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Recarbrio
imipenem/ cilastatin/ relebactam
Adult Dosing .
Dosage forms: INJ
Special Note
- [strength clarification]
- Info: doses expressed as total imipenem + cilastatin + relebactam amount; 1.25 g imipenem/cilastatin/relebactam contains 0.5 g imipenem + 0.5 g cilastatin + 0.25 g relebactam
pneumonia, hospital-acquired or ventilator-associated
- [1.25 g IV q6h x7 days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines
intra-abdominal infections, complicated
- [1.25 g IV q6h x4-14 days]
- Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
UTI, complicated
- [1.25 g IV q6h x4-14 days]
- Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
renal dosing
- [see below]
- CrCl 60-89: 1 g q6h; CrCl 30-59: 0.75 g q6h; CrCl 15-29: 0.5 g q6h; CrCl <15: avoid unless HD within 48h
- HD: 0.5 g q6h, on dialysis days administer after dialysis; consider supplement if next maintenance dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [strength clarification]
- Info: doses expressed as total imipenem + cilastatin + relebactam amount; 1.25 g imipenem/cilastatin/relebactam contains 0.5 g imipenem + 0.5 g cilastatin + 0.25 g relebactam
pneumonia, hospital-acquired or ventilator-associated
- [37 wk gestation and older, <3 mo, >2 kg]
- Dose: 112.5 mg/kg/day IV divided q8h x4-14 days
- [3 mo and older, <30 kg]
- Dose: 150 mg/kg/day IV divided q6h x4-14 days
- [3 mo and older, >30 kg]
- Dose: 1.25 g IV q6h x4-14 days
intra-abdominal infections, complicated
- [37 wk gestation and older, <3 mo, >2 kg]
- Dose: 112.5 mg/kg/day IV divided q8h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
- [3 mo and older, <30 kg]
- Dose: 150 mg/kg/day IV divided q6h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
- [3 mo and older, >30 kg]
- Dose: 1.25 g IV q6h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
UTI, complicated
- [37 wk gestation and older, <3 mo, >2 kg]
- Dose: 112.5 mg/kg/day IV divided q8h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
- [3 mo and older, <30 kg]
- Dose: 150 mg/kg/day IV divided q6h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
- [3 mo and older, >30 kg]
- Dose: 1.25 g IV q6h x4-14 days; Info: for patients with limited or no alternative tx options; duration varies with infection type, pathogen susceptibility
renal dosing
- [<30 kg]
- renal impairment: avoid use
- HD/PD: avoid use
- [>30 kg]
- CrCl 60-89: 1 g q6h; CrCl 30-59: 0.75 g q6h; CrCl 15-29: 0.5 g q6h; CrCl <15: avoid unless HD within 48h
- HD: 0.5 g q6h, on dialysis days administer after dialysis; consider supplement if next maintenance dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- renal impairment (peds patients <30 kg)
- CrCl <15 (except patients on hemodialysis within 48h)
- caution: hypersensitivity to beta-lactams
- caution: renal impairment
- caution: CNS disorder
- caution: seizure history
- caution: seizure risk
- caution: abx-associated colitis history, recent
Drug Interactions .
Overview
cilastatin
renal dehydropeptidase inhibitor
-
None
imipenem
penem
- alters GI flora
- impairs immunomodulatory bacterial infective agent
- lowers seizure threshold
relebactam
beta-lactamase inhibitor
-
None
Avoid/Use Alternative
- aldesleukin
- amifampridine
- BCG live intravesical
- cholera vaccine, live
- fecal microbiota, live
- ganciclovir
- iohexol
- methotrexate
- typhoid vaccine, live
- valganciclovir
- valproic acid
Monitor/Modify Tx
- bupropion
- iopamidol
- warfarin
Caution Advised
- acetazolamide
- brivaracetam
- busulfan
- cannabidiol
- carbamazepine
- cenobamate
- chlorambucil
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- diazepam
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fosphenytoin
- gabapentin
- ganaxolone
- hydroxychloroquine
- lacosamide
- lactulose
- lamotrigine
- levetiracetam
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rufinamide
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tiagabine
- topiramate
- tramadol
- treosulfan
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- neurotoxicity
- seizures
- superinfection
- C. difficile-associated diarrhea
- hemorrhagic colitis
- myelosuppression
- hemolytic anemia
- hepatotoxicity
- acute renal failure
Common Reactions
- anemia
- hypokalemia
- hyponatremia
- nausea
- diarrhea
- headache
- constipation
- vomiting
- LFTs incr.
- thrombophlebitis
- HTN
- fever
- Cr incr.
- eosinophils incr.
- rash
- seizures (peds patients)
- Plt abnormalities
- oliguria (peds patients)
- anuria (peds patients)
- Hct decr.
Safety/Monitoring .
Monitoring Parameters
BUN/Cr at baseline, then if prolonged tx continue periodically; CBC, LFTs if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; possible risk of embryo-fetal death and teratogenicity based on conflicting animal data
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties and limited human data with other carbapenems; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for imipenem: kidney; CYP450: unknown; for cilastatin: unknown; CYP450: unknown; for relebactam: minimal; CYP450: none
Excretion: for imipenem/cilastatin: urine 70%; Half-life: 1h; for relebactam: urine >90%; Half-life: 1.2h
Subclass: Beta-Lactamase Inhibitors ; Beta-Lactams ; Penems
Mechanism of Action
for imipenem: binds to peptidoglycan, inhibiting cell wall synthesis; for cilastatin: inhibits renal dihydropeptidase I, preventing imipenem metabolism; for relebactam: inhibits beta-lactamases, preventing beta-lactam degradation
Formulary .
No Formulary Selected
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