Medical term:
Doribax
doripenem monohydrate
Pharmacologic class: Carbapenem
Therapeutic class: Anti-infective
Pregnancy risk category B
GI: nausea, diarrhea, oral candidiasis, Clostridium difficile-associated diarrhea
Action
Acts against aerobic and anaerobic gram-positive and gram-negative bacteria
Availability
Powder for reconstitution for infusion: 500 mg single-use vials
Indications and dosages
➣ Complicated intra-abdominal infections caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Streptococcus intermedius, Streptococcus constellatus, and Peptostreptococcus micros; complicated urinary tract infections (UTIs), such as pyelonephritis caused by E. coli (including cases with concurrent bacteremia), K. pneumoniae, Proteus mirabilis, P. aeruginosa, and Acinetobacter baumannii
Adults ages 18 and older: 500 mg q 8 hours by I.V. infusion over 1 hour; continue for 5 to 14 days for complicated intra-abdominal infections and 10 days for complicated UTIs, with possible extension to 14 days for patients with concurrent bacteremia
Dosage adjustment
• Renal impairment
Contraindications
• Serious hypersensitivity to drug or other carbapenems
• History of anaphylactic reactions to beta-lactams
Precautions
Use cautiously in:
• renal impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
☞ Don't use constituted suspension for direct injection; dilute further before giving by I.V. infusion.
• To prepare 500-mg dose, constitute vial with 10 ml sterile water for injection or normal saline solution for injection, and shake gently to form suspension; resulting concentration is 50 mg/ml. Withdraw suspension using syringe with 21G needle, and add it to infusion bag containing 100 ml normal saline solution or 5% dextrose; shake gently until clear. Final infusion solution concentration is 4.5 mg/ml.
• To prepare 250-mg dose, constitute vial with 10 ml sterile water for injection or normal saline solution for injection, and shake gently to form suspension. Resulting concentration is 50 mg/ml. Withdraw suspension using syringe with 21G needle, and add it to infusion bag containing 100 ml normal saline solution for injection or 5% dextrose; shake gently until clear. Remove 55 ml of this solution from bag and discard. Infuse remaining solution, which contains 250 mg (4.5 mg/ml).
• To prepare infusions in Baxter Minibag Plus infusion bags, see infusion bag manufacturer's instructions.
• Know that infusion solutions range from clear and colorless to clear and slightly yellow. Color variations within this range don't affect product potency.
• Don't mix with or physically add to solutions containing other drugs.
• Don't administer by inhalation.
Adverse reactions
CNS: headache
CV: phlebitis
GI: nausea, diarrhea, oral candidiasis, Clostridium difficile-associated diarrhea
GU: vulvomycotic infection
Hematologic: anemia
Respiratory: pneumonitis (with inhalation use)
Skin: rash, allergic or bullous dermatitis, erythema, macular and papular eruptions, urticaria, erythema multiforme
Other: hypersensitivity reactions (including anaphylaxis)
Interactions
Drug-drug. Probenecid: reduced doripenem renal clearance
Valproic acid: decreased valproic acid level and loss of seizure control
Drug-diagnostic tests. ALT, AST, liver enzymes, transaminases: increased levels
Patient monitoring
• Closely monitor patient for diarrhea.
☞ If allergic reaction occurs, discontinue drug and intervene for serious anaphylactic reactions by giving epinephrine and taking other emergency measures as ordered and needed, including oxygen, I.V. fluids and antihistamines, corticosteroids, pressor amines, and airway management.
• Monitor renal function in patients with moderate to severe renal impairment.
Patient teaching
☞ Tell patient to immediately report rash, diarrhea, or difficulty breathing.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
doripenem
(do-ri-pen-em) ,Doribax
(trade name)Classification
Therapeutic: anti infectivesPharmacologic: carbapenems
Indications
- complicated intra-abdominal infections,
- complicated urinary tract infections, including pyelonephritis.
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | unknown | end of infusion | 8 hr* |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
- headache (most frequent)
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- nausea (most frequent)
- diarrhea
- ↑ liver enzymes
Hematologic
- anemia (most frequent)
- thrombocytopenia
Dermatologic
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- pruritis
- rash
Local
- phlebitis
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
- infection with resistant organisms
- superinfection
Interactions
Drug-Drug interaction
May ↓ serum valproate levels (↑ risk of seizures).May ↓ blood levels of valproic acid ; this may result in loss of seizure control.Probenecid ↓ renal clearance and ↑ blood levels.Route/Dosage
Renal Impairment
Intravenous (Adults) CCr 30–50 mL/min—250 mg every 8 hr; CCr >10–<30 mL/min—250 mg every 12 hr.Availability
Nursing implications
Nursing assessment
- Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain a history before initiating therapy to determine previous use of and reactions to penicillins, cephalosporins, or carbapenems. Persons with a negative history of penicillin sensitivity may still have an allergic response.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Have epinephrine, an antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Assess patient for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening. Stevens-Johnson syndrome may develop. Treat symptomatically; may recur once treatment is stopped.
- Lab Test Considerations: May cause ↑ AST, ALT, serum alkaline phosphatase levels.
- May cause anemia.
Potential Nursing Diagnoses
Risk for infection (Indications, Side Effects)Implementation
- Do not confuse Doribax with Zovirax.
- May switch to appropriate oral therapy after at least 3 days of parenteral therapy, once clinical improvement has been demonstrated.
Intravenous Administration
- Intermittent Infusion: Reconstitute 500-mg vial with 10 mL of sterile injection or 0.9% NaCl and shake gently to form a suspension of 50 mg/mL. Diluent: Withdraw the resulting solution using a 21-gauge needle and add it to 100 mL of 0.9% NaCl or D5W; gently shake until clear. For moderate or severe renal impairment, withdraw 55 mL of this solution from the bag and discard. Solution should be clear and colorless to slightly yellow.Concentration: Final concentration is 4.5 mg/mL. Suspension is stable for 1 hr prior to dilution in infusion bag. Administer within 8 hr of reconstitution with 0.9% NaCl or 4 hr of reconstitution with D5W at room temperature or 24 hr if refrigerated; do not freeze.
- Rate: Administer over 1 hr. Do not administer direct IV.
- Y-Site Compatibility: acyclovir, amikacin, aminophylline, amiodarone, anidulafungin, atropine, azithromycin, bumetanide, calcium gluconate, carboplatin, caspofungin, ceftaroline, ciprofloxacin, cisplatin, cyclophosphamide, cyclosporine, daptomycin, dexamethasone, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin, enalaprilat, esmolol, esomeprazole, etoposide phosphate, famotidine, fentanyl, fluconazole, fluorouracil, foscarnet, fucosemide, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone sodium succinate, hydromorphone, ifosfamide, insulin, labetalol, levofloxacin, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, methotrexate, methylprednisolone, metoclopramide, metronidazole, micafungin, midazolam, milrinone, morphine, moxifloxacin, norepinephrine, ondansetron, paclitaxel, pantoprazole, phenobarbital, phenylephrine, potassium chloride, ranitidine, sodium bicarbonate, sodium phosphates, tacrolimus, telavancin, tigecycline, tobramycin, vancomycin, voriconazole, zidovudine
- Y-Site Incompatibility: Do not mix with or physically add to solutions containing other medications,diazepam, potassium phosphates, propofol
Patient/Family Teaching
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy. Consult health care professional before treating with antidiarrheals.
- Caution patient to notify health care professional if rash or fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection. Duration may be extended up to 14 days for patients with concurrent bacteremia.
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