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

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (4)

              • BCG vaccine live

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

              • cholera vaccine

                meropenem, 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

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

              • valproic acid

                meropenem 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 (12)

              • amifampridine

                meropenem increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

              • bazedoxifene/conjugated estrogens

                meropenem 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

                meropenem 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 meropenem both decrease serum potassium. Use Caution/Monitor.

              • dienogest/estradiol valerate

                meropenem 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

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

              • estradiol

                meropenem 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

                meropenem 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

                meropenem 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

                meropenem 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.

              • probenecid

                probenecid increases levels of meropenem by decreasing elimination. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                meropenem 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 (6)

              • balsalazide

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

              • biotin

                meropenem 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

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

              • pyridoxine

                meropenem 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)

                meropenem 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

                meropenem 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

              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

              Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), erythema multiforme and acute generalized exanthematous pustulosis

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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 or a prophylactic indication

              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

              Severe cutaneous adverse reactions (SCAR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), erythema multiforme (EM) and acute generalized exanthematous pustulosis (AGEP) reported; if signs and symptoms suggestive of these reactions appear, therapy should be withdrawn immediately and an alternative treatment considered

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              Pregnancy & Lactation

              Pregnancy

              There are insufficient human data to establish whether there is a drug-associated risk of major birth defects or miscarriages with meropenem in pregnant women

              Animal data

              • No fetal toxicity or malformations were observed in pregnant rats and Cynomolgus monkeys administered intravenous meropenem during organogenesis at doses up to 2.4 and 2.3 times the maximum recommended human dose (MRHD) based on body surface area comparison, respectively; in rats administered intravenous meropenem in late pregnancy and during lactation period, there were no adverse effects on offspring at doses equivalent to approximately 3.2 times the MRHD based on body surface area comparison

              Lactation

              Drug has been reported to be excreted in human milk; no information is available on effects of drug on breast-fed child or on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breast-fed child from therapy or from the 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

              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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              500 mg vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              1 gram vial
              meropenem intravenous
              -
              500 mg vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              meropenem intravenous

              MEROPENEM - INJECTION

              (MER-oh-PEN-em)

              COMMON BRAND NAME(S): Merrem

              USES: Meropenem is used to 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 meropenem 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 vein as directed by your doctor, usually every 8 hours.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, constipation, or diarrhea may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor 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.Tell your doctor right away if you have any serious side effects, such as: easy bruising/bleeding, hearing changes (such as decreased hearing, ringing in the ears), mental/mood changes (such as confusion), numb/tingling skin, swelling ankles/feet, unusual weight gain, unusual tiredness.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: fever that doesn't go away, new or worsening lymph node swelling, 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 meropenem, 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. 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).This drug may rarely cause headaches, numb/tingling skin, or seizures. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.Some forms of this medication have sodium. Consult your doctor or pharmacist if you are on a salt-restricted diet or if you have a condition that could get worse if you have more salt (such as congestive heart failure).Meropenem 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 August 2021. 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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              • View the formulary and any restrictions for each plan.
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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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.