Preparation of Intravenous Ceftriaxone
For intravenous administration, reconstitute ceftriaxone powder with an appropriate IV diluent to achieve a concentration between 10-40 mg/mL, then infuse over 30 minutes (60 minutes in neonates). 1
Reconstitution Process
Step 1: Add Diluent to Vial
Add the appropriate volume of IV diluent directly into the ceftriaxone vial according to the following volumes 1:
- 250 mg vial: Add 2.4 mL of diluent
- 500 mg vial: Add 4.8 mL of diluent
- 1 gram vial: Add 9.6 mL of diluent
- 2 gram vial: Add 19.2 mL of diluent
After reconstitution with these volumes, each 1 mL of solution contains approximately 100 mg of ceftriaxone. 1
Step 2: Mix Thoroughly
Shake the vial thoroughly to form a complete solution. 1
Step 3: Dilute to Final Concentration
Withdraw the entire contents of the reconstituted vial and dilute further with the appropriate IV diluent to achieve the desired final concentration between 10-40 mg/mL (lower concentrations may be used if desired). 1
Acceptable IV Diluents
The following solutions are compatible for reconstitution and dilution 1:
- 0.9% Sodium Chloride Solution
- 5% Dextrose Solution (D5W)
- Sterile Water for Injection
Administration Guidelines
- Infusion duration: Administer over 30 minutes in adults and children 1
- Neonatal infusion: Administer over 60 minutes in neonates to reduce the risk of bilirubin encephalopathy 1
- Recommended concentration range: 10-40 mg/mL 1
Critical Incompatibilities to Avoid
Never use calcium-containing diluents such as Ringer's solution or Hartmann's solution, as particulate formation will result. 1
The following medications are incompatible with ceftriaxone in admixtures and must not be physically mixed 1:
- Vancomycin
- Amsacrine
- Aminoglycosides
- Fluconazole
When these drugs must be given concomitantly, administer them sequentially with thorough flushing of IV lines between administrations using compatible fluids. 1
Stability After Reconstitution
Reconstituted ceftriaxone IV solutions remain stable (less than 10% potency loss) for 1:
- Room temperature (25°C): 2 days at 100 mg/mL concentration
- Refrigerated (4°C): 10 days at 100 mg/mL concentration
The solution color ranges from light yellow to amber depending on storage length, concentration, and diluent used; this color variation is normal and does not require protection from normal light after reconstitution. 1
Special Compatibility Note
Ceftriaxone is compatible with metronidazole (Flagyl IV) at concentrations not exceeding 5-7.5 mg/mL metronidazole with 10 mg/mL ceftriaxone, stable for 24 hours at room temperature only in 0.9% sodium chloride or D5W—do not refrigerate this admixture as precipitation will occur. 1