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Rocephin (ceftriaxone) Disease Interactions

There are 8 disease interactions with Rocephin (ceftriaxone):


Antibiotics (applies to Rocephin) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.


  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  4. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  5. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  6. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  7. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  8. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  9. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  10. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  11. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  12. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  13. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  14. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  15. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  16. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  17. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  18. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  19. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  20. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  21. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  22. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  23. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  24. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  25. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  26. "Multum Information Services, Inc. Expert Review Panel"
  27. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  28. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  29. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  30. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  31. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
  32. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  33. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  34. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  35. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  36. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  37. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  38. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  39. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  40. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  41. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  42. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  43. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  44. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  45. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  46. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  47. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
View all 47 references

Ceftriaxone (applies to Rocephin) hyperbilirubinemia

Major Potential Hazard, High plausibility.

Hyperbilirubinemic neonates, especially premature, should not be treated with ceftriaxone for injection. Studies have shown that ceftriaxone can displace bilirubin from its binding to serum albumin, leading to possible risk of bilirubin encephalopathy in these patients.


Ceftriaxone (applies to Rocephin) gallbladder disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease, Biliary Obstruction

Ceftriaxone can precipitate in the gallbladder. Sonographic abnormalities and symptoms of gallbladder disease have been reported. Therapy with ceftriaxone should be administered cautiously in patients with preexisting disease of the gallbladder, biliary tract, or liver. Serial abdominal ultrasonography may be appropriate during therapy. The drug should be discontinued in patients who develop signs and symptoms suggestive of gallbladder disease while being treated with ceftriaxone.


  1. Zinberg J, Chernaik R, Coman E, Rosenblatt R, brandt LJ "Reversible symptomatic biliary obstruction associated with ceftriaxone pseudolithiasis." Am J Gastroenterol 86 (1991): 1251-4
  2. Lopez AJ, O'Keefe P, Morrissey M, Pickleman J "Ceftriaxone-induced cholelithiasis." Ann Intern Med 115 (1991): 712-4
  3. "Product Information. Rocephin (ceftriaxone)." Roche Laboratories, Nutley, NJ.
  4. Kirejczyk WM, Crowe HM, Mackay IM, Quintiliani R, Cronin EB "Disappearing "gallstones": biliary pseudolithiasis complicating ceftriaxone therapy." Am J Roentgenol 159 (1992): 329-30
  5. Maranan MC, Gerber SI, Miller GG "Gallstone pancreatitis caused by ceftriaxone." Pediat Inf Dis J 17 (1998): 662-3
  6. Meyboom RH, Kuiper H, Jansen A "Ceftriaxone and reversible cholelithiasis." BMJ 297 (1988): 858
  7. Pigrau C, Pahissa A, Gropper S, Sureda D, Martinez Vazquez JM "Ceftriaxone-associated biliary pseudolithiasis in adults." Lancet 2 (1989): 165
View all 7 references

Ceftriaxone (applies to Rocephin) pancreatitis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction

Cases of pancreatitis, possibly secondary to biliary obstruction, have been reported rarely in patients treated with ceftriaxone. Most patients presented with risk factors for biliary stasis and biliary sludge (preceding major therapy, severe illness, total parenteral nutrition). A cofactor role of ceftriaxone-related biliary precipitation cannot be ruled out.


Ceftriaxone (applies to Rocephin) prothrombin time alterations

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease, Vitamin K Deficiency, Malnourished

Alterations in prothrombin times have rarely occurred in patients treated with ceftriaxone. Patients with impaired vitamin K synthesis or low vitamin K stores, such a patients with chronic hepatic disease and malnutrition, require monitoring of prothrombin time during treatment. Vitamin K administration (10 mg per week) might be needed if prothrombin time is prolonged before or during therapy.


Ceftriaxone (applies to Rocephin) renal/liver disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Biliary Obstruction

Ceftriaxone is eliminated by both renal and hepatobiliary excretion. At usual dosages (i.e. 1 to 2 g/day), adjustments are generally not necessary in either renal or hepatobiliary impairment. However, serum drug concentrations should be monitored periodically, and the dosage decreased accordingly if drug accumulation occurs. In patients with both hepatic and severe renal impairment, ceftriaxone dosage should not exceed 2 grams per day without close monitoring of serum concentrations.


