Ceftriaxone IV Fluid Compatibility
Ceftriaxone should NOT be administered with any calcium-containing IV fluids such as Ringer's solution or Hartmann's solution due to risk of particulate formation. 1
Compatible IV Fluids for Ceftriaxone
Recommended Compatible IV Fluids
- 0.9% Sodium Chloride Solution (stable for 2 days at room temperature, 10 days refrigerated) 1
- 5% Dextrose Solution (stable for 2 days at room temperature, 10 days refrigerated) 1
- 10% Dextrose Solution (stable for 2 days at room temperature, 10 days refrigerated) 1
Additional Compatible IV Fluids (stable for 24 hours at room temperature)
- Sodium Lactate (PVC container)
- 10% Invert Sugar (glass container)
- 5% Sodium Bicarbonate (glass container)
- Freamine III (glass container)
- Normosol-M in 5% Dextrose (glass and PVC containers)
- Ionosol-B in 5% Dextrose (glass container)
- 5% Mannitol (glass container)
- 10% Mannitol (glass container) 1
Incompatible IV Fluids and Medications
Incompatible IV Fluids
- Calcium-containing solutions (e.g., Ringer's solution, Hartmann's solution) 1
- 5% Dextrose + 0.9% Sodium Chloride Solution (incompatible when refrigerated) 1
- 5% Dextrose + 0.45% Sodium Chloride Solution (incompatible when refrigerated) 1
- 0.45% Sodium Chloride (incompatible beyond 5 hours at 40 mg/mL concentration) 2
- Plasma-Lyte A (incompatible beyond 8 hours at 40 mg/mL concentration) 2
Incompatible Medications
- Vancomycin
- Amsacrine
- Aminoglycosides
- Fluconazole 1
Administration Guidelines
Concentration and Preparation
- Recommended concentrations: 10-40 mg/mL for IV infusion 1
- Reconstitute with appropriate diluent (see compatible fluids above)
- For 1g vial: add 9.6 mL diluent to yield approximately 100 mg/mL solution 1
Administration Method
- Administer by IV infusion over 30 minutes (60 minutes in neonates) 1
- When administering other incompatible drugs:
- Give sequentially
- Thoroughly flush IV lines with compatible fluid between administrations
- Do not physically mix or piggyback into solutions containing other antimicrobial drugs 1
Special Considerations
Metronidazole Compatibility
- Compatible with metronidazole hydrochloride under specific conditions:
- Concentration should not exceed 5-7.5 mg/mL metronidazole with 10 mg/mL ceftriaxone
- Stable for 24 hours at room temperature only
- Only in 0.9% sodium chloride or 5% dextrose in water
- Do not refrigerate this admixture (precipitation will occur) 1
Storage After Reconstitution
- Reconstituted solutions should be used within the stability timeframes noted above
- After the indicated stability periods, unused portions should be discarded
- Reconstituted solutions can be stored frozen (-20°C) in PVC or polyolefin containers for up to 26 weeks
- Thaw frozen solutions at room temperature before use and do not refreeze 1
Common Pitfalls and Caveats
- NEVER mix ceftriaxone with calcium-containing solutions - fatal reactions have been reported
- Always visually inspect for particulate matter before administration
- Recent research indicates potential incompatibility with 0.45% sodium chloride and Plasma-Lyte A at higher concentrations (40 mg/mL) beyond specific time points 2
- Different generic versions of ceftriaxone may have varying compatibility profiles with calcium-containing products 3
- When in doubt about compatibility, administer separately with line flushing between medications
By following these compatibility guidelines, you can ensure safe and effective administration of ceftriaxone via intravenous route.