From the Guidelines
Meropenem can cause several side effects, including diarrhea, nausea, vomiting, headache, rash, and injection site reactions, with more serious side effects such as seizures, allergic reactions, and blood disorders also possible. According to the evidence provided, the most relevant information regarding meropenem side effects is found in the study by 1, which lists common side effects and toxicities of various drugs, including meropenem. However, meropenem is not explicitly mentioned in this table, but imipenem, a similar carbapenem antibiotic, is listed with side effects including gastrointestinal disturbance, hypersensitivity, central nervous system effects, hepatitis, and hematologic effects. Given the similarity between imipenem and meropenem, it is reasonable to consider that meropenem may have a similar side effect profile.
Common Side Effects
- Diarrhea
- Nausea
- Vomiting
- Headache
- Rash
- Injection site reactions
Serious Side Effects
- Seizures, especially in patients with brain lesions or renal impairment
- Allergic reactions, ranging from mild rash to severe anaphylaxis
- Clostridioides difficile-associated diarrhea
- Blood disorders like thrombocytopenia or neutropenia
- Central nervous system effects such as confusion or hallucinations
- Hepatic dysfunction It is essential for patients to report any unusual symptoms to their healthcare provider immediately, especially severe diarrhea, signs of allergic reaction, unusual bleeding or bruising, or neurological symptoms. Most side effects resolve after discontinuation of the medication. The study by 1 provides guidelines for the use of antimicrobial agents in neutropenic patients with cancer but does not specifically discuss meropenem side effects in detail.
From the FDA Drug Label
6.1 Adverse Reactions from Clinical Trials ... Systemic Adverse Reactions Systemic adverse events that were reported with meropenem for injection occurring in greater than 1.0% of the patients were diarrhea (4.8%), nausea/vomiting (3.6%), headache (2.3%), rash (1.9%), sepsis (1.6%), constipation (1.4%), apnea (1.3%), shock (1.2%), and pruritus (1.2%).
Additional systemic adverse events that were reported with meropenem for injection and occurring in less than or equal to 1.0% but greater than 0.1% of the patients are listed below within each body system in order of decreasing frequency: ... Nervous System:insomnia, agitation, delirium, confusion, dizziness, seizure, nervousness, paresthesia, hallucinations, somnolence, anxiety, depression, asthenia [see Warnings and Precautions (5.3) and (5.9)]
Meropenem side effects include:
- Gastrointestinal: diarrhea (4.8%), nausea/vomiting (3.6%), constipation (1.4%)
- Nervous System: headache (2.3%), insomnia, agitation, delirium, confusion, dizziness, seizure, nervousness, paresthesia, hallucinations, somnolence, anxiety, depression, asthenia
- Dermatologic: rash (1.9%), pruritus (1.2%)
- Cardiovascular: sepsis (1.6%), shock (1.2%)
- Other side effects: apnea (1.3%) 2
From the Research
Meropenem Side Effects
- The most common adverse events reported for meropenem were diarrhoea (2.5%), rash (1.4%) and nausea/vomiting (1.2%) 3.
- No adverse event occurred in more than 3% of patient exposures to meropenem, indicating a low overall frequency of adverse events as well as excellent gastrointestinal tolerability 3.
- The incidence of seizures considered by investigators to be related to meropenem treatment was 0.07% in infections other than meningitis 3.
- Meropenem has a low propensity for inducing seizures, making it suitable for treating bacterial meningitis 4.
Special Considerations
- Meropenem can be safely given to patients with known or unknown allergic reactions to penicillin, including those with anaphylactic reactions, without penicillin skin testing 5.
- Therapeutic drug monitoring (TDM) of meropenem can be beneficial in guiding therapy, especially in critically ill patients and those with impaired renal function 6.
- Prolonged infusion of meropenem may be associated with lower mortality and better clinical improvement rates compared to intermittent infusion, particularly in patients with lower disease severity 7.