Meropenem (Monograph)

Brand name: Merrem

Drug class: Carbapenems
Chemical name: [4R-[3(3S*,5S*),4α,5β,6β(R)]]-3-[[5- [(Dimethylamino)carbonyl]-3-
pyrrolidinyl]thio]-6-(1-hydroxyethyl)-4-methyl-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-2-
carboxylic acid trihydrate
Molecular formula: C17H25N3O5S•3H2OC17H25N3O5S
CAS number: 119478-56-7
Medically reviewed by Drugs.com on Jun 30, 2023. Written by ASHP.

 Introduction
 Uses
 Dosage
 Warnings
 Interactions
 Stability

Introduction
Antibacterial; carbapenem β-lactam antibiotic.

Uses for Meropenem

Intra-abdominal Tract Infections
Treatment of intra-abdominal infections (complicated appendicitis, peritonitis)
caused by susceptible viridans streptococci, Escherichia coli, Klebsiella
pneumonia, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron,
or Peptostreptococcus.

Has a broad spectrum of antibacterial activity against both aerobes and

anaerobes; may be used empirically to treat intra-abdominal infections before
identification of the causative organism.
For immunosuppressed patients or those with severe intra-abdominal infections,
IDSA recommends an initial empiric regimen with broad spectrum of activity such
as meropenem or imipenem; a third or fourth generation cephalosporin
(cefepime, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone) in conjunction with
metronidazole; ciprofloxacin in conjunction with metronidazole; piperacillin-
tazobactam; or aztreonam in conjunction with metronidazole. For mild to
moderate community-acquired intra-abdominal infections, IDSA recommends an
initial empiric regimen with narrower spectrum of activity such as ampicillin-
sulbactam; cefazolin or cefuroxime in conjunction with metronidazole; ticarcillin-
clavulanate; ertapenem; or a fluoroquinolone (ciprofloxacin, gatifloxacin,
levofloxacin, moxifloxacin) in conjunction with metronidazole.

For postoperative (nosocomial) intra-abdominal infections, IDSA recommends

the empiric regimen be selected based on local nosocomial susceptibility
patterns; these infections usually require treatment with multiple-drug regimens
and often involve resistant organisms.

Meningitis
Treatment of bacterial meningitis caused by susceptible Streptococcus
pneumoniae, Haemophilus influenzae (including β-lactamase-producing strains),
or Neisseria meningitidis in children ≥3 months of age. Also has been used for
treatment of meningitis in adults† [off-label].

Efficacy for treatment of meningitis caused by highly penicillin- or cephalosporin-

resistant S. pneumoniae has not been established.

Can be used as monotherapy for meningitis caused by susceptible

bacteria. Although not usually considered initial drug of choice, recommended as
an alternative in children and adults for treatment of meningitis caused by S.
pneumoniae or H. influenzae. Also may be useful for meningitis caused by
susceptible gram-negative bacteria (e.g., Enterobacter† [off-label], Citrobacter† [off-
label]
, Serratia marcescens† [off-label]) resistant to usually recommended regimens.

Respiratory Tract Infections

Treatment of respiratory tract infections† [off-label], including community-acquired
pneumonia (CAP) and nosocomial pneumonia.

ATS, IDSA, and others consider meropenem an alternative, not a drug of first
choice, for empiric treatment of CAP† caused by S. pneumoniae. ATS and IDSA
suggest the drug be reserved for when CAP may be caused by Ps.
aeruginosa, Klebsiella, or other gram-negative bacteria. Also may be considered
when anaerobes are known or suspected to be involved.

A drug of choice for empiric treatment of nosocomial pneumonia†. ATS, IDSA,

and others recommend an antipseudomonal cephalosporin (cefepime,
ceftazidime), antipseudomonal penicillin (piperacillin-tazobactam, ticarcillin-
clavulanate), or antipseudomonal carbapenem (imipenem or meropenem) for
initial therapy of hospital-acquired pneumonia, ventilator-associated pneumonia,
or health-care associated pneumonia because these drugs have broad spectrum
of activity against gram-positive, gram-negative, and anaerobic bacteria. In
severely ill patients or in those with late-onset disease or risk factors for
multidrug-resistant bacteria, initial regimen should also include an
aminoglycoside (amikacin, gentamicin, tobramycin) or antipseudomonal
fluoroquinolone (ciprofloxacin or levofloxacin) to improve coverage
against Pseudomonas. In hospitals where oxacillin-resistant (methicillin-
resistant) Staphylococcus are common or if there are risk factors for these
strains, the initial regimen also should include vancomycin or linezolid. In
hospitals where multidrug-resistant Ps. aeruginosa are frequent causes of
nosocomial pneumonia, an initial regimen of cefepime or a carbapenem
(imipenem or meropenem) in conjunction with an aminoglycoside is
recommended.

