Sask.

Parenteral Manual - ADULT meropenem

Disclaimer: Official controlled document is the Sask Parenteral Manual - Adult online copy. The user should ensure that
any paper copy version is the same as the online version before use.

OTHER NAMES CLASSIFICATION pH 7.3 to 8.3 ALLERGY ALERT

Merrem Antibiotic - carbapenem, beta-lactam See Contraindications/Cautions
INDICATIONS FOR IV USE
1
HEALTH CANADA APPROVED
 Treatment of various infections due to susceptible organisms, including the following: lower respiratory tract, skin and
soft tissue, intra-abdominal, gynecological, meningitis and bacteremia

CONTRAINDICATIONS
 Hypersensitivity to meropenem, any component of formulation or other carbapenem antibiotics e.g. imipenem,
ertapenem

CAUTIONS
 Previous hypersensitivity to penicillins or cephalosporins
 Compromised renal function and/or CNS lesions; potential to cause seizures
1

DRUG – DRUG INTERACTION

 Valproic acid serum concentrations may be reduced to subtherapeutic levels, resulting in a loss of seizure control.
Monitor valproic acid levels. Consider alternative antibacterial therapy. If administration of meropenem is necessary,
1
supplemental anticonvulsant therapy should be considered
 PREGNANCY/BREAST FEEDING: Consult pharmacy or specialised on-line references for most recent information

ADMINISTRATION
In order to administer a medication in the Sask. Parenteral Manual-ADULT you must be able to meet the
“REQUIREMENTS” and “MONITORING REQUIRED” sections within the monograph. If you are unable to meet
these parameters, contact the Most Responsible Physician for further direction (e.g. higher level of care needed).
DIRECT IV INTERMITTENT INFUSION CONTINUOUS INFUSION
MODE
YES YES YES
Dilute 500mg in 50 mL minibag; NS preferred
1g and 2g in 100 mL NS

Max. conc: 20 mg/mL Dilute 1 g in 100 mL NS

Doses of 1 g or less 3 g/24 h: give as 3 sequential 1 g over 8 h
ADULT 2 Infuse over 20 minutes
over 3 to 5 minutes 4 g/24 h: give as 4 sequential 1 g over 6 h
5,6
extended to over 3 hours; see DOSE See COMPATIBILITY and DOSE
Adult Syringe Driver, where available/applicable
See Regional Syringe Driver prep chart for
guidelines.
REQUIRE
- MENTS None
MONITORING
REQUIRED
 None

RECOMMENDED
 None

RECONSTITUTION

1
Vials may be reconstituted with sterile water, NS or D5W . A reconstitution device may be used
 Volume of diluent required may vary with brand. See vial for exact volume of diluent and resulting concentration

Sask. Parenteral Manual - ADULT Revised: November 2018

Page 1 of 4
Sask. Parenteral Manual - ADULT meropenem
Disclaimer: Official controlled document is the Sask Parenteral Manual - Adult online copy. The user should ensure that
any paper copy version is the same as the online version before use.

COMPATIBILITY/STABILITY3
 Must consider meropenem’s limited room temperature stability if using extended or continuous infusions

4
Stable in NS (1 to 20 mg/mL) for at least 8 hours at room temperature and 24 hours in the refrigerator

4
Stable in D5W (1 to 20 mg/mL) for at least 3 hour at room temperature and 6 hours in the refrigerator
 Compatible with dextrose, saline, dextrose-saline combinations, Ringer's and lactated Ringer's solution

1
Vials reconstituted with SWFI or NS are stable for 3 hours at room temperature and at least 16 hours in the refrigerator
 Vials reconstituted with D5W are stable for 1 hour at room temperature and 8 hours in the refrigerator
 For drug-drug compatibility, consult pharmacy or specialised on-line references

ADVERSE EFFECTS1
LOCAL REACTIONS
 Inflammation at injection site, thrombophlebitis
HYPERSENSITIVITY
 Anaphylaxis, including bronchospasm and hypotension (rare)
 Urticaria, pruritus
GASTROINTESTINAL
 Nausea and vomiting, diarrhea
 Pseudomembranous colitis (rare)
MISCELLANEOUS
 Headache, rash
 Seizures

DOSE
ADULT
 500 mg every 6 hours or 1 g every 8 hours
4

 Max: 2 g every 8 hour

1

 Extended infusion method: Dose can be given over 3 hours vs 20 minutes

2,6,7

 Continuous infusion: 3 to 4 g total daily dose over 24 hours. Give as sequential 1 g doses infused over 8 or 6 hours as
. 8-11
appropriate due to limited stability Consider an initial 1 g load over 30 minutes prior to starting continuous infusion
ELDERLY
 No specific dosage adjustment required other than for age-related renal impairment
2

15
RENAL IMPAIRMENT ADJUSTMENTS
Creatinine clearance (mL/minute)

greater than 50 26 to 50 10 to 25 less than 10

500 mg q6h 500 mg q8h 500 mg q12h 500 mg q24h
1 to 2 g q8h 1 to 2 g q12h 1 to 2 g q12h 500 mg q24h

HEPATIC IMPAIRMENT ADJUSTMENTS

1
None required as long as renal function is normal

6
HEMO/PERITONEAL DIALYSIS
 Is removed by hemodialysis: 500 mg to 1 g q24h Administer post dialysis
16 16

 CAPD: is dialysed: 500 mg q24h

17

MISCELLANEOUS
IM or subcutaneous use: no information available at this time

Sask. Parenteral Manual - ADULT Revised: November 2018

Page 2 of 4
meropenem - references

1. Merrem [Product Monograph], Mississauga, ON: AstraZeneca Canada, Inc.; Jun 2017.
TM TM
2. Meropenem In: Lexi-Comp Online , Lexi-Drugs Online , Hudson, Ohio: Lexi-Comp, Inc.; [cited 2017 Nov].
th
3. Meropenem In: Trissel LA, editor. Handbook of injectable drugs. 16 ed. Bethesda, MD: American Society of
Hospital Pharmacists; 2011:p. 1010-1017.

