Meropenem-Vaborbactam (Vaborem®)

General Information

Restricted formulary antimicrobial: For details see OUH netFormulary

AWaRe antibiotic classification: 'Reserve'. All indications to be discussed with Micro/ID.

Each vial contains 1g meropenem + 1g vaborbactam.

Standard dose of 4g meropenem-vaborbactam is 2g meropenem + 2g vaborbactam which is 2 vials.

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Renal impairment

Creatinine clearance (ml/min)	IV dose
20–39	2g (1g meropenem+1g vaborbactam) TDS
10–19	2g (1g meropenem+1g vaborbactam) BD
Less than 10	1g (500mg meropenem + 500mg vaborbactam) BD

Note: dose ranges use creatinine clearance, rather than eGFR.

Meropenem and vaborbactam are removed by haemodialysis. Doses adjusted for renal impairment should be administered after a dialysis session.

Hepatic impairment

No dose adjustment necessary but monitor liver function closely.

Pregnancy

Discuss with pharmacy.

Breastfeeding

Discuss with pharmacy.

There is a clinically significant interaction between carbapenems and sodium valproate or valproic acid which results in reduced valproate plasma concentrations with potential for inadequate seizure control. If patient is already prescribed sodium valproate or valproic acid and meropenem-vaborbactam is recommended discuss with Micro/ID and relevant medical team.
A 2g vial (which contains 1g meropenem+1g vaborbactam) contains 250 mg of sodium which is equivalent to 12.5% of the WHO recommended maximum daily intake of 2 g of sodium for an adult.
Note that the BNF expresses dose in terms of meropenem e.g. a 2g meropenem-vaborbactam dose is presented as 1g of meropenem. Caution with dose selection if using BNF.

Summary of Product Characteristics (SPC) for Vaborem 1 g/1 g powder for concentrate for solution for infusion. Last updated 15/10/20. Accessed via www.medicines.org.uk on 6/11/21.
BNF online accessed via www.medicinescomplete.com on 6/11/21
MHRA. Drug Safety update (December 2014). Carbapenems: concomitant use with valproic acid not recommended. Accessed at https://www.gov.uk/drug-safety-update/carbapenems-concomitant-use-with-valproic-acid-not-recommended