What are the administration instructions for Ceftriaxone (Ceftriaxone) 1000 mg via Intramuscular (IM) injection?

Ceftriaxone 1000 mg IM Administration Instructions

For intramuscular (IM) administration of Ceftriaxone 1000 mg, reconstitute with an appropriate diluent, inject deep into a large muscle, and administer the full dose at once.

Reconstitution Instructions

• Reconstitute the 1 gram vial with one of the following diluent volumes 1:

  • 3.6 mL of diluent to achieve a concentration of 250 mg/mL
  • 2.1 mL of diluent to achieve a concentration of 350 mg/mL

• Appropriate diluents include:

  • 1% Lidocaine solution (without epinephrine)
  • Sterile water for injection
  • 0.9% sodium chloride

• Do NOT use diluents containing calcium, such as Ringer's solution or Hartmann's solution, as precipitation may occur 1

Administration Technique

1. After reconstitution, shake the vial thoroughly until the powder is completely dissolved
2. Withdraw the entire contents of the vial into the syringe
3. Inject deep into a large muscle mass, such as the gluteus maximus (upper outer quadrant of buttock) or the lateral aspect of the thigh
4. Aspirate before injection to avoid inadvertent injection into a blood vessel 1
5. Administer the full dose at once

Important Considerations

• Pain management: IM injection of ceftriaxone can be painful. Using 1% lidocaine as the diluent may help reduce injection pain 2

• Injection site: Divide large volumes between two injection sites to minimize discomfort

• Storage: After reconstitution, the solution should be used promptly. If not used immediately, store at room temperature (20-25°C) and use within 24 hours 1

• Contraindications:

  • Do not administer to hyperbilirubinemic neonates, especially premature infants 1
  • Do not administer simultaneously with calcium-containing IV solutions 1

• Dosing frequency: For most indications in adults, a single daily dose of 1-2 grams is sufficient 1

Monitoring

• Observe the patient for any immediate hypersensitivity reactions
• Monitor the injection site for pain, inflammation, or abscess formation
• No routine therapeutic drug monitoring is required for ceftriaxone 2

Clinical Pearls

• Ceftriaxone has an exceptionally long half-life (5.8-8.7 hours) compared to other cephalosporins, allowing for once-daily dosing 3
• After IM injection, peak plasma concentrations (approximately 81 μg/mL for a 1g dose) are achieved within 2-3 hours 4
• Intramuscular administration provides similar pharmacokinetics to intravenous administration, with plasma concentrations becoming equivalent by 2.5 hours post-administration 4
• The bioavailability of IM ceftriaxone is nearly 100%, making it an excellent option for outpatient parenteral therapy 5