Septicemia
Treatment of septicemia† caused by susceptible bacteria.

Skin and Skin Structure Infections

Treatment of complicated skin and skin structure infections caused by
susceptible S. aureus (including β-lactamase-producing strains, but not oxacillin-
resistant [methicillin-resistant] strains), S. pyogenes (group A β-hemolytic
streptococci), S. agalactiae (group B streptococci), viridans
streptococci, Enterococcus faecalis (not vancomycin-resistant strains), Ps.
aeruginosa, E. coli, Proteus mirabilis, B. fragilis, or Peptostreptococcus.

Urinary Tract Infections

Treatment of complicated urinary tract infections† caused by susceptible bacteria.
Acinetobacter Infections
Treatment of infections caused by Acinetobacter†; a drug of choice used with or
without an aminoglycoside.

Anthrax
Recommended as one of several anti-infectives that can be included in multiple-
drug regimens used for the treatment of anthrax†, including inhalational anthrax
and anthrax meningitis.

Has in vitro activity against Bacillus anthracis; data not available regarding in vivo
activity.

Bacillus Infections
Treatment of infections caused by Bacillus cereus†. Vancomycin considered drug
of choice; carbapenems (imipenem or meropenem) or clindamycin are
alternatives.

Burkholderia Infections
Treatment of melioidosis† caused by Burkholderia pseudomallei. Severe illness
requires an initial parenteral regimen of ceftazidime, imipenem, or meropenem
(with or without concomitant co-trimoxazole or doxycycline), followed by a
prolonged oral maintenance regimen of co-trimoxazole in conjunction with
doxycycline or amoxicillin-clavulanate.

Treatment of glanders† caused by B. mallei. Experience is limited regarding

treatment of human cases; optimum regimens not identified. Some clinicians
suggest streptomycin used in conjunction with tetracycline or chloramphenicol or
imipenem monotherapy. Others suggest that, pending results of in vitro
susceptibility tests, regimens used for treatment of melioidosis can be used for
initial empiric treatment of glanders.

The US Army Medical Research Institute of Infectious Diseases (USAMRIID) and

European Commission’s Task Force on Biological and Chemical Agent Threats
(BICHAT) state that the same treatment regimens recommended for naturally
occurring melioidosis or glanders should be used if these Burkholderia infections
occur in the context of biologic warfare or bioterrorism. These experts suggest
that postexposure prophylaxis with doxycycline or co-trimoxazole for ≥10 days
can be attempted in such situations, but is of unproven benefit.

Campylobacter Infections
Treatment of systemic infections caused by Campylobacter fetus†; a drug of
choice.

Capnocytophaga Infections
Treatment of infections caused by Capnocytophaga canimorsus†.

Optimum regimens for treatment of Capnocytophaga infections not identified;

some clinicians recommend use of penicillin G or, alternatively, a third generation
cephalosporin (cefotaxime, ceftizoxime, ceftriaxone), a carbapenem (imipenem
or meropenem), vancomycin, a fluoroquinolone, or clindamycin.

Clostridium Infections
Treatment of infections caused by Clostridium perfringens†; alternative to
penicillin G for those with penicillin hypersensitivity or for polymicrobial infections.

Nocardia Infections
Treatment of infections caused by Nocardia†. Co-trimoxazole usually drug of first
choice; alternatives include sulfisoxazole, a tetracycline (e.g., doxycycline,
minocycline), a carbapenem (imipenem or meropenem), amikacin, ceftriaxone,
amoxicillin-clavulanate, cycloserine, or linezolid.

Rhodococcus Infections
Treatment of infections caused by Rhodococcus equi†. Optimum regimens not
identified; combination regimens usually recommended, including vancomycin
given with a fluoroquinolone, rifampin, a carbapenem (imipenem or meropenem),
or amikacin.

