Meropenem Dosing for Hemodialysis Patients
For patients on hemodialysis, administer meropenem 500 mg once daily after each dialysis session, or 500 mg every 24 hours on non-dialysis days. 1
Pharmacokinetic Rationale
The elimination half-life of meropenem is dramatically prolonged in end-stage renal disease, extending from approximately 1 hour in healthy individuals to 6.8-7.0 hours in anuric patients. 2, 1 This prolongation necessitates substantial dose reduction and interval extension to prevent drug accumulation and toxicity.
Hemodialysis removes approximately 50% of meropenem from the circulation, shortening the elimination half-life from 7.0 hours to 2.9 hours during dialysis sessions. 2, 1 The dialysis clearance of meropenem is approximately 79 ml/min, making it readily dialyzable. 3
Specific Dosing Algorithm
Standard Recommendation
- 500 mg IV after each hemodialysis session (typically 3 times per week) 1
- On non-dialysis days: 500 mg every 24 hours if additional dosing is needed 1
- Administer the dose after dialysis is completed to prevent premature drug removal and facilitate directly observed therapy 1
Critical Safety Consideration
The 500 mg daily dose may still carry seizure risk, particularly in Asian patients with lower body mass index. 4 A case report documented tonic-clonic seizures in a hemodialysis patient receiving the recommended 500 mg daily dose after the 7th dose, which completely resolved upon drug discontinuation. 4
Timing Principles
Following the same principles used for other dialyzable medications, always administer meropenem after the dialysis session completes. 5 This approach:
- Prevents loss of medication during dialysis 1
- Ensures the full therapeutic dose is retained 5
- Allows for easier medication supervision and adherence monitoring 5
- Follows established hemodialysis medication management principles 5
Monitoring Requirements
Given the risk of central nervous system toxicity, particularly seizures, closely monitor for neurological symptoms including confusion, myoclonus, or seizure activity, especially after multiple doses. 4 If any neurological symptoms develop, discontinue meropenem immediately. 4
Plasma drug concentration monitoring should be considered to avoid toxicity, particularly in patients with additional risk factors such as low body weight or Asian ethnicity. 2, 4
Common Pitfall to Avoid
Do not use the standard 1-2 g every 8 hours dosing regimen used in patients with normal renal function, as this will lead to dangerous drug accumulation and significantly increased seizure risk. 2, 1 The dosing interval must be extended in direct proportion to the decline in creatinine clearance. 1