Names and pronunciation
(er-tah-pen′em) INVanz
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Drug reference
(er-tah-pen′em) INVanz
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Func. class.: Antiinfective— miscellaneous
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Chem. class.: Carbapenem
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Do not confuse: INVanz/AVINza
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ACTION: Interferes with cell-wall replication of susceptible organisms; bactericidal
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USES: Bacteroides distasonis, Bacte- roides fragilis, Bacteroides ovatus, Bacte- roides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Citro- bacter freundii, Citrobacter koseri, Clos- tridium clostridioforme, Clostridium perfringens, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Eubacterium lentum, Fusobacterium sp., Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta- lactamase positive), Haemophilus parain- fluenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis, Mor- ganella morganii, Peptostreptococcus sp., Porphyromonas asaccharolytica, Prevotella bivia, Proteus mirabilis, Pro- teus vulgaris, Providencia rettgeri, Provi- dencia stuartii, Serratia marcescens, Staphylococcus aureus (MSSA), Staphylo- coccus epidermidis, Streptococcus aga- lactiae (group B streptococci), Strepto- coccus pneumoniae, Streptococcus pyogenes (group A beta-hemolytic strepto- cocci); bacteremia, community-acquired pneumonia, diabetic foot ulcer, endometri- tis, GYN/intraabdominal skin/skin struc- ture/urinary tract infections, surgical infec- tion prophylaxis
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CONTRAINDICATIONS: Hyper- sensitivity to this product, its components, amide-type local anesthetics (IM only); anaphylactic reactions to beta-lactams, other carbapenems Precautions: Pregnancy, breastfeeding, children, geriatric patients, GI/renal/ hepatic disease, seizures
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SIDE EFFECTS CNS: Insomnia, seizures, dizziness, head- ache, agitation, confusion, somnolence, disorientation, edema, hypotension CV: Tachycardia, seizures GI: Diarrhea, nausea, vomiting, CDAD, abdominal pain GU: Vaginitis, dysuria INTEG: Rash, pain at injection site, phle- bitis/thrombophlebitis, erythema at injection site, dermatitis RESP: Dyspnea, cough, pharyngitis, crackles, respiratory distress SYST: Anaphylaxis, angioedema
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INTERACTIONS Increase: ertapenem levels—probene- cid; do not coadminister Decrease: effect of valproic acid; moni- tor valproic acid level, seizure control Drug/Lab Test Increase: hepatic enzymes, albumin, alka- line phosphatase, bilirubin, creatinine, PT Decrease: Hct, WBC
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TREATMENT OF OVERDOSE: EPINEPHrine, antihistamines; resuscitate if needed (anaphylaxis)
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DOSAGE AND ROUTES • Adult/child ≥13 yr: IM/IV 1 g/day × 14 days (IV), 7 days (IM) • Infant/child 3 mo-12 yr: IM/IV 15 mg/kg q12hr (max 1 g/day) × 5-14 days Renal dose • Adult: IM/IV CCr ≤30 mL/min 500 mg daily Available form: Powder, lyophilized, 1 g/ vial
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Administer: IM route • Reconstitute 1-g vial of ertapenem with 3.2 mL of 1% lidocaine HCl injection (without EPINEPHrine) (280 mg/mL), agitate; the IM reconstituted formulation is not for IV use E • IM may be used as an alternative to IV administration in the treatment of infections where IM therapy is appropriate; only give via IM injection × 7 days • For a 1-g dose: immediately with- draw the contents of the vial and inject deeply into a large muscle, aspirate prior to injection to avoid injection into a blood vessel • For a dose <1 g (for pediatric patients 3 mo-12 yr): immediately withdraw a vol- ume equal to 15 mg/kg (max 1 g/day) and inject deeply into a large muscle, as- pirate prior to injection to avoid injecting into a blood vessel; use the reconstituted IM solution within 1 hr after preparation IV route • Visually inspect for particulate matter and discoloration prior to use, may be colorless to pale yellow; do not mix with other products; dextrose solutions are not compatible • 1-g vial: For each gram reconstitute with 10 mL of either NS