Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

Probenecid competes with meropenem for active tubular secretion and thus inhibits the renal excretion, with the effect of increasing the elimination half-life and plasma concentration of meropenem.
Caution is required if probenecid is co-administered with meropenem.

The potential effect of Meropenem/ANFARM on the protein binding of other drugs or metabolism has not been studied. The protein binding of Meropenem/ANFARM is low (approximately 2%) and therefore no interactions with other compounds based on displacement from plasma proteins would be expected.

Meropenem/ANFARM may reduce serum valproic acid levels. Subtherapeutic levels may be reached in some patients.
Meropenem/ANFARM has been administered concomitantly with other medications without adverse pharmacological interactions. However, no other specific data regarding potential drug interactions is available (apart from probenecid as mentioned above).
Decrease in blood levels of valproic acid have been reported when it is co-administered with carbapenem agents resulting in a 60-100% decrease in valproic acid levels in about two days. Due to the rapid onset and the extent of the decrease, co-administration of Meropenem/ANFARM in patients stabilised on valproic acid is not considered to be manageable and therefore should be avoided (see section 4.4).
Oral anti-coagulants
Simultaneous administration of antibiotics with warfarin may augment its anti-coagulant effects. There have been many reports of increases in anti-coagulant effects of orally administered anticoagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents. The risk may vary with underlying infection, age and general status of the patient so that contribution of antibiotic to the increase in INR (international normalised ratio) is difficult to assess. It is recommended that the INR should be monitored frequently during and shortly after co- administration of antibiotics with an oral anticoagulant agent.