Empiric Therapy in Febrile Neutropenic Patients

Empiric anti-infective therapy of presumed bacterial infections in febrile
neutropenic patients†. Used alone or in conjunction with other anti-infectives.

Consult published protocols for the treatment of infections in febrile neutropenic

patients for specific recommendations regarding selection of the initial empiric
regimen, when to change the initial regimen, possible subsequent regimens, and
duration of therapy in these patients. Consultation with an infectious disease
expert knowledgeable about infections in immunocompromised patients also is
advised.

Meropenem Dosage and Administration

Administration
Administer by IV injection or infusion.

For solution and drug compatibility information, see Compatibility under Stability.

IV Injection

Reconstitution
Reconstitute single-use vials containing 500 mg or 1 g with 10 or 20 mL,
respectively, of sterile water for injection to provide a solution containing
approximately 50 mg/mL. The vial should be shaken until dissolution occurs and
then allowed to stand until the solution is clear.

Rate of Administration
The appropriate dose of reconstituted solution should be injected over a period of
3–5 minutes.

IV Infusion

Reconstitution and Dilution

Reconstitute infusion vials containing 500 mg or 1 g with a compatible IV solution
(e.g., 0.9% sodium chloride, 5% dextrose) to provide solutions containing
approximately 2.5–50 mg/mL. Alternatively, reconstitute vials containing 500 mg
or 1 g with 10 or 20 mL, respectively, of sterile water for injection and then further
dilute in a compatible IV.
 Rate of Administration
Infuse IV over 15–30 minutes.

Dosage
Available as the trihydrate; dosage expressed in terms of anhydrous
meropenem.

To minimize risk of seizures, closely adhere to dosage recommendations,

especially in patients with factors known to predispose to seizure activity; dosage
adjustment recommended for patients with advanced age and/or renal
impairment.

Anticonvulsant therapy should be continued in patients with existing seizure

disorders. (See CNS Effects under Cautions.)

Detailed Meropenem dosage information

Cautions for Meropenem

Contraindications
 Known hypersensitivity to meropenem, other carbapenems, or any ingredient in
the formulation.
 History of anaphylactic reaction to β-lactams.

Warnings/Precautions
Warnings

Superinfection/Clostridium difficile-associated Colitis

Possible emergence and overgrowth of nonsusceptible organism. Careful
observation of the patient is essential. Institute appropriate therapy if
superinfection occurs.

Treatment with anti-infectives may permit overgrowth of

clostridia. Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-
associated pseudomembranous colitis) if diarrhea develops and manage
accordingly.

Some mild cases of C. difficile-associated diarrhea and colitis may respond to

discontinuance alone. Manage moderate to severe cases with fluid, electrolyte,
and protein supplementation; appropriate anti-infective therapy (e.g., oral
metronidazole or vancomycin) recommended if colitis is severe.

CNS Effects
Seizures and other CNS effects reported, especially in those with CNS disorders
(e.g., brain lesions, history of seizures) or with bacterial meningitis and/or renal
impairment.

Do not exceed recommended dosage, especially in those with known factors that
predispose to seizures. Anticonvulsant therapy should be continued in those with
known seizure disorders.

If focal tremors, myoclonus, or seizures occur, evaluate the patient

neurologically, initiate anticonvulsant therapy if necessary, and determine
whether meropenem dosage should be decreased or the drug discontinued.

Sensitivity Reactions

Hypersensitivity Reactions
Serious and occasionally fatal hypersensitivity reactions (e.g., anaphylaxis)
reported with β-lactams.

If hypersensitivity occurs, discontinue meropenem and institute appropriate

therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an
adequate airway and oxygen).

Cross-hypersensitivity
Partial cross-allergenicity among β-lactam antibiotics, including penicillins,
cephalosporins, and other β-lactams.

Prior to initiation of therapy, make careful inquiry concerning previous

hypersensitivity reactions to meropenem, cephalosporins, penicillins, or other
drugs.
General Precautions

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of
meropenem and other antibacterials, use only for treatment or prevention of
infections proven or strongly suspected to be caused by susceptible bacteria.

