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Imipenem

Le informazioni riportate non sono consigli medici e potrebbero non essere accurate. I contenuti hanno solo fine illustrativo e non sostituiscono il parere medico: leggi le avvertenze.
Imipenem
Caratteristiche generali
Formula bruta o molecolareC12H17N3O4S
Massa molecolare (u)299,347 g/mol
Numero CAS74431-23-5
Numero EINECS264-734-5
Codice ATCJ01DH51
PubChem47317
DrugBankDBDB01598
SMILES
CC(C1C2CC(=C(N2C1=O)C(=O)O)SCCN=CN)O
Dati farmacologici
Categoria farmacoterapeuticacarbapenemi
Teratogenicitàno
Modalità di
somministrazione		Intravenosa, intramuscolare
Dati farmacocinetici
Legame proteico20%
Metabolismoepatico
Emivita1 ora
Escrezionerenale
Indicazioni di sicurezza
Frasi H---
Consigli P---[1]
Modifica dati su Wikidata · Manuale

L'imipenem è un antibiotico β-lattamico, appartenente alla classe dei carbapenemi. Il suo utilizzo risale al 1985. È un derivato del farmaco antibiotico carbapenemico tienamicina, dal quale differisce per un gruppo formidoile anziché di un gruppo amminico NH2 libero.

Farmacodinamica

Il principio attivo viene utilizzato in combinazione con la cilastatina sodica, inibitore dell'enzima diidropeptidasi 1, per infezioni nosocomiali gravi causate da ceppi resistenti agli altri antibiotici. L'Imipenem presenta una spiccata resistenza alla β-lattamasi prodotte sia da gram+ sia da gram-. Questo farmaco è attivo su germi aerobi e anaerobi gram+ e gram- come i proteus rettgeri, Morganella, serratia, enterobacter, pseudomonas, quasi tutti gli streptococchi e stafilococchi anche se meticilino resistente, bacterioides, nocardia e listeria. Di particolare interesse è l'efficacia contro acinetobacter e stenotrophomonas resistenti a molti altri antibiotici anche se sono in netto aumento i batteri produttori di carbapenemasi. La resistenza è frequente negli pseudomonas aeruginosa durante la cura grazie alla scomparsa della proteina porinica della membrana esterna.

Farmacocinetica

La farmacocinetica dell'imipenem è del tutto particolare. Infatti a livello renale l'antibiotico viene idrolizzato dalla deidropeptidasi (DHP) con l'apertura dell'anello β-lattamico e la formazione di metaboliti più tossici. Per questa ragione l'imipenem è associato alla cilastatina, inibitore specifico dell'enzima DHP. L'imipenem si somministra per via parenterale: dopo 0,5 mg di imipenem-cilastatina in endovena i picchi ematici sono rispettivamente 40 µg/ml mentre per via intramuscolare raggiungono i 4 µg/ml. L'imipenem presenta un legame sierico del 20% mentre la cilastatina del 40%, la distribuzione è buona passando a livello liquorale. I due farmaci vengono metabolizzati a livello epatico ed escreti per via renale. L'emivita è di circa un'ora e di 3,5 ore in caso di insufficienza renale salvo in pazienti in emodialisi la quale rimuove il farmaco.

Effetti collaterali

Fra gli effetti collaterali riscontrati si evidenziano nausea, cefalea, esantema, vomito, sordità.

L'imipenem presenta l'inconveniente di essere facilmente idrolizzato, dando un metabolita nefrotossico, ad opera delle diidropeptidasi renali di tipo I (DHP-I), questa molecola, quindi, ha un'emivita molto breve a causa dell'elevato metabolismo renale.

Note

  1. ^ Sigma Aldrich; rev. del 12.06.2012, riferita al monoidrato

Bibliografia

  • Douglas M. Anderson, A. Elliot Michelle, Mosby’s medical, nursing, & Allied Health Dictionary sesta edizione, New York, Piccin, 2004, ISBN 88-299-1716-8.
  • British national formulary, Guida all’uso dei farmaci 4 edizione, Lavis, agenzia italiana del farmaco, 2007.

Altri progetti

Collegamenti esterni

  Portale Chimica

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