Meropenem Dosing in Hemodialysis Patients
Administer meropenem 500 mg immediately after each hemodialysis session to prevent drug removal during dialysis and ensure adequate therapeutic levels.
Timing of Administration
The critical principle is to give meropenem after hemodialysis is completed, not before. 1, 2
- Hemodialysis removes approximately 50% of meropenem from the bloodstream, significantly reducing drug exposure 3
- When meropenem infusion is completed right before dialysis initiation, substantial drug removal occurs, leading to subtherapeutic levels and potential treatment failure 4
- Post-dialysis administration prevents premature drug removal and maintains adequate peak concentrations needed for bacterial killing 1, 2
Recommended Dosing Regimen
For patients on intermittent hemodialysis (typically 3 times weekly):
- Dose: 500 mg intravenously after each dialysis session 2
- Frequency: Administered only on dialysis days, immediately following completion of HD 2
- Infusion time: 30 minutes to 3 hours 2, 4
Pharmacokinetic Rationale
The dosing strategy is based on meropenem's altered pharmacokinetics in end-stage renal disease:
- Half-life increases dramatically from 1 hour in healthy individuals to 6.8-13.7 hours in anuric patients 3, 5
- Hemodialysis shortens the elimination half-life from 7.0 hours to 2.9 hours during the dialysis session 2
- Dialysis clearance of meropenem is approximately 79 ml/min, making it readily dialyzable 5
- The extended dosing interval (every 48-72 hours on dialysis days) maintains adequate drug exposure while preventing accumulation 1, 2
Critical Timing Considerations
If pre-dialysis dosing is unavoidable:
- Complete the infusion at least 2 hours before dialysis initiation to allow drug distribution and minimize dialysis-related losses 4
- However, post-dialysis administration remains strongly preferred 1, 2
Safety Monitoring
Important caveat: The standard recommended dose of 500 mg may still carry seizure risk in some hemodialysis patients, particularly those with lower body mass index 6
- Monitor closely for central nervous system toxicity including confusion, myoclonus, or seizures 6
- Consider therapeutic drug monitoring in critically ill patients to ensure adequate levels without excessive accumulation 1
- If seizures occur, discontinue meropenem immediately 6
Key Pitfall to Avoid
Never administer meropenem immediately before hemodialysis. This timing error results in substantial drug removal during dialysis, leading to inadequate antimicrobial coverage and potential treatment failure 4. The post-dialysis timing is not merely convenient—it is pharmacologically essential for therapeutic efficacy 1, 2.