Indications
Cilastatin is not used on its own. It is always combined with the antibiotic Imipenem to treat serious bacterial infections in hospital, such as infections inside the abdomen, pneumonia, complicated urinary tract infections, skin, bone and joint infections, infections of the womb and pelvis, blood infections, and fever in people with a very low white blood cell count.
How It Works
The kidneys contain an enzyme called dehydropeptidase-I that quickly breaks down Imipenem. Cilastatin blocks this enzyme. This keeps Imipenem at effective levels in the body and urine and helps protect the kidneys. Cilastatin has no antibacterial effect of its own.
Dosage and Administration
Cilastatin comes already combined with Imipenem in equal amounts. It is given by a doctor or nurse as a slow infusion (drip) into a vein, usually every 6 to 8 hours. The dose depends on the infection, body weight and kidney function and is given as prescribed.
Interactions
- Valproic acid (Sodium Valproate): the combination with Imipenem can sharply lower valproate levels and lead to fits, so it is usually avoided.
- Ganciclovir: higher risk of fits.
- Probenecid can raise blood levels.
- Blood thinners such as Warfarin may need closer monitoring.
Contraindications
Do not use if you are allergic to Cilastatin, Imipenem or any other carbapenem, or if you have had a severe allergic reaction (such as anaphylaxis) to a penicillin or cephalosporin.
Side Effects
Side effects are those of the Imipenem combination: nausea, vomiting, diarrhoea, rash, and pain or swelling of the vein where the drip goes in. Blood tests may show changes in liver enzymes or blood counts.
Get urgent medical help (tell the doctor or nurse at once) if you notice:
- Fits (seizures), shaking, confusion or hallucinations
- Swelling of the face, lips or throat, difficulty breathing, or blistering or peeling skin
- Severe, watery or bloody diarrhoea
- Much less urine than usual
Pregnancy and Lactation
It is used in pregnancy only if the doctor decides the benefit clearly outweighs any risk. Small amounts pass into breast milk; the doctor will advise whether breastfeeding can continue.
Precautions and Warnings
- Tell the doctor about any history of fits, head injury, stroke or other brain disorders.
- Kidney disease needs a lower dose.
- Tell the doctor about any previous antibiotic allergy.
- Long courses need blood tests.
Overdose
Overdose is uncommon because it is given in hospital. Too much may cause fits, confusion or muscle twitching, especially in people with kidney problems. The medical team gives supportive treatment, and dialysis can remove the medicine from the blood.
Therapeutic Class
Renal dehydropeptidase inhibitor (used with the carbapenem antibiotic Imipenem).
Storage
Store unopened vials below 30°C in a dry place, away from light and out of the reach of children. Once mixed, hospital staff use it within the time stated in the product leaflet.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.