When selecting or modifying anti-infective therapy, use results of culture and in

vitro susceptibility testing. In the absence of such data, consider local
epidemiology and susceptibility patterns when selecting anti-infectives for empiric
therapy.

Laboratory Monitoring
Periodically assess organ system functions, including renal, hepatic, and
hematopoietic, during prolonged therapy.

Sodium Content
Each g of meropenem contains 3.92 mEq (90.2 mg) of sodium as sodium
carbonate.

Specific Populations

Pregnancy
Category B.

Lactation
Not known whether distributed into milk. Use with caution.

Pediatric Use
Safety and efficacy not established in children <3 months of age.

Geriatric Use
No substantial differences in safety and efficacy relative to younger adults, but
increased sensitivity cannot be ruled out.
 Substantially eliminated by kidneys; risk of toxicity may be greater in patients with
impaired renal function. Select dosage with caution and assess renal function
periodically since geriatric patients are more likely to have renal impairment.

No dosage adjustments except those related to renal function. (See Renal

Impairment under Dosage and Administration.)

Hepatic Impairment
Pharmacokinetics not affected by hepatic impairment; dosage adjustments not
required.

Renal Impairment
Decreased clearance. Dosage adjustments recommended in patients with
Clcr ≤50 mL/minute. (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

GI effects (diarrhea, nausea, vomiting, constipation), local reactions (pain and
inflammation at injection site, phlebitis/thrombophlebitis), headache, anemia,
rash, pruritus, sepsis, apnea, shock, glossitis, oral candidiasis.

Interactions for Meropenem

Specific Drugs
Drug Interaction Comments

Aminoglycosides In vitro evidence of synergistic antibacterial effects against Ps. aeruginosa

Probenecid Decreased renal tubular secretion of meropenem; increased meropenem Concomitant use not
concentrations and AUC and prolonged half-life recommended

Valproic acid Valproic serum concentrations may be decreased to subtherapeutic Use concomitantly with
concentrations; possible increased risk of seizures caution
Meropenem drug interactions (more detail)

Meropenem Pharmacokinetics
Distribution
Extent
Well distributed into body tissues and fluids, including bronchial mucosa, lung,
bile, gynecologic tissue (endometrium, myometrium, ovary, cervix, fallopian
tube), muscle, heart valves, skin, and interstitial and peritoneal fluid.

Distributed into CSF.

Plasma Protein Binding

Approximately 2%.

Elimination
Metabolism
Partially metabolized; at least 1 metabolite is microbiologically active.

Elimination Route
Eliminated in urine as unchanged drug. 70% of an IV dose eliminated in urine as
unchanged drug.

Half-life
Adults with normal renal function: approximately 1 hour.

Children 3 months to 2 years of age: approximately 1.5 hours.

Special Populations
Pharmacokinetics not affected by hepatic impairment.

Decreased clearance in patients with renal impairment.

Stability
Storage
Parenteral

Powder for Injection

20–25°C. Do not freeze reconstituted or diluted solutions.

Solutions for IV injection containing approximately 50 mg/mL prepared using

water for injection are stable for 2 hours at 15–25°C or 12 hours at 4°C.

Solutions for IV infusion containing 2.5–50 mg/mL prepared using 0.9% sodium
chloride are stable for up to 2 hours at 15–25°C or 18 hours at 4°C; those
prepared using 5% dextrose are stable for up to 1 hour at 15–25°C or 8 hours at
4°C.

Compatibility
For information on systemic interactions resulting from concomitant use, see
Interactions.

Parenteral

Solution CompatibilityHID

Incompatible (by conventional definition, but recommended for dilution with use in shorter periods of time)

Dextrose 5% with potassium chloride 0.15%

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% with sodium bicarbonate 0.02%

