DN

Posted: 01 Jul 2009 07:18 PM PDT

The US Food and Drug Administration (FDA) is updating earlier recommendations about the interaction between the antibiotic ceftriaxone and intravenous products that contain calcium. In certain circumstances, this interaction can cause dangerous precipitates to form. Ceftriaxone is sold as Rocephin and also as a generic. Products that contain calcium include Ringer's solution, Hartmann's solution and parenteral nutrition formulations that contain calcium.

FDA had previously recommended that ceftriaxone and calcium-containing IV products not be administered within 48 hours of one another for patients of all ages. This has now changed. It is no longer necessary to wait 48 hours in patients over 28 days old, provided that certain precautions are followed. And FDA is still stressing that ceftriaxone must not be used in neonates if they are receiving or will receive calcium-containing IV products.

Ceftriaxone and products that contain calcium may now be administered sequentially to patients older than 28 days of age, as long as the infusion lines are thoroughly flushed between infusions with a compatible fluid. However, ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions through a Y-site. FDA also continues to advise practitioners not to reconstitute or mix ceftriaxone with products that contain calcium.

There are no data on whether ceftriaxone might interact with calcium-containing products that are given orally. It's also not clear whether intramuscular ceftriaxone might interact with calcium-containing products, either IV or oral.

Source:
Update on Precipitate Formation with Ceftriaxone and Calcium-containing Products (FDA, July 2009)