ertapenem (Rx)

Brand and Other Names:Invanz
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 1g/vial

Community-Acquired Pneumonia

1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically

Complicated Urinary Tract Infections (Including Pyelonephritis)

1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically

Acute Pelvic Infections

1 g/day IV/IM for 3-10 days

Complicated Intra-abdominal Infections

1 g/day IV/IM for 5-14 days

Complicated Skin/Skin Structure Infections

1 g/day IV/IM for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)

Dosing Modifications

Renal impairment

  • CrCl >30 mL/min/1.73 m²: Dosage adjustment not necessary
  • CrCl <30 mL/min/1.73 m² and end-stage renal disease (ESRD): 500 mg/day IV
  • Dialysis: 500 mg/day IV; if given ≤6 hr before dialysis, supplemental dose of 150 mg afterward

Dosage Forms & Strengths

powder for injection

  • 1g/vial

Community-Acquired Pneumonia

<3 months: Safety and efficacy not established

3 months - 12 years: 15 mg/kg IV/IM q12hr up to 14 days; not to exceed 1 g q12hr; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically  

>12 years: 1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically

Complicated Urinary Tract Infections (Including Pyelonephritis)

<3 months: Safety and efficacy not established

3 months-12 years: 15 mg/kg IV/IM q12hr up to 14 days; not to exceed 1 g q12hr; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically  

>12 years: 1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically

Acute Pelvic Infections

<3 months: Safety and efficacy not established

3 months -12 years: 15 mg/kg IV/IM q12hr for 3-10 days

>12 years: 1 g/day IV/IM for 3-10 days

Complicated Intra-abdominal Infections

<3 months: Safety and efficacy not established

3 months -12 years: 15 mg/kg IV/IM q12hr for 5-14 days

>12 years: 1 g/day IV/IM for 5-14 days

Complicated Skin/Skin Structure Infections

<3 months: Safety and efficacy not established

3 months -12 years: 15 mg/kg IV/IM q12hr for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)

>12 years: 1 g/day IV/IM for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)

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Interactions

Interaction Checker

and ertapenem

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (4)

              • BCG vaccine live

                ertapenem decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                ertapenem, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • typhoid vaccine live

                ertapenem decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • valproic acid

                ertapenem decreases levels of valproic acid by unknown mechanism. Avoid or Use Alternate Drug. Risk of seizure. Possible decreased GI absorption and/or increased renal clearance of valproic acid.

              Monitor Closely (10)

              • bazedoxifene/conjugated estrogens

                ertapenem will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • conjugated estrogens

                ertapenem will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and ertapenem both decrease serum potassium. Use Caution/Monitor.

              • dienogest/estradiol valerate

                ertapenem will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • digoxin

                ertapenem will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • estradiol

                ertapenem will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                ertapenem will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                ertapenem will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • mestranol

                ertapenem will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                ertapenem decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              Minor (7)

              • balsalazide

                ertapenem will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                ertapenem will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pantothenic acid

                ertapenem will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • probenecid

                probenecid increases levels of ertapenem by decreasing elimination. Minor/Significance Unknown.

              • pyridoxine

                ertapenem will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                ertapenem will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • thiamine

                ertapenem will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Diarrhea (2-12%)

              1-10%

              Elevated liver function tests (LFTs) (7-9%)

              Nausea (6-9%)

              Headache (6-7%)

              Infused vein complications (5-7%)

              Increased platelet count (4-7%)

              Increased alkaline phosphatase (4-7%)

              Altered mental status (3-5%)

              Fever (2-5%)

              Abdominal pain (4%)

              Vomiting (4%)

              Constipation (3-4%)

              Insomnia (3%)

              Swelling or edema (3%)

              Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) (2-3%)

              Rash (2-3%)

              Vaginitis (1-3%)

              Dizziness (2%)

              Phlebitis or thrombophlebitis (1.5-2%)

              Pruritus (1-2%)

              Tachycardia (1-2%)

              Acid regurgitation (1-2%)

              Eosinophilia (1-2%)

              Hypotension (1-2%)

              Erythema (1-2%)

              Hypertension (0.7-2%)

              Chest pain (1%)

              Dyspepsia (1%)

              Fatigue (1%)

              Anxiety (0.8-1%)

              Oral candidiasis (0.1-1%)

              Postmarketing Reports

              Immune system disorders: Anaphylaxis including anaphylactoid reactions

              Musculoskeletal and connective tissue disorders: Muscular weakness

              Nervous system disorders: Coordination abnormal, depressed level of consciousness, dyskinesia, gait disturbance, myoclonus, tremor

              Psychiatric disorders: Altered mental status (including aggression, delirium), hallucinations

              Skin and subcutaneous tissue disorders: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS syndrome); acute generalized exanthematous pustulosis (AGEP), hypersensitivity vasculitis

              Teeth staining

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              Warnings

              Contraindications

              Hypersensitivity to ertapenem, beta-lactams, or other drugs in this class

              IM administration: Hypersensitivity to amide local anesthetics (eg, lidocaine)

