Critical Drug Alert! Do not use Ceftriaxone and Calcium-Containing IV Products together

A recent alert issued by the Directorate of Drugs Control, Punjab, highlights serious concerns about using intravenous (IV) ceftriaxone with calcium-containing products, such as Ringer Lactate. This alert is based on reports of adverse drug reactions and underscores the risk of IV admixture incompatibility. Healthcare professionals are advised to take immediate action to ensure patient safety.   

Details of the Alert

Issued By: Punjab Pharmacovigilance Center 

Key Concern

Using IV ceftriaxone and calcium-containing products together can cause severe, potentially fatal complications due to precipitation in the bloodstream. This issue is particularly critical in neonates but extends to older infants and adults under specific conditions. 

 Pharmacovigilance Center Findings

The Pharmacovigilance Center in Punjab has reported numerous adverse reactions related to the combined use of IV ceftriaxone and calcium-containing products. Investigations revealed: 

1. Ceftriaxone was being diluted with Ringer Lactate.

2. Ceftriaxone and Ringer Lactate were administered through the same IV site, causing severe adverse effects.   

 Clinical Guidelines and Recommendations 

For Neonates (up to 28 days old):  

- Contraindication: Do not use ceftriaxone with calcium-containing IV products, even through different lines, due to high risk of fatal outcomes from precipitation.
  

For Older Infants (>28 days old) and Adults:

1. Sequential Administration: 
Administer ceftriaxone and calcium-containing solutions sequentially through the same IV line only if the line is thoroughly flushed with a compatible fluid between infusions. 

2. No Simultaneous Administration:
 Do not administer ceftriaxone and calcium-containing solutions through the same IV site simultaneously.

General Guidelines: 

Do not reconstitute, dilute, or mix ceftriaxone with any calcium-containing products, including Lactated Ringer's, Hartmann's solution, or parenteral nutrition solutions.  

Contact Information:

Email: p&pvddcp.pshealth@punjab.gov.pk
Phone: +92-42-99206209