  1. Stoeckel K, Koup JR "Pharmacokinetics of ceftriaxone in patients with renal and liver insufficiency and correlations with a physiologic nonlinear protein binding model." Am J Med 77 (1984): 26-32
  2. Pollock AA, Tee PE, Patel IH, Spicehandler J, Simberkoff MS, Rahal JJ "Pharmacokinetic characteristics of intravenous ceftriaxone in normal adults." Antimicrob Agents Chemother 22 (1982): 816-23
  3. Garcia RL, Santivanez V, Battilana CA "Single-dose pharmacokinetics of ceftriaxone in patients with end-stage renal disease and hemodialysis." Chemotherapy 34 (1988): 261-6
  4. McNamara PJ, Stoeckel K, Ziegler WH "Pharmacokinetics of ceftriaxone following intravenous administration of a 3g dose." Eur J Clin Pharmacol 22 (1982): 71-5
  5. "Product Information. Rocephin (ceftriaxone)." Roche Laboratories, Nutley, NJ.
  6. Stoeckel K, Tuerk H, Trueb V, McNamara PJ "Single-dose ceftriaxone kinetics in liver insufficiency." Clin Pharmacol Ther 36 (1984): 500-9
  7. Wise R, Wright N "The pharmacokinetics of cefotaxime and ceftriaxone in renal and hepatic dysfunction." Infection 13 (1985): s145-50
  8. Kowalsky SF, Echols RM, Parker MA "Pharmacokinetics of ceftriaxone in subjects with renal insufficiency." Clin Pharm 4 (1985): 177-81
  9. Cohen D, Appel GB, Scully B, Neu HC "Pharmacokinetics of ceftriaxone in patients with renal failure and in those undergoing hemodialysis." Antimicrob Agents Chemother 24 (1983): 529-32
  10. Patel IH, Chen S, Parsonnet M, et al "Pharmacokinetics of ceftriaxone in humans." Antimicrob Agents Chemother 20 (1981): 634-41
  11. Holazo, AA, Patel IH, Weinfeld RE, Konikoff JJ, Parsonnet M "Ceftriaxone pharmacokinetics following multiple intramuscular dosing." Eur J Clin Pharmacol 30 (1986): 109-12
  12. Stoeckel K, McNamara PJ, Hoppe-Seyler G, Blumberg A, Keller E "Single-dose ceftriaxone kinetics in functionally anephric patients." Clin Pharmacol Ther 33 (1983): 633-41
  13. Fraschini F, Braga PC, Scarpazza G, et al "Human pharmacokinetics and distribution in various tissues of ceftriaxone." Chemotherapy 32 (1986): 192-9
  14. Hary L, Andrejak M, Leleu S, et al "The pharmacokinetics of ceftriaxone and cefotaxime in cirrhotic patients with ascites." Eur J Clin Pharmacol 36 (1989): 613-6
  15. Ti TY, Fortin L, Kreeft JH, East DS, Ogilvie RI, Somerville PJ "Kinetic disposition of intravenous ceftriaxone in normal subjects and patients with renal failure on hemodialysis or peritoneal dialysis." Antimicrob Agents Chemother 25 (1984): 83-7
View all 15 references

Cephalosporins (applies to Rocephin) liver disease

Moderate Potential Hazard, Moderate plausibility.

Cases of hepatitis have been reported with the use of certain cephalosporins. Transient rise in SGOT, SGPT, and alkaline phosphatase levels have also been observed. Caution and monitoring is recommended when these agents are prescribed to patients with hepatic disorders.


Cephalosporins (applies to Rocephin) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Cephalosporins have been implicated in triggering seizures. Nonconvulsive status epilepticus (NCSE), encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have been reported with cephalosporins particularly in patients with a history of epilepsy and/or when recommended dosages of cephalosporins were exceeded due to renal impairment. Adjust dosing based on creatinine clearance. Anticonvulsant therapy should be continued in patients with known seizure disorders. If CNS adverse reactions including seizures occur, patients should undergo a neurological evaluation to determine whether treatment should be discontinued.

Rocephin (ceftriaxone) drug interactions

There are 39 drug interactions with Rocephin (ceftriaxone)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.