increased the Cmax and AUC an average of 111% and 114%, respectively, compared to administration in the fasting state (i.e. at least 1 hour before or 2 hours after a meal or snack). Over the total day of dosing (2000 mg orally three times a day), there was a mean increase of 48% and 97% in Cmax and AUC, respectively, and a 36% decrease in half-life during administration with meals.

MANAGEMENT: To ensure maximal oral absorption, oral ganciclovir should be administered with or immediately after a meal.

References (3)
  1. (2002) "Product Information. Cytovene (ganciclovir)." Genentech
  2. Lavelle J, Follansbee S, Trapnell CB, Buhles WC, Griffy KG, Jung D, Dorr A, Conner J (1996) "Effect of food on the relative bioavailability of oral ganciclovir." J Clin Pharmacol, 36, p. 238-41
  3. Jung D, Griffy K, Dorr A (1999) "Effect of food on high-dose oral ganciclovir disposition in HIV-positive subjects." J Clin Pharmacol, 39, p. 161-5

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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

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