What are the common and possible side effects of meropenem?

Common and Possible Side Effects of Meropenem

Meropenem commonly causes gastrointestinal side effects, diarrhea, nausea, vomiting, headache, rash, and injection site inflammation, with more serious adverse effects including seizures, liver enzyme elevations, and blood disorders occurring less frequently. 1

Common Side Effects (>1% incidence)

Gastrointestinal Effects

• Diarrhea (2.3%)
• Nausea and vomiting (1.4%)
• Oral moniliasis
• Anorexia
• Dyspepsia

Skin Reactions

• Rash (1.4%)
• Injection site inflammation (1.1%)
• Urticaria
• Sweating

Hematologic Abnormalities

• Thrombocytosis (1.6%)
• Eosinophilia
• Anemia

Hepatic Effects

• Elevated liver enzymes (1.5-4.3%): ALT, AST, alkaline phosphatase, LDH, and bilirubin 1, 2

Neurological Effects

• Headache
• Insomnia
• Agitation
• Dizziness

Less Common but Serious Side Effects (<1% incidence)

Neurological Complications

• Seizures (0.08% in non-meningitis patients) 1, 2
• Confusion
• Delirium
• Paresthesia
• Hallucinations
• Somnolence

Cardiovascular Effects

• Heart failure
• Tachycardia
• Hypertension
• Hypotension
• Bradycardia

Renal Effects

• Increased creatinine
• Increased BUN
• Kidney failure (higher risk in patients with moderate to severe renal impairment) 1

Severe Allergic Reactions

• Angioedema
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Drug reaction with eosinophilia and systemic symptoms (DRESS)
• Erythema multiforme 1

Blood Disorders

• Agranulocytosis
• Neutropenia
• Leukopenia
• Hemolytic anemia
• Positive Coombs test 1

Special Considerations

Pediatric Patients

In pediatric patients, the most common side effects include:

• Diarrhea (3.5-4.7%)
• Rash (1.6-3.1%)
• Nausea and vomiting (0.8%)
• Oral moniliasis (1.9%)
• Glossitis (1.0%) 1

Patients with Renal Impairment

• Higher incidence of heart failure, kidney failure, seizure, and shock 1
• Requires dosage adjustment based on creatinine clearance 3

Administration Considerations

• Prolonged or continuous infusion (3 hours) may improve clinical outcomes and reduce side effects, especially in critically ill patients 3
• Infusion-related nausea and vomiting occur less frequently with meropenem than with other carbapenems like imipenem 4

Monitoring Recommendations

• Regular monitoring of liver function tests, especially in patients with underlying liver disease
• Monitoring of renal function, particularly in patients with pre-existing renal impairment
• Observation for neurological symptoms, especially in patients with CNS disorders or risk factors for seizures
• Complete blood count to monitor for hematologic abnormalities
• Clinical assessment for allergic reactions, particularly during early treatment 2, 5

Risk Factors for Increased Side Effects

• Renal impairment (increased risk of neurological and renal side effects)
• Advanced age
• History of seizures or CNS disorders
• Concomitant use of medications that lower seizure threshold
• Higher doses (although studies suggest that increased doses are not necessarily associated with increased adverse events) 2, 6

The safety profile of meropenem is generally favorable compared to other antibiotics in its class, with a lower incidence of seizures compared to imipenem, making it potentially safer for patients with CNS disorders or at risk for seizures 2, 6.

Human Factors: When administering meropenem, be vigilant for early signs of allergic reactions, monitor renal function closely in at-risk patients, and be aware that gastrointestinal side effects are most common but usually mild and self-limiting.