Can a patient use lidocaine (lido) with epinephrine (epi) for ceftriaxone (Rocephin) administration?

Lidocaine with Epinephrine for Ceftriaxone Reconstitution

No, you should NOT use lidocaine with epinephrine for ceftriaxone (Rocephin) reconstitution—only plain 1% lidocaine without epinephrine is appropriate for intramuscular administration. 1

Critical Safety Requirements

Use Plain Lidocaine Only

• The CDC explicitly recommends using 1% lidocaine WITHOUT epinephrine as the diluent when reconstituting ceftriaxone for intramuscular injection. 1
• The FDA drug label for ceftriaxone confirms that lidocaine solutions remain stable for 24 hours at room temperature and 10 days refrigerated when using plain 1% lidocaine (without epinephrine) at concentrations of 100,250, or 350 mg/mL. 2
• The addition of epinephrine is specifically contraindicated by the CDC for this purpose. 1

Why This Matters

• Epinephrine is added to local anesthetics to prolong anesthetic effect and provide hemostasis through vasoconstriction, but this is unnecessary and potentially problematic when the sole purpose is to reduce injection pain during ceftriaxone administration. 3
• Using plain lidocaine achieves the goal of reducing intramuscular injection pain without introducing unnecessary vasoactive substances. 4
• Pharmacokinetic studies demonstrate that 1% lidocaine significantly reduces pain intensity and frequency at the injection site without altering ceftriaxone bioavailability or elimination parameters. 4

Absolute Contraindications

Never Give Intravenously

• Intravenous administration of ceftriaxone solutions containing lidocaine (with or without epinephrine) is absolutely contraindicated. 2
• This reconstitution method is exclusively for intramuscular administration. 1, 2

Lidocaine-Specific Contraindications

• When using lidocaine as a solvent for intramuscular ceftriaxone, you must exclude all contraindications to lidocaine itself by referring to lidocaine prescribing information. 2

Common Pitfall to Avoid

The most critical error would be assuming that because lidocaine with epinephrine is safe for local infiltrative anesthesia (including digits, nose, and ears per dermatologic surgery guidelines 3), it is therefore appropriate for ceftriaxone reconstitution. These are entirely different clinical contexts with different requirements and recommendations. 1