AHFS Class:

8:12.07.08 Carbapenems

Ertapenem is available as a lyophilized powder in 1-g single-use vials as the sodium salt with sodium bicarbonate 175 mg and sodium hydroxide to adjust the pH.²⁹⁷³ For intravenous administration, reconstitute the contents of a 1-g vial with 10 mL of sterile water for injection, bacteriostatic water for injection, or sodium chloride 0.9% and shake well,²⁹⁷³ yielding a concentration of 100 mg/mL.²⁹⁷⁵ For adult patients, immediately transfer the appropriate dose of the reconstituted solution to 50 mL of sodium chloride 0.9%.²⁹⁷³ For pediatric patients, transfer the appropriate dose of reconstituted solution to a volume of sodium chloride 0.9% that is sufficient to yield a final concentration of 20 mg/mL or less.²⁹⁷³

Ertapenem also is available as a lyophilized powder in 1-g single-use ADD-Vantage vials as the sodium salt.²⁹⁷³ Each ADD-Vantage vial also contains sodium bicarbonate 175 mg and sodium hydroxide to adjust the pH.²⁹⁷³ Prepare ADD-Vantage vials of ertapenem sodium with 50 or 100 mL of sodium chloride 0.9% in ADD-Vantage diluent containers.²⁹⁷³

For intramuscular injection, reconstitute the contents of a 1-g vial with 3.2 mL of lidocaine hydrochloride 1% (without epinephrine) and shake well,²⁹⁷³ yielding a final volume of approximately 3.6 mL and a concentration of approximately 280 mg/mL.²⁹⁷⁵ Upon dissolution, administer within 1 hour.²⁹⁷³ Do not administer the reconstituted intramuscular injection intravenously.²⁹⁷³

pH

7.5.²⁹⁷³

Sodium Content

Each 1-g vial contains approximately 137 mg or 6 mEq of sodium.²⁹⁷³

Trade Name(s)

Invanz

Ertapenem sodium diluted in sodium chloride 0.9% may be administered by intravenous infusion over 30 minutes.²⁹⁷³ Ertapenem sodium prepared with lidocaine hydrochloride 1% for intramuscular administration may be administered by deep intramuscular injection into a large muscle mass (e.g., gluteal muscle, lateral part of the thigh).²⁹⁷³

Intact vials of ertapenem sodium should be stored at a temperature not exceeding 25°C.²⁹⁷³ The reconstituted drug solution for intravenous administration should be diluted immediately in sodium chloride 0.9%,²⁹⁷³ but has been noted to remain stable in the vial for 2 hours at 25°C or 6 hours at 5°C when reconstituted with sterile water for injection, sodium chloride 0.9%, bacteriostatic water with benzyl alcohol 0.9%, or Ringer’s injection, lactated.²⁹⁷⁵ The manufacturer recommends that solutions of ertapenem not be frozen.²⁹⁷³

Dextrose-containing solutions should not be used to dilute ertapenem²⁹⁷³ as an unacceptable loss due to degradation has been observed with their use; however, limited contact over a short period of time (e.g., ertapenem run as a piggyback into the same line as dextrose) should not adversely affect ertapenem stability.²⁹⁷⁵

Ertapenem diluted for infusion from both single-use vials and ADD-Vantage single-use vials may be stored and used within 6 hours at room temperature or may be stored for 24 hours under refrigeration and used within 4 hours after removal from refrigeration.²⁹⁷³

Ertapenem prepared for intramuscular administration should be used within 1 hour.²⁹⁷³

Freezing Solutions

The manufacturer recommends that solutions of ertapenem not be frozen due to degradation of the drug.²⁹⁷³; ²⁹⁷⁵

Ertapenem (Merck) 100 mg/mL in sodium chloride 0.9% in polypropylene syringes was frozen at -20°C for 14 or 28 days immediately after preparation, followed by thawing at room temperature for 1 hour.²⁹⁷⁴ Upon thawing for 1 hour, the solution frozen for 28 days was found to have undergone about 5% loss.²⁹⁷⁴ The solution frozen for 14 days was found to have undergone about 7% loss after 5 hours at room temperature (including the 1 hour of thawing time).²⁹⁷⁴

Syringes

Ertapenem (Merck) 100 mg/mL in sodium chloride 0.9% was packaged as 10 mL in 20-mL polypropylene syringes (Monoject).²⁹⁷⁴ The drug was found to be stable for approximately 30 minutes at room temperature or 24 hours under refrigeration followed by up to 4 hours at room temperature after removal from refrigeration.²⁹⁷⁴

Solution Compatibility

Additive Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions March 31, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.