Drug Guide
Imipenem, Cilastatin Sodium, Relebactam
Classification
Therapeutic: Antibiotic, Beta-Lactamase Inhibitor Combination
Pharmacological: Carbapenem Antibiotic with Beta-Lactamase Inhibitors
FDA Approved Indications
- Treatment of complicated intra-abdominal infections in adults
- Treatment of complicated urinary tract infections in adults, including pyelonephritis
Mechanism of Action
Recarbrio combines imipenem, a carbapenem antibiotic that inhibits bacterial cell wall synthesis, with cilastatin sodium, which inhibits renal dehydropeptidase to prevent imipenem degradation, and relebactam, a beta-lactamase inhibitor that restores activity against certain resistant bacteria.
Dosage and Administration
Adult: 1.5 g (containing imipenem 500 mg, cilastatin 500 mg, relebactam 250 mg) administered intravenously every 6 hours, over 30 minutes.
Pediatric: Safety and effectiveness not established in pediatric patients.
Geriatric: Adjust dosage based on renal function, typical dosing guidelines apply.
Renal Impairment: Adjust dose for reduced renal function based on creatinine clearance.
Hepatic Impairment: No specific adjustment necessary.
Pharmacokinetics
Absorption: Not applicable, administered intravenously.
Distribution: Widely distributed in body fluids and tissues.
Metabolism: Imipenem is hydrolyzed in the kidney; cilastatin inhibits this hydrolysis, prolonging imipenem activity; relebactam is not extensively metabolized.
Excretion: Primarily via renal excretion of unchanged drugs and metabolites.
Half Life: Approximately 1 hour for imipenem; similar for relebactam.
Contraindications
- Hypersensitivity to beta-lactam antibiotics or any component of the formulation.
Precautions
- Use cautiously in patients with history of seizures, as carbapenems may lower seizure threshold.
- Assess for allergy history, especially to penicillins and cephalosporins.
Adverse Reactions - Common
- Nausea (Common)
- Rash (Common)
- Diarrhea (Common)
Adverse Reactions - Serious
- Seizures (Rare)
- Clostridioides difficile-associated diarrhea (Rare)
- Hypersensitivity reactions (anaphylaxis) (Rare)
Drug-Drug Interactions
- Valproic acid (may decrease seizure protection)
- Other nephrotoxic drugs
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor renal function (serum creatinine, BUN), signs of allergy, and infection resolution.
Diagnoses:
- Risk for allergy reactions
- Impaired skin integrity
- Risk for secondary infections
Implementation: Administer IV as prescribed, monitor infusion site, monitor for adverse reactions.
Evaluation: Assess for improvement in infection signs and laboratory markers.
Patient/Family Teaching
- Complete full course of therapy.
- Report any signs of allergic reactions such as rash, itching, swelling.
- Inform about possible kidney function effects and the importance of hydration.
Special Considerations
Black Box Warnings:
- Seizure risk at high doses or in predisposed individuals.
Genetic Factors: Not specifically relevant for this medication.
Lab Test Interference: May cause false elevations in certain lab tests (e.g., bilirubin, aspartate aminotransferase).
Overdose Management
Signs/Symptoms: Seizures, confusion, gastrointestinal disturbances.
Treatment: Supportive care, seizure control as needed, avoid hemodialysis as it's not effective for removal.
Storage and Handling
Storage: Store vials at 20°C to 25°C (68°F to 77°F).
Stability: Stable for the duration specified in the package insert when stored properly.