Dextrose 2.5% in sodium chloride 0.45%

Dextrose 5% in sodium chloride 0.2 or 0.9%

Dextrose 5 or 10% in water

Mannitol 2.5 or 10%

Normosol M with dextrose 5%

Ringer’s injection

Ringer’s injection, lactated

Sodium bicarbonate 5%

Sodium chloride 0.45%

Sodium lactate 1/6 M

Variable

Sodium chloride 0.9%

Drug Compatibility

Admixture CompatibilityHID

Compatible

Aminophylline

Atropine sulfate

Dexamethasone sodium phosphate

Dobutamine HCl

Dopamine HCl

Enalaprilat

Fluconazole

Furosemide

Gentamicin sulfate

Heparin sodium

Insulin, regular

Magnesium sulfate

Metoclopramide HCl

Morphine sulfate

Norepinephrine bitartrate

Phenobarbital sodium

Ranitidine HCl
Vancomycin HCl

Incompatible

Amphotericin B

Multivitamins

Variable

Acyclovir sodium

Doxycycline hyclate

Ondansetron HCl

Zidovudine

Y-Site CompatibilityHID

Compatible

Aminophylline

Anidulafungin

Atropine sulfate

Caspofungin acetate

Cyclosporine

Dexamethasone sodium phosphate

Digoxin

Diphenhydramine HCl

Docetaxel

Enalaprilat

Fluconazole

Furosemide

Gentamicin sulfate

Heparin sodium
 Insulin, regular

Linezolid

Metoclopramide HCl

Milrinone lactate

Morphine sulfate

Norepinephrine bitartrate

Phenobarbital sodium

Potassium chloride

Telavancin HCl

Vancomycin HCl

Vasopressin

Incompatible

Amphotericin B

Diazepam

Variable

Acyclovir sodium

Calcium gluconate

Doxycycline hyclate

Ondansetron HCl

Zidovudine

Actions and Spectrum

 Synthetic carbapenem β-lactam antibiotic; structurally and pharmacologically
related to imipenem and ertapenem.
 Usually bactericidal in action.
 Like other β-lactam antibiotics, antibacterial activity results from inhibition of
bacterial cell wall synthesis.
 Spectrum of activity includes many gram-positive and -negative aerobic bacteria
and some gram-positive and -negative anaerobic bacteria. Stable in the
presence of a variety of β-lactamases (including penicillinases,
cephalosporinases, and extended-spectrum β-lactamases).
 Gram-positive aerobes: Active in vitro and in clinical infections
against Streptococcus pneumoniae (penicillin-susceptible strains only) and
viridans streptococci. Also active in vitro against Staphylococcus aureus and S.
epidermidis. Oxacillin-resistant (methicillin-resistant) staphylococci are resistant.
 Gram-negative aerobes: Active in vitro and in clinical infections
against Escherichia coli, Haemophilus influenzae (including β-lactamase-
producing strains), Klebsiella pneumoniae, Neisseria
meningitidis and Pseudomonas aeruginosa. Also active in vitro
against Acinetobacter, Aeromonas hydrophila, Campylobacter
jejuni, Citrobacter, Enterobacter, H. influenzae (ampicillin-resistant, non-β-
lactamase-producing strains; BLNAR), Havnia alvei, K. oxytoca, Moraxella
catarrhalis, Morganella morganii, Pasteurella multocida, Proteus mirabilis, P.
vulgaris, Salmonella, Shigella, Serratia marcescens, and Yersinia enterocolitica.
 Anaerobes: Active in vitro and in clinical infections against Bacteroides fragilis, B.
thetaiotaomicron, and Peptostreptococcus. Also active in vitro against B.
distasonis, B. ovatus, B. uniformis, B. ureolyticus, B. vulgatus, Clostridium
difficile, C. perfringens, Eubacterium lentum, Fusobacterium, Prevotella bivia, P.
intermedia, P. melaninogenica, Porphyromonas asaccharolytica,
and Propionibacterium acnes.

Advice to Patients
 Advise patients that antibacterials (including meropenem) should only be used to
treat bacterial infections and not used to treat viral infections (e.g., the common
cold).
 Importance of completing full course of therapy, even if feeling better after a few
days.
 Advise patients that skipping doses or not completing the full course of therapy
may decrease effectiveness and increase the likelihood that bacteria will develop
resistance and will not be treatable with meropenem or other antibacterials in the
future.
 Importance of informing clinicians of other medical conditions, including history of
seizures.
 Importance of discontinuing therapy and informing clinician if an allergic or
hypersensitivity reaction occurs.
 Importance of informing clinicians of existing or contemplated concomitant
therapy, including prescription and OTC drugs.
 Importance of women informing clinicians if they are or plan to become pregnant
or plan to breast-feed.
 Importance of informing patients of other important precautionary
information. (See Cautions.)

