Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include seizures; slow breathing; tremors.
Proper storage of Tirex:
Tirex is usually handled and stored by a health care provider. If you are using Tirex at home, store Tirex as directed by your pharmacist or health care provider. Keep Tirex out of the reach of children and away from pets.
Overdose of Tirex in details
When a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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In the case of overdosage, discontinue the Imipenem (Tirex)/Cilastatin (Tirex) injection (Tirex), treat symptomatically, and institute supportive measures as required. Imipenem (Tirex)-Cilastatin (Tirex) sodium is hemodialyzable. However, usefulness of this product in the overdosage setting is questionable.
What should I avoid while taking Tirex?
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.
Tirex warnings
Warnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
SERIOUS AND OCCASIONALLY FATAL HYPERSENSITIVITY (anaphylactic) REACTIONS HAVE BEEN REPORTED IN PATIENTS RECEIVING THERAPY WITH BETA-LACTAMS. THESE REACTIONS ARE MORE LIKELY TO OCCUR IN INDIVIDUALS WITH A HISTORY OF SENSITIVITY TO MULTIPLE ALLERGENS. THERE HAVE BEEN REPORTS OF INDIVIDUALS WITH A HISTORY OF PENICILLIN HYPERSENSITIVITY WHO HAVE EXPERIENCED SEVERE REACTIONS WHEN TREATED WITH ANOTHER BETA-LACTAM. BEFORE INITIATING THERAPY WITH PRIMAXIN® I.M. (Imipenem (Tirex) and Cilastatin (Tirex)), CAREFUL INQUIRY SHOULD BE MADE CONCERNING PREVIOUS HYPERSENSITIVITY REACTIONS TO PENICILLINS, CEPHALOSPORINS, OTHER BETA-LACTAMS, AND OTHER ALLERGENS. IF AN ALLERGIC REACTION OCCURS, PRIMAXIN® SHOULD BE DISCONTINUED. SERIOUS ANAPHYLACTIC REACTIONS REQUIRE IMMEDIATE EMERGENCY TREATMENT WITH EPINEPHRINE. OXYGEN, INTRAVENOUS STEROIDS, AND AIRWAY MANAGEMENT, INCLUDING INTUBATION, MAY ALSO BE ADMINISTERED AS INDICATED.
Seizure Potential
Seizures and other CNS adverse experiences, such as myoclonic activity, have been reported during treatment with PRIMAXIN I.M.
Carbapenems, including Imipenem (Tirex), may reduce serum valproic acid concentrations to subtherapeutic levels, resulting in loss of seizure control. Serum valproic acid concentrations should be monitored frequently after initiating carbapenem therapy. Alternative antibacterial or anticonvulsant therapy should be considered if serum valproic acid concentrations drop below the therapeutic range or a seizure occurs.
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including PRIMAXIN I.M., and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD.
Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
Lidocaine HCl - Refer to the package circular for lidocaine HCl.
What should I discuss with my healthcare provider before taking Tirex?
Some medical conditions may interact with Tirex. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to a penicillin antibiotic (eg, amoxicillin) or cephalosporin antibiotic (eg, cephalexin)
if you have kidney, liver, or heart problems; severe high blood pressure; a history of seizures or central nervous system problems (eg, brain lesions); you have been very ill or weakened; or you are in shock
if you are on dialysis
Some MEDICINES MAY INTERACT with Tirex. Tell your health care provider if you are taking any other medicines, especially any of the following:
Ganciclovir because risk of seizures may be increased
Amiodarone, beta-blockers (eg, propranolol), cimetidine, mexiletine, or probenecid because actions and side effects of Tirex, such as heart or nerve toxicity, may be increased
Succinylcholine because actions and side effects may be increased by Tirex
Divalproex sodium or valproic acid because their effectiveness may be decreased by Tirex
Other medicines that may increase your risk of seizures (eg, tramadol) because the risk of seizures may be further increased when combined with Tirex. Ask your doctor or pharmacist if you have questions about whether any of your other medicines may increase your risk of seizures
This may not be a complete list of all interactions that may occur. Ask your health care provider if Tirex may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Tirex precautions
Certain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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General: There is some clinical and laboratory evidence of partial cross-allergenicity between Tirex and the other β-lactam antibiotics, penicillins and cephalosporins. Severe reactions (including anaphylaxis) have been reported with most β-lactam antibiotics. Before therapy with Tirex, careful inquiry should be made concerning previous hypersensitivity reactions to β-lactam antibiotics. If an allergic reaction to Tirex occurs, the drug should be discontinued and appropriate measures undertaken.
Pseudomembranous colitis has been reported with virtually all antibiotics and can range from mild to life-threatening in severity. Antibiotics should, therefore, be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis. It is important to consider a diagnosis of pseudomembranous colitis in patients who develop diarrhea in association with antibiotic use. While studies indicate that a toxin produced by Clostridium difficile is a primary cause of antibiotic-associated colitis, other causes should also be considered.
Central Nervous System: As with other β-lactam antibiotics, CNS side effects eg, myoclonic activity, confusional states, or seizures have been reported with the IV formulation, especially when recommended dosages based on renal function and body weight were exceeded. These experiences have been reported most commonly in patients with CNS disorders (eg, brain lesions or history of seizures) and/or compromised renal function in whom accumulation of the administered entities could occur. Hence, close adherence to recommended dosage schedules is urged, especially in these patients. Anticonvulsant therapy should be continued in patients with a known seizure disorder.
If focal tremors, myoclonus or seizures occur, patients should be evaluated neurologically and placed on anticonvulsant therapy if not already instituted. If CNS symptoms continue, the dosage of Tirex should be decreased or discontinued.
Patients with creatinine clearances of ≤5 mL/min/1.73 m2 should not receive Tirex unless hemodialysis is instituted within 48 hrs. For patients on hemodialysis, Tirex is recommended only when the benefit outweighs the potential risk of seizures.
Use in pregnancy: There are no adequate and well-controlled studies in pregnant women. Tirex should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Use in lactation: Imipenem (Tirex) has been detected in human milk. If the use of Tirex is deemed essential, the patient should stop nursing.
Use in children: Clinical data are insufficient to recommend the use of Tirex for children under 3 months of age, or pediatric patients with impaired renal function (serum creatinine >2 mg/dL).
What happens if I miss a dose of Tirex?
When you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.
If Imipenem (Tirex) and Cilastatin (Tirex) is given in a hospital setting, it is not likely that you will miss a dose. If you are using the medication at home and you miss a dose, give the injection as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
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References
DailyMed. "CILASTATIN SODIUM; IMIPENEM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
DailyMed. "CILASTATIN SODIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