              Cautions

              Use with caution in CNS disorders (eg., history of seizures); adjust dose in renal impairment to avoid risk of seizures; carbapenem use has been associated with seizures

              Do not coinfuse with other medications or use dextrose diluent

              Prolonged use increases risk of superinfections

              Use caution in renal impairment; adjust dose in moderate to severe renal dysfunction

              Carbapenem use may decrease serum levels of divalproex sodium or valproic acid

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              Pregnancy & Lactation

              Pregnancy

              Available data from a small number of postmarketing cases with use in pregnancy are insufficient to inform any drug-associated risks for major birth defects, miscarriage, or adverse maternal or fetal outcomes

              Animal data

              • In animal reproduction studies after intravenous administration of ertapenem during period of organogenesis, there was no evidence of developmental malformations in rats at systemic exposures (AUC) up to approximately 1.2 times the human exposure at maximum recommended human dose (MRHD) and in mice at doses up to approximately 3 times MRHD based on body surface area comparison; in pregnant rats administered ertapenem during organogenesis through lactation, fetal toxicity, developmental delays, and impaired reproduction did not occur in first generation offspring at systemic exposures (AUC) approximately 1.2 times the human exposure at MRHD

              Lactation

              Ertapenem is present in human milk; there are no data on effects on breastfed infant or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              1-beta methyl-carbapenem; inhibits cell-wall synthesis by binding to penicillin-binding proteins; resistant to most beta-lactamases

              Absorption

              Bioavailability: IM, 90%

              Peak plasma time: IM, 2.3 hr

              Distribution

              Protein bound (concentration dependent): 300 mcg/mL, 85%; <100 mcg/mL, 95%

              Vd: 3 months-12 years, 0.2 L/kg; 13-17 years, 0.16 L/kg; adults, 0.12 L/kg

              Metabolism

              Hydrolyzed to inactive metabolite

              Elimination

              Half-life: 3 months-12 years, 2.5 hr; >12 years, 4 hr

              Excretion: Urine (80% as unchanged drug and metabolite), feces (10%)

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              Administration

              IV Incompatibilities

              Do not mix with other medications or use diluents containing dextrose

              IV Preparation

              Reconstitute 1 g vial with 10 mL SWI, NS, or BWI; shake well; transfer to 50 mL NS

              IV Administration

              Infuse over 30 minutes

              IM Preparation

              Reconstitute 1 g vial with 3.2 mL of 1% lidocaine injection (without epinephrine); shake well; use within 1 hour after preparation

              IM Administration

              Make sure patient does not have allergy to lidocaine or another amide anesthetic

              Administer by deep IM injection into large muscle mass (eg, gluteal muscle or lateral part of thigh)

              Do not administer IM preparation or drug reconstituted for IM administration IV

              Storage

              Before reconstitution, store at <25°C (77°F)

              Reconstituted IV solution may be either (a) stored at room temperature and used within 6 hours or (b) refrigerated, stored for up to 24 hours, and used within 4 hours after removal from refrigerator

              Do not freeze

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              ertapenem injection
              -
              1 gram vial
              ertapenem injection
              -
              1 gram vial
              ertapenem injection
              -
              1 gram vial
              ertapenem injection
              -
              1 gram vial
              ertapenem injection
              -
              1 gram vial
              Invanz injection
              -
              1 gram vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              ertapenem injection

              ERTAPENEM - INJECTION

              (ER-ta-PEN-em)

              COMMON BRAND NAME(S): Invanz

              USES: Ertapenem is used to prevent and treat a wide variety of bacterial infections. This medication is known as a carbapenem-type antibiotic. It works by stopping the growth of bacteria.

              HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using ertapenem and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is given by injection into a muscle or vein as directed by your doctor, usually once or twice daily. If you are using this medication to prevent an infection, it is given by injection into a vein by a health care professional. It is given as directed by your doctor, usually 1 hour before your surgery.If this medication is given by injection into a muscle, follow the manufacturer's directions for mixing with lidocaine 1 percent solution. Do not use this solution for injection into a vein.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on age and weight.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed treatment period is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

              SIDE EFFECTS: Swelling, redness, pain, or soreness at the injection site may occur. Upset stomach, headache, nausea, vomiting, or diarrhea may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Get medical help right away if you have any very serious side effects, such as: seizures, unusual weakness.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, such as: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using ertapenem, tell your doctor or pharmacist if you are allergic to it; or to other carbapenems (such as imipenem); or to penicillins or cephalosporins; or if you have any other allergies. Before getting ertapenem by injection into a muscle, also tell your doctor or pharmacist if you are allergic to any amide-type local anesthetics (such as lidocaine). This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as seizures, head injury, tumor), kidney disease, stomach/intestinal diseases (such as colitis).Ertapenem may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: valproic acid and related drugs (such as divalproex sodium, sodium valproate).

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Lab and/or medical tests (such as complete blood count, kidney function tests) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised October 2020. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
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