Preparations
Excipients in commercially available drug preparations may have clinically
important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on
shortages of one or more of these preparations.

Meropenem (Trihydrate)

Routes Dosage Forms Strengths Brand Names Manu

Parenteral For injection, for IV use only 500 mg (of anhydrous meropenem) Merrem I.V. Astra

1 g (of anhydrous meropenem) Merrem I.V. Astra

AHFS DI Essentials™. © Copyright 2023, Selected Revisions July 10, 2013. American
Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900,
Bethesda, Maryland 20814.

Pediatric Patients

Intra-abdominal Infections

IV
Children ≥3 months of age weighing ≤50 kg: 20 mg/kg (up to 1 g) every 8 hours.

Children ≥3 months weighing >50 kg: 1 g every 8 hours.

Meningitis

IV
Children ≥3 months of age weighing ≤50 kg: 40 mg/kg (up to 2 g) every 8 hours.
Children ≥3 months weighing >50 kg: 2 g every 8 hours.

Skin and Skin Structure Infections

IV
Children ≥3 months of age weighing ≤50 kg: 10 mg/kg (up to 500 mg) every 8
hours.

Children ≥3 months weighing >50 kg: 500 mg every 8 hours.

Burkholderia Infections†

Initial Treatment of Severe Disease†

IV
Children ≥3 months of age weighing ≤40 kg: 10–20 mg/kg every 8 hours.

Children ≥3 months weighing >40 kg: use adult dosage.

Initial IV regimen continued for ≥14 days and until clinical improvement
occurs. When appropriate, switch to a prolonged oral maintenance regimen (e.g.,
co-trimoxazole with doxycycline, amoxicillin-clavulanate). Lifelong follow-up
recommended for all patients to identify relapse.

Adults

Intra-abdominal Infections

IV
1 g every 8 hours.

Meningitis†

IV
6 g daily. Dosage of 40 mg/kg every 8 hours (up to 6 g daily) has been used in
conjunction with ceftriaxone or cefotaxime.

Respiratory Tract Infections†

Nosocomial Pneumonia†
IV
1 g every 8 hours.

Skin and Skin Structure Infections

IV
500 mg every 8 hours.

Burkholderia Infections†

Initial Treatment of Severe Disease†

IV
25 mg/kg IV every 8 hours (up to 6 g daily) recommended by USAMRIID and
others; concomitant co-trimoxazole (8 mg/kg of trimethoprim daily given IV in 4
divided doses) also may be indicated. Other clinicians recommend 0.5–1 g every
8 hours with or without co-trimoxazole.

Initial IV regimen continued for ≥14 days and until clinical improvement
occurs. When appropriate, switch to a prolonged oral maintenance regimen (e.g.,
co-trimoxazole with doxycycline, amoxicillin-clavulanate). Lifelong follow-up
recommended for all patients to identify relapse.

Prescribing Limits
Pediatric Patients

IV
2 g every 8 hours.

Special Populations
Hepatic Impairment
Dosage adjustments not required.

Renal Impairment
Dosage adjustments recommended in adults with Clcr ≤50 mL/minute. Data
insufficient to make dosage recommendations for pediatric patients with renal
impairment.

Dosage for Adults with Renal Impairment1

Clcr (mL/min) Daily Dosage

26–50 usual dose every 12 hours

10–25 50% of usual dose every 12 hours

<10 50% of usual dose once every 24 hours

Manufacturer states data insufficient to make dosage recommendations in

patients undergoing hemodialysis or peritoneal dialysis. Meropenem removed by
hemodialysis; some clinicians suggest that supplemental doses be given after
each hemodialysis session. Also removed by various forms of continuous renal
replacement therapy, including continuous venovenous hemodiafiltration
(CVVHDF), continuous venovenous hemofiltration (CVVHF), and continuous
ambulatory peritoneal dialysis (CAPD). To avoid inadequate concentrations in
anuric patients undergoing these procedures, some clinicians suggest dosage
adjustments are necessary and should be based on characteristics of the specific
procedure (e.g., filter or membrane type, amount of filtrate produced, dialysate
flow rate).

Geriatric Patients
No dosage adjustments except those related to renal impairment. (See Renal
Impairment under Dosage and Administration.)