History of Cerebrovascular Events: A Relative Contraindication to Ertapenem Treatment

Saidel-Odes, Lisa; Borer, Abraham; Riesenberg, Klaris; Smolyakov, Rozalia; Schlaeffer, Francisc

doi:10.1086/505304

Cited by 20 publications

(11 citation statements)

References 8 publications

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“…). The CNS toxicity occurred abruptly after 3–7 consecutive recommended dosages of ertapenem (Table ) in our cases, as in previous reports (Table ). This may be due to anuria and almost exhausted residual renal function in most regular HD patients, leading to very significant decrease in ertapenem clearance and increased risk of accumulation of drugs or toxic metabolites.…”

Section: What Is Newsupporting

confidence: 88%

“…Although 500 mg daily is the recommended dose of ertapenem to avoid CNS toxicity in patients with advanced renal failure /ESRD, the significantly longer half‐life of ertapenem in patients with advanced renal failure /ESRD as compared to healthy adults (14·1 h vs. 4 h) may be the cause of CNS toxicity in previous reports and in our present report (Table , Fig. ).…”

Section: What Is Newmentioning

confidence: 48%

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The recommended dose of ertapenem poses a potential risk for central nervous system toxicity in haemodialysis patients - case reports and literature reviews

Lee

Ueng

et al. 2014

J Clin Pharm Ther

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This is the first report of ertapenem-associated CNS toxicity in patients on regular HD and utilizing the plasma ertapenem concentration to demonstrate the causal relationship. The recommended dosage of 500 mg ertapenem daily may be still too high in regular HD patients, especially in Asians, owing to their relatively small body size. An increased awareness of ertapenem-associated CNS toxicity would avoid unnecessary examinations, hospitalization, and potentially catastrophic complications.

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Section: What Is Newsupporting

confidence: 88%

Section: What Is Newmentioning

confidence: 48%

The recommended dose of ertapenem poses a potential risk for central nervous system toxicity in haemodialysis patients - case reports and literature reviews

Lee

Ueng

et al. 2014

J Clin Pharm Ther

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“…Ertapenem associated seizures were reported in a patient under peritoneal dialysis and classified as possible-related to the antimicrobial treatment, and appeared despite using the recommended doses for patients with advanced renal insufficiency [8]. In another report, 2 patients with known cerebrovascular disease developed seizures during ertapenem therapy [9]. Again, these events happened even when reduced doses were prescribed for concurrent renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Seizures associated with ertapenem use in patients with CNS disorders and renal insufficiency

Fíca

Abusada

2008

Scandinavian Journal of Infectious Diseases

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“…A total of nine reports in the literature are detailed in Table 3. [107][108][109][110][111] Available data for patients with reported seizures deemed drug related during ertapenem clinical studies are also included in Table 3. 92,97,98 The first seizure episode occurred a mean ± SD of 6.7 ± 2.5 days after start of ertapenem therapy.…”

Section: Ertapenemmentioning

confidence: 99%

Epileptogenic Potential of Carbapenem Agents: Mechanism of Action, Seizure Rates, and Clinical Considerations

et al. 2011

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Antimicrobials are the most frequently implicated class of drugs in drug-induced seizure, with β-lactams being the class of antimicrobials most often implicated. The seizure-inducing potential of the carbapenem subclass may be directly related to their β-lactam ring structure. Data on individual carbapenems and seizure activity are scarce. To evaluate the available evidence on the association between carbapenem agents and seizure activity, we conducted a literature search of the MEDLINE (1966-May 2010), EMBASE (1974-May 2010), and International Pharmaceutical Abstracts (1970-May 2010) databases. Reference citations from the retrieved articles were also reviewed. Mechanistically, seizure propensity of the β-lactams is related to their binding to γ-aminobutyric acid (GABA) receptors. There are numerous reports of seizure activity associated with imipenem-cilastatin, with seizure rates ranging from 3-33%. For meropenem, doripenem, and ertapenem, the seizure rate for each agent is reported as less than 1%. However, as their use increases and expands into new patient populations, the rate of seizures with these agents may increase. High-dose therapy, especially in patients with renal dysfunction, preexisting central nervous system abnormalities, or a seizure history increases the likelihood of seizure activity. Although specific studies have not been conducted, data indicate that carbapenem-associated seizure is best managed with benzodiazepines, followed by other agents that enhance GABA transmission. Due to the drug interaction between carbapenems and valproic acid, resulting in clinically significant declines in valproic acid serum concentrations, the combination should be avoided whenever possible. Clinicians should be vigilant regarding the possibility of carbapenem-induced seizures when selecting and dosing antimicrobial therapy.

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History of Cerebrovascular Events: A Relative Contraindication to Ertapenem Treatment

Cited by 20 publications

References 8 publications

The recommended dose of ertapenem poses a potential risk for central nervous system toxicity in haemodialysis patients - case reports and literature reviews

The recommended dose of ertapenem poses a potential risk for central nervous system toxicity in haemodialysis patients - case reports and literature reviews

Seizures associated with ertapenem use in patients with CNS disorders and renal insufficiency

Epileptogenic Potential of Carbapenem Agents: Mechanism of Action, Seizure Rates, and Clinical Considerations

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