injection, sterile water for injection, or bacteriostatic wa- ter for injection to 100 mg/mL, shake • 1 g dose: Immediately transfer con- tents of the reconstituted vial to 50 mL of NS injection; for a dose <1 g (pediat- ric patients 3 mo-12 yr): from the re- constituted vial, immediately withdraw a volume equal to 15 mg/kg of body weight (max 1 g/day) and dilute in NS injection to a concentration of 20 mg/ mL or less Intermittent IV INFUSION route • Complete the infusion within 6 hr of reconstitution, infuse over 30 min; do not co-infuse with other medications • The reconstituted IV solution may be stored at room temperature if used within 6 hr, or store under refrigeration for 24 hr and use within 4 hours after removal from refrigeration; do not freeze Y-site compatibilities: Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid com- plex, amphotericin B liposome, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleo- mycin, bumetanide, buprenorphine, busul- fan, butorphanol, calcium chloride/ gluconate, CARBOplatin, carmustine, chloramphenicol, cimetidine, ciprofloxa- cin, cisatracurium, CISplatin, cyclophos- phamide, cycloSPORINE, cytarabine, dacar- bazine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dexra- zoxane, digoxin, diltiazem, diphenhydrA MINE, DOCEtaxel, dolasetron, DOPamine, doxacurium, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, erythromycin, esmolol, etoposide, etopo- side phosphate, famotidine, fenoldopam, fluconazole, fludarabine, fluorouracil, fos- carnet, fosphenytoin, furosemide, ganciclo- vir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, inamrinone, insulin (regular), irinotecan, isoprotere- nol, ketorolac, labetalol, lepirudin, leucov- orin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methyldopate, methylPREDNISolone, meto- clopramide, metroNIDAZOLE, milrinone, mitoMYcin, mivacurium, morphine, moxi- floxacin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepineph- rine, octreotide, oxaliplatin, oxytocin, PACLitaxel, pamidronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phentolamine, phenyleph- rine, polymyxin B, potassium acetate/chlo- ride/phosphates, procainamide, proprano- lol, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacroli- mus, telavancin, teniposide, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, trimethobenzamide, vancomycin, vasopres- sin, vecuronium, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zole- dronic acid
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Assess: • Renal disease: lower dose may be re- quired • CNS symptoms: for confusion, sei- zures; may increase seizure risk • CDAD: bowel pattern, abdominal pain, mucus or blood in stools daily; if severe diarrhea occurs, product should be dis- continued • For infection: temperature, sputum, characteristics of wound, monitor WBC prior to, during, after treatment • Allergic reactions, anaphylaxis; rash, urticaria, pruritus; may occur a few days after therapy begins; sensitivity to carbape- nem antibiotics, other beta-lactam antibiot- ics, penicillins; have emergency equipment, epinephrine close by • Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough or sputum • Pregnancy/breastfeeding: use only when clearly needed; use caution in breastfeeding
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Evaluate: • Therapeutic response: negative C&S; absence of signs, symptoms of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • CDAD: to report severe diarrhea, CNS side effects • To report overgrowth of infection: black, furry tongue; vaginal itching; foul- smelling stools • Pregancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding to avoid breastfeeding; product is excreted in breast milk
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PHARMACOKINETICS IV: Onset immediate; peak dose depen- dent; IM: Peak 2.3 hr half-life 4 hr; metabolized by liver; excreted in urine, feces, breast milk
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• Adult/child ≥13 yr: IM/IV 1 g/day × 14 days (IV), 7 days (IM)
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• Infant/child 3 mo-12 yr: IM/IV 15 mg/kg q12hr (max 1 g/day) × 5-14 days Renal dose
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• Adult: IM/IV CCr ≤30 mL/min 500 mg daily Available form: Powder, lyophilized, 1 g/ vial
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