MEROPENEM AND SODIUM CHLORIDE IN DUPLEX CONTAINER
Clinical safety rating: safe
No significant drug interactions Can cause hypernatremia and fluid overload.
Meropenem is a carbapenem antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.
| Metabolism | Meropenem is primarily metabolized by hydrolysis of the beta-lactam ring via renal dehydropeptidase-1 (DHP-1) located in the kidney, producing an inactive metabolite. It is not significantly metabolized by hepatic CYP450 enzymes. |
| Excretion | Renal: ~70% unchanged via glomerular filtration and tubular secretion; hepatic metabolism: ~20% via hydrolysis of beta-lactam ring; fecal: <2%. |
| Half-life | 1.0–1.5 hours in healthy adults; prolonged to 4–6 hours in moderate renal impairment (CrCl 30–50 mL/min) and 8–12 hours in severe renal impairment (CrCl <10 mL/min). |
| Protein binding | ~2% bound to serum proteins (primarily albumin). |
| Volume of Distribution | 0.23–0.35 L/kg, approximating extracellular fluid volume; indicates limited tissue penetration except in inflamed tissues. |
| Bioavailability | IV: 100% (only route); no oral bioavailability. |
| Onset of Action | IV: Immediate therapeutic concentrations achieved in plasma within 30 minutes of infusion start; clinical effect typically observed within 1–2 hours. |
| Duration of Action | Administration every 8 hours maintains plasma levels above MIC for most susceptible pathogens for approximately 60% of the dosing interval; prolonged in renal impairment. |
1 g IV every 8 hours infused over 15-30 minutes; dose range 0.5-2 g every 8 hours depending on infection severity
| Dosage form | POWDER |
| Renal impairment | CrCl 26-50 mL/min: 1 g every 12 hours; CrCl 10-25 mL/min: 0.5 g every 12 hours; CrCl <10 mL/min: 0.5 g every 24 hours |
| Liver impairment | No adjustment required for hepatic impairment; pharmacokinetics unaffected by Child-Pugh class |
| Pediatric use | Infants ≥3 months and children: 20-40 mg/kg IV every 8 hours (max 2 g/dose); higher doses up to 60 mg/kg every 8 hours for meningitis |
| Geriatric use | Dose based on renal function (CrCl); no age-specific adjustments beyond renal considerations |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Meropenem is excreted into human breast milk in low concentrations (M/P ratio approximately 0.25). It is considered compatible with breastfeeding, but caution is advised in nursing infants with renal impairment, prematurity, or gastrointestinal pathology. Monitor infant for diarrhea, candidiasis, or allergic reactions. |
| Teratogenic Risk |
■ FDA Black Box Warning
No FDA black box warning for meropenem; however, carbapenems may cause serious hypersensitivity reactions and should be used with caution in patients with history of beta-lactam allergy.
| Common Effects | Rash Headache Vomiting Nausea Itching Diarrhea Injection site inflammation Anemia low number of red blood cells Sepsis Constipation Apnea absence of breathing Shock |
| Serious Effects |
["Hypersensitivity to meropenem or any component of the formulation.","Hypersensitivity to other carbapenems (e.g., imipenem, ertapenem).","History of anaphylactic reaction to penicillins or cephalosporins (relative contraindication)."]
| Precautions | ["Hypersensitivity reactions: Serious and occasionally fatal anaphylactic reactions, especially in patients with history of penicillin, cephalosporin, or other beta-lactam allergy.","Seizures: May cause CNS adverse effects including seizures, especially in patients with renal impairment, CNS disorders, or those receiving high doses.","Clostridioides difficile-associated diarrhea (CDAD): May range from mild diarrhea to fatal colitis; evaluate if diarrhea occurs.","Renal impairment: Dose adjustment required; may increase risk of seizures due to accumulation.","Bleeding: Reports of coagulation abnormalities, including prolonged prothrombin time and bleeding, particularly in malnourished or renal failure patients."] |
Loading safety data…
| Meropenem is classified as FDA Pregnancy Category B. Animal studies have not demonstrated fetal harm, but no adequate and well-controlled studies exist in pregnant women. First trimester: No increased risk of major malformations reported in human data. Second and third trimesters: Use only if clearly needed; no known fetal toxicity at standard doses. However, caution is advised due to potential alteration of gut flora and risk of neonatal infection if used near delivery. |
| Fetal Monitoring | Monitor renal function (serum creatinine, BUN) and complete blood count during prolonged therapy. Assess for signs of hypersensitivity or superinfection. In pregnancy, fetal monitoring as per routine obstetrical care; no specific fetal monitoring required. |
| Fertility Effects | No evidence of impaired fertility in animal studies. No human data on fertility effects are available. |