Drug Interaction Report

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).