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Label Changes for:

Rocephin (ceftriaxone sodium) For Injection

August 2008

Changes have been made to the CONTRAINDICATIONS, WARNINGS, PRECAUTIONS and ADVERSE REACTIONS sections of the safety label.

Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) -- August 2008


The detailed view includes drug products with safety labeling changes to the BOXED WARNING, CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE REACTIONS, or PATIENT PACKAGE INSERT/MEDICATION GUIDE sections. Deletions or editorial revisions made to these sections are not included in this summary.

Summary View


Sections Modified Summary of Changes to Contraindications and Warnings


  • Neonates ( < 28 days)


  • Interaction with Calcium-Containing Products


  • General
    • Cases of pancreatitis, possibly secondary to biliary obstruction, have been reported rarely in patients treated with Rocephin...
    • The elimination of Rocephin is not altered by probenecid.
    • As with other cephalosporins, anaphylactic shock cannot be ruled out...
  • Geriatric Use (subsection added)


  • Postmarketing Experience (subsection added)
    • Gastrointestinal
    • Genitourinary
    • Dermatologic
  • Cephalosporin Class Adverse Reactions


Neonates ( < 28 days)

...Rocephin must not be co-administered with calcium-containing IV solutions, including continuous calcium-containing infusions such as parenteral nutrition, in neonates because of the risk of precipitation of ceftriaxone-calcium salt. Cases of fatal reactions with ceftriaxone-calcium precipitates in lung and kidneys in neonates have been described. In some cases the infusion lines and the times of administration of ceftriaxone and calcium-containing solutions differed...


Interaction with Calcium-Containing Products

There are no reports to date of intravascular or pulmonary precipitations in patients, other than neonates, treated with ceftriaxone and calcium-containing IV solutions. However, the theoretical possibility exists for an interaction between ceftriaxone and IV calcium-containing solutions in patients other than neonates. Therefore, Rocephin and calcium-containing solutions, including continuous calcium-containing infusions such as parenteral nutrition, should not be mixed or co-administered to any patient irrespective of age, even via different infusion lines at different sites. As a further theoretical consideration and based on 5 half-lives of ceftriaxone, Rocephin and IV calcium-containing solutions should not be administered within 48 hours of each other in any patient (see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION).

No data are available on potential interaction between ceftriaxone and oral calcium containing products or interaction between intramuscular ceftriaxone and calcium-containing products (IV or oral).