meropenem (Rx)

Brand and Other Names:Merrem IV
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injectable solution

  • 500mg/vial
  • 1g/vial

Complicated Skin/Skin Structure Infections

Indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species

500 mg IV q8hr; not to exceed 2 g IV q8hr

Complicated Intra-abdominal Infections

Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species

1 g IV q8hr; not to exceed 2 g IV q8hr

Community-Acquired Pneumonia (Off-label)

500 mg IV q8hr for ≤5 days in combination with fluoroquinolone

Febrile Neutropenia (Off-label)

1 g IV q8hr

Dosage Modifications

Renal impairment

  • CrCl >50 mL/min: 0.5-1 g IV q8hr
  • CrCl 26-50 mL/min: 0.5-1 g IV q12hr
  • CrCl 10-25 mL/min: 0.25-0.5 g IV q12hr
  • CrCl <10 mL/min: 0.25-0.5 g IV q24hr

Dosage Forms & Strengths

powder for injectable solution

  • 500mg/vial
  • 1g/vial

Bacterial Meningitis

Indicated as a single agent therapy for the treatment of bacterial meningitis caused by Streptococcus pneumoniae (penicillin susceptible isolates), Haemophilus influenzae, and Neisseria meningitidis

≥3 months: 40 mg/kg IV q8hr; not to exceed 2 g IV q8hr  

Complicated Intra-abdominal Infections

Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species

≥3 months: 20 mg/kg IV q8hr; not to exceed 1 g q8hr 

<3 months

  • Infants <32 weeks GA and PNA <2 weeks: 20 mg/kg IV q12hr
  • Infants <32 weeks GA and PNA ≥2 weeks: 20 mg/kg IV q8hr
  • Infants ≥32 weeks GA and PNA <2 weeks: 20 mg/kg IV q8hr
  • Infants ≥32 weeks GA and PNA ≥2 weeks: 30 mg/kg IV q8hr
  • Infuse IV over 30 min

Complicated Skin/Skin Structure Infections

Indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species

≥3 months: 10 mg/kg IV q8hr; not to exceed 500 mg IV q8hr  

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Interactions

Interaction Checker

and meropenem

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Constipation (1-7%)

            Diarrhea (4-5%)

            Nausea or vomiting (1-4%)

            Rash (2-3%; includes diaper-area moniliasis in pediatric patients)

            Headache (2%)

            Inflammation at injection site (2%)

            Sepsis (2%)

            Oral moniliasis (≤2% in pediatric patients)

            Bleeding (1.2%)

            Apnea (1%)

            Constipation (1%)

            Glossitis (1%)

            Injection-site reaction (1%)

            Phlebitis or thrombophlebitis (1%)

            Pruritus (1%)

            Septic shock (1%)

            <1%

            Agranulocytosis

            Angioedema

            Erythema multiforme

            Hypersensitivity reaction

            Hypokalemia

            Leukopenia

            Neutropenia

            Pleural effusion

            Stevens-Johnson syndrome

            Toxic epidermal necrolysis

            Postmarketing Reports

            Eosinophilia and Systemic Symptoms (DRESS syndrome)

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            Warnings

            Contraindications

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

            Cautions

            Hypersensitivity reactions have been reported, including fatalities; these reactions are more likely to occur in individuals with history of sensitivity to multiple allergens

            Seizures have been reported, most commonly in patients with CNS disorders (eg, brain lesions, history of seizures) or with bacterial meningitis or compromised renal function

            Seizures, headaches, or paresthesias may occur, potentially interfering with mental alertness or causing motor impairment

            Clostridium difficile-associated diarrhea has been reported

            To avoid development of drug resistance, drug should be used only in proven or strongly suspected bacterial infections

            Prolonged use may result in overgrowth of nonsusceptible organisms

            Thrombocytopenia has been reported in patients with renal impairment

            Co-administration of meropenem IV with valproic acid or divalproex sodium reduces serum concentrations of valproic acid potentially increasing risk of breakthrough seizures

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Unknown whether drug is excreted in breast milk; use with caution

            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

            Inhibits cell-wall synthesis by binding to penicillin-binding proteins; resistant to most beta-lactamases

            Absorption

            Peak tissue time: 1 hr after infusion

            Distribution

            Penetrates well into most body fluids and tissues; CSF concentrations approximate those in plasma

            Protein bound: 2%

            Vd: Adults, 15-20 L; children, 0.3-0.4 L/kg

            Metabolism

            Metabolized in liver to open beta-lactam form (inactive)

            Elimination

            Half-life: Normal renal function, 1-1.5 hr; CrCl >30-80 mL/min, 1.9-3.3 hr; CrCl >2-30 mL/min, 3.82-5.7 hr

            Excretion: Urine (~25% as inactive metabolites)

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            Administration

            IV Incompatibilities

            Additive: Amphotericin B, metronidazole, multivitamins

            Y-site: Amphotericin B, diazepam, metronidazole

            IV Administration

            Administer IV infusion over 15-30 minutes; administer IV bolus over 3-5 minutes

            Storage

            Store powder at controlled room temperature

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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.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            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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