What are the common side effects of Meropenem?

Common Side Effects of Meropenem

The most common side effects of meropenem include diarrhea (2.5%), rash (1.4%), nausea/vomiting (1.2%), and injection site inflammation (1.1%). 1, 2

Gastrointestinal Effects

• Diarrhea (2.3-2.5% of patients)
• Nausea and vomiting (1.2-1.4%)
• Oral moniliasis
• Anorexia
• Constipation
• Flatulence

Dermatologic Effects

• Rash (1.4%)
• Urticaria
• Sweating
• In rare cases, more severe skin reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme have been reported in post-marketing surveillance 1

Hematologic Effects

• Thrombocytosis (1.6%)
• Eosinophilia
• Decreased platelets
• Decreased hemoglobin and hematocrit
• Leukocytosis

Hepatic Effects

• Increased liver enzymes (1.5-4.3%):
  • Elevated alanine transaminase (ALT)
  • Elevated aspartate transaminase (AST)
  • Elevated alkaline phosphatase
  • Elevated lactate dehydrogenase (LDH)
  • Elevated bilirubin 1, 2

Neurological Effects

• Headache
• Seizures (rare in non-meningitis patients, 0.07-0.08%)
• Dizziness
• Insomnia
• Agitation
• Confusion 1

Renal Effects

• Increased creatinine
• Increased blood urea nitrogen (BUN)
• Risk of nephrotoxicity is increased in patients with renal impairment 1

Special Populations

Pediatric Patients

In pediatric patients with serious bacterial infections (excluding meningitis), the most common side effects are:

• Diarrhea (3.5%)
• Rash (1.6%)
• Nausea and vomiting (0.8%) 1

In pediatric patients with meningitis:

• Diarrhea (4.7%)
• Rash (3.1%)
• Oral moniliasis (1.9%)
• Glossitis (1.0%) 1

Patients with Renal Impairment

Patients with moderate to severe renal impairment have an increased incidence of:

• Heart failure
• Kidney failure
• Seizures
• Shock 1

Important Safety Considerations

1. Drug Interactions:

   • Probenecid: Increases plasma concentrations of meropenem and co-administration is not recommended 1
   • Valproic acid: Meropenem may reduce valproic acid concentrations, potentially increasing seizure risk 1

2. Monitoring:

   • Liver function tests should be monitored, especially in patients with pre-existing hepatic disease
   • Renal function should be monitored, particularly in elderly patients and those with renal impairment
   • Complete blood count monitoring is recommended during extended therapy

3. Advantages over other carbapenems:

   • Meropenem has a lower risk of seizures compared to imipenem/cilastatin, making it suitable for treating bacterial meningitis 2, 3
   • Well tolerated across a wide range of adult and pediatric populations 2

Safety data from extensive clinical experience involving over 6,000 patients confirms that meropenem has a favorable safety profile with a low overall frequency of adverse events and excellent gastrointestinal tolerability 2.