4. Patel PR, Cook SE. Stability of meropenem in intravenous solutions. Am J Health Syst Pharm. 1997 Feb
15;54(4):412-21. PubMed PMID: 9043564.

5. Meropenem [Antibiotics: Antimicrobial Dosing Guide and Daily Costs : Adult Dosing Guide and Daily Costs :
Carbapenems] In: Blondel-Hill E, Fryters S. editors. Bugs and Drugs. Alberta Health Services. Edmonton. AB:
2017: on line version. Available at http://www.bugsanddrugs.org/ [cited 2017 Nov].

6. Dow RJ, Rose WE, Fox BC, Thorpe JM, Fish JT. Retrospective study of prolonged versus intermittent infusion
piperacillin–tazobactam and meropenemin intensive care unit patients at an academic medical center. Infect Dis
Clin Pract 2011;19:413–7.

7. Wang D. Experience with extended-infusion meropenem in the management of ventilator-associated pneumonia

due to multidrug-resistant Acinetobacter baumannii. Int J Antimicrob Agents. 2009 Mar;33(3):290-1.

8. Chytra I, Stepan M, Benes J, Pelnar P, Zidkova A, Bergerova T, Pradl R, Kasal E. Clinical and microbiological
efficacy of continuous versus intermittent application of meropenem in critically ill patients: a randomized open-label
controlled trial. Critical care. 2012 Jun;16(3):R113.

9. Dulhunty JM, Roberts JA, Davis JS, Webb SA, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J,
Paterson DL, Lipman J. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind,
randomized controlled trial. Clin Infect Dis. 2013 Jan;56(2):236-44. Epub 2012 Oct 16.

10. Lorente L, Lorenzo L, Martín MM, Jiménez A, Mora ML. Meropenem by continuous versus intermittent infusion in
ventilator-associated pneumonia due to gram-negative bacilli. Ann Pharmacother. 2006 Feb;40(2):219-23. Epub
2006 Jan 31.

11. Roberts JA, Kirkpatrick CM, Roberts MS, Robertson TA, Dalley AJ, Lipman J. Meropenem dosing in critically ill
patients with sepsis and without renal dysfunction: intermittent bolus versus continuous administration? Monte
Carlo dosing simulations and subcutaneous tissue distribution. J Antimicrob Chemother. 2009 Jul;64(1):142-50.
Epub 2009 Apr 27.

12. Meropenem In: BC Children’s and Women’s Hospital (C&W) Online Formulary. Pediatric Drugs, Vancouver, BC:
BC Children’s and Women’s Hospital; [cited 2017 Nov].

13. Meropenem In: BC Children’s and Women’s Hospital (C&W) Online Formulary. Neonatal Drugs, Vancouver, BC:
BC Children’s and Women’s Hospital; [cited 2017 Nov].
® rd
14. Young TE, Mangum B, editors. Neofax 2010: A manual of drugs used in neonatal care. 23 ed. Raleigh: Acorn;
2010 p. 60-61.

15. Meropenem [Antibiotics : Adult Dosing Recommendations in Renal Impairment : Carbapenems] In: Blondel-Hill E,
Fryters S. editors. Bugs and Drugs. Alberta Health Services. Edmonton. AB: 2017: on line version. Available at
http://www.bugsanddrugs.org/ [cited 2017 Nov].

16. Kwok P, Leung M. Dialyze-IHD. Dialyzability of medications in patients undergoing intermittent hemodialysis.
Vancouver, BC. [cited 2017 Nov] Available at : http://www.dialyzeihd.com/
th
17. Ashley C and Dunleavy A. editors. UK Renal Pharmacy Group. The Renal Drug handbook. 4 ed. London;
Radcliffe Publishing; 2014. p 598.

Sask. Parenteral Manual - ADULT Revised: November 2018

Page 3 of 4
REVISION REVISED Second
REVISION SUMMARY: Check By:
DATE: BY:
December Removed any references to pediatric or neonate. Added “Adult Syringe Dose” under SM
2015 Intermittent Infusion
January Changed intermittent infusion values in Admin section. ??
2016
January Continuous Infusion is not a selection in drug library-removed “Dilute ½ the daily dose in 500 JP
2016 mL NS Infuse over 12 hours”
February Added: Disclaimer: Official controlled document is the Sask Parenteral Manual - Adult online BJ, 3SH
2016 copy. The user should insure that any paper copy version is the same as the online version
before use. Insert link
November Edit administration clause as per DLWG. Remove “insert link” from disclaimer. Add page CS – Sask
2016 numbers. Reword Admin to “Adult Syringe Driver, where available/applicable. See Regional Smart Pump
Program.
Syringe Driver prep chart for guidelines.”
February Grammatical changes. Format changes to align with Sask manual template. CS – Sask
2017 Smart Pump
Program.
May 2018 Monograph updated as per VIHA update (November 2017) TB – Sask. CD –CNES
Smart Pump SHA
Program
AP – CNE
SHA
November 1. Monograph updated as per VIHA update (May 2018) TB – Sask. CD – CNES
2018 Smart Pump SHA
2. Monograph updated to included continuous infusion as per the IVFMT Program

Sask. Parenteral Manual - ADULT Revised: November 2018

Page 4 of 4