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Drug Interactions between Aminosyn II 3.5%-Dextrose 25%,Electrolytes,Ca and ceftriaxone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

cefTRIAXone parenteral nutrition solution w/electrolytes

Applies to: ceftriaxone and Aminosyn II 3.5%-Dextrose 25%,Electrolytes,Ca (parenteral nutrition solution w/electrolytes)

CONTRAINDICATED: Coadministration of ceftriaxone with calcium-containing solutions, even via different infusion lines, may cause precipitation of ceftriaxone-calcium salt. There have been cases of fatal reactions involving the presence of these precipitates in the lung and kidneys of both term and premature neonates as well as infants up to 1 year of age. In some cases, separate infusion lines and times of administration of ceftriaxone and calcium-containing solutions were used. There have been no reports to date of intravascular or pulmonary precipitations in older patients. Two in vitro studies, one using adult plasma and the other neonatal plasma from umbilical cord blood, were conducted with varying ceftriaxone and calcium concentrations to assess the potential for precipitation when ceftriaxone and calcium-containing products are mixed in vials and in infusion lines. The results suggest that ceftriaxone-calcium precipitation occurs at a lower calcium concentration in neonatal plasma than in adult plasma.

MANAGEMENT: Ceftriaxone must not be mixed or administered simultaneously with intravenous calcium-containing solutions (e.g., Ringer's or Hartmann's solution; parenteral nutrition containing calcium) via a Y-site in any patient regardless of age. Concomitant use of ceftriaxone and intravenous calcium-containing products (or within 48 hours of each other) is considered contraindicated in neonates 28 days of age or younger, even when administered via different infusion lines at different sites. Ceftriaxone should not be used in neonates if they are receiving, or are expected to receive, calcium-containing intravenous products. In patients older than 28 days, ceftriaxone and calcium-containing products may be administered sequentially, provided the infusion lines are thoroughly flushed between infusions with a compatible fluid. No data or recommendations are available for concomitant use of intravenous ceftriaxone and oral calcium-containing products or intramuscular ceftriaxone and calcium-containing products (IV or oral).

References

  1. (2002) "Product Information. Rocephin (ceftriaxone)." Roche Laboratories
  2. Canadian Vigilance program (2008) Notice to hospitals: Health Canada issued important safety informatin on ceftriaxone. Association of ceftriaxone with fatal outcome when administered intravenously with calcium-containing solutions. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/p
  3. Bradley JS, Wassel RT, Lee L, Nambiar S (2009) "Intravenous Ceftriaxone and Calcium in the Neonate: Assessing the Risk for Cardiopulmonary Adverse Events." Pediatrics
  4. CDER. Center for Drug Evaluation and Research. FDA. U.S. Food and Drug Admninistration (2009) Information for health care professionals: ceftriaxone (marketed as Rocephin and its generics). http://www.fda.gov/cder/drug/InfoSheets/HCP/ceftriaxone042009HCP.htm
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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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

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