From the FDA Drug Label
If superinfection does occur during therapy, appropriate measures should be taken.
- 9 Potential for Neuromotor Impairment Alert patients receiving meropenem for injection on an outpatient basis regarding adverse events such as seizures, delirium, headaches and/or paresthesias that could interfere with mental alertness and/or cause motor impairment
Systemic adverse events that were reported with meropenem for injection occurring in greater than 1.0% of the patients were ... headache (2.3%), ... 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:
Delirium is mentioned as an adverse event.
Meropenem may cause psychosis or delirium in patients, as delirium is listed as an adverse event in the drug label 1.
From the Research
Meropenem can potentially cause psychosis in some patients, though it is considered a rare side effect. Meropenem is a broad-spectrum carbapenem antibiotic typically administered intravenously at doses of 500mg to 2g every 8 hours, depending on the infection being treated. Neuropsychiatric side effects including hallucinations, confusion, delirium, and psychosis have been reported, particularly in elderly patients, those with renal impairment, or patients with pre-existing central nervous system disorders. The risk appears higher when higher doses are used or when the medication accumulates due to reduced kidney function.
Key Points to Consider
- Healthcare providers should monitor patients on meropenem for any behavioral changes, confusion, or hallucinations, especially in high-risk groups 2.
- If psychosis or other neuropsychiatric symptoms develop, dose adjustment or discontinuation may be necessary.
- The mechanism behind these effects likely involves the drug crossing the blood-brain barrier and affecting neurotransmitter systems, particularly GABA receptors, which can disrupt normal brain function.
- Patients with a history of seizures or psychiatric disorders should be monitored more closely when receiving meropenem 3.
Evidence Review
The most recent and highest quality study on the safety profile of meropenem was published in 2007, which included data from over 6,000 patients treated with meropenem 4. This study found that meropenem has a favorable and acceptable safety profile, with the most common adverse events being diarrhea, rash, and nausea/vomiting. However, it did not specifically address the risk of psychosis or other neuropsychiatric side effects.
Clinical Implications
In clinical practice, it is essential to weigh the benefits of meropenem against the potential risks, particularly in high-risk patients. Close monitoring and prompt intervention are crucial to minimize the risk of psychosis and other neuropsychiatric side effects. If meropenem is deemed necessary, healthcare providers should closely monitor patients for any signs of psychosis or other neuropsychiatric symptoms and adjust the treatment plan accordingly.