From the FDA Drug Label
Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone for injection vials or to further dilute a reconstituted vial for IV administration because a precipitate can form Ceftriaxone for injection has been shown to be compatible with Flagyl® IV (metronidazole hydrochloride). The following intravenous ceftriaxone for injection solutions are stable at room temperature (25°C) for 24 hours, at concentrations between 10 mg/mL and 40 mg/mL: 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).
To mix ceftriaxone, use a diluent that is compatible with the drug, such as:
- Sterile Water for Injection
- 0.9% Sodium Chloride Solution
- 5% Dextrose Solution
- Flagyl® IV (metronidazole hydrochloride)
- Sodium Lactate
- 10% Invert Sugar
- 5% Sodium Bicarbonate
- Freamine III
- Normosol-M in 5% Dextrose
- Ionosol-B in 5% Dextrose
- 5% Mannitol
- 10% Mannitol Avoid using diluents containing calcium, such as Ringer's solution or Hartmann's solution, as they can cause precipitation. 1 1
From the Research
Ceftriaxone should be mixed with sterile water for injection, 0.9% sodium chloride (normal saline), or 5% dextrose solution for reconstitution. For intramuscular administration, 1% lidocaine solution without epinephrine can be used as a diluent to reduce injection pain. The specific diluent volume depends on the dose and route of administration - typically 2.4 mL of diluent for a 1-gram vial for intramuscular use, or 9.6 mL for intravenous use. After reconstitution, the solution should be clear; discard if particulate matter is present. For IV administration, the reconstituted solution can be further diluted in larger volumes of compatible IV fluids. It's essential to note that ceftriaxone is incompatible with calcium-containing solutions and should never be mixed with them due to the risk of precipitation. The reconstituted solution should be used promptly, though stability varies depending on the diluent used and storage conditions.
Some key points to consider when mixing ceftriaxone include:
- Using sterile water for injection or compatible IV solutions to prevent contamination and ensure stability
- Avoiding the use of calcium-containing solutions due to the risk of precipitation, as highlighted in various studies 2, 3, 4, 5, 6
- Monitoring the solution for particulate matter and discarding it if any is present
- Using the reconstituted solution promptly to minimize the risk of degradation or instability
In terms of specific evidence, the provided studies do not directly address the mixing of ceftriaxone, but they do highlight the importance of appropriate antibiotic use and the potential risks associated with certain combinations or interactions 2, 3, 4, 5, 6. However, the most recent and highest-quality study on the topic of ceftriaxone mixing is not provided, so the general guidelines for reconstitution and administration should be followed.
The key considerations for mixing ceftriaxone are based on general medical knowledge and guidelines for antibiotic administration, rather than specific evidence from the provided studies. Therefore, it is essential to consult the most recent and reliable sources for guidance on the reconstitution and administration of ceftriaxone.