Meropenem Containing Sodium
Patients are on a controlled sodium diet
are at an increased risk while taking Meropenem. Meropenem powder of 1000 mg for a solution for infusion or injection contains about 4.0 mEq of sodium/vial which should be considered by patients who are on a controlled sodium diet.
Possibility of Neuromotor Abnormality
It should be advised to patients not to operate motorized or machinery vehicles unless it is reported that Meropenem is well tolerated. Patients should be aware of the side effects such as seizures
, mental confusion
or abnormal sensation in the body. These side effects could interfere with mental alertness or disorders of the nervous system.
Low Levels of Thrombocytes
Patients with kidney abnormality are at an increased risk while using this medicine. In patients with kidney abnormality, low levels of thrombocytes have been observed. There have been no reports of clinical bleeding
Overgrowth of Non-Sensitive Organisms
Long term use of Meropenem may result in excess of non-sensitive organisms. Repeated evaluation of the patient is required. If superinfection occurs during treatment, proper measures should be taken.
Development of Drug-Resistant Bacteria
Giving Meropenem in the absence of suspected bacterial infection or a preventive
indication does not give an advantage to the patient. This enhances the risk of the growth of drug-resistant bacteria.
Clostridium difficile-associated diarrhea
has been observed over two months of the use of Meropenem and may vary in severity from moderate diarrhea to life-threatening inflammation of the colon. Treatment with Meropenem changes the normal flora of the colon leading to overgrowth of C. difficile, contributing to hospital-acquired diarrhea. These can cause an increased fatality and disease rate. Patients with such condition may require the removal of the colon. If CDAD is doubted or confirmed, the use of Meropenem against C. difficile needs to be discontinued. Suitable fluid and electrolyte use, protein supplementation, antibacterial therapy of C. difficile, and operational
evaluation should be started as indicated.
Risk of Breakthrough Seizures
Patients taking Meropenem in combination with valproic acid are at an increased risk. It is shown that combined use of these drugs results in a decrease in valproic acid levels. As a result of this interaction, valproic acid levels may fall below the therapeutic range, therefore increases the risk of sudden seizure
attack (breakthrough seizures). The combined use of Meropenem and divalproex sodium
or valproic acid is generally not advised. If the use of Meropenem is required, consider additive anticonvulsant therapy. Use of antibacterial drugs other than Meropenem should be considered to treat the infections in patients whose seizures are well-controlled when being on divalproex sodium or valproic acid.
Patients with brain disorders (e.g. history of seizures
or brain lesions) or with inflammation of the brain and spinal cord membranes and improper functioning of the kidneys are at an increased risk when using this medicine. Seizures and other central nervous system side effects have been seen during treatment with Meropenem. It is recommended to adjust the dose in old and adult patients with lowered creatinine
clearance. Patients with seizure disorders should continue with anticonvulsant therapy. If seizures occur, assess neurologically, start taking anticonvulsant therapy if not previously begun. Also, re-examine the dosage of Meropenem to learn whether it should be lowered or discontinued.
Severe Allergic Reactions
Patients with a history of sensitivity to cephalosporins, other beta-lactams, penicillins and various allergens are at an increased risk when using Meropenem. Serious and infrequently fatal allergic reactions have been seen in patients with beta-lactams use. Before starting treatment with Meropenem, it is important to examine previous allergic reactions to cephalosporins, penicillins, other beta-lactams, and another allergen. Discontinue the medicine immediately, if an allergic reaction to Meropenem occurs.