ertapenem (Rx)

Brand and Other Names:Invanz
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 1g/vial
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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
more...

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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            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)

            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

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.