Hypersensitivity to cephalosporins; hyperbilirubinemic neonates (28 days or younger); concomitant use with calcium-containing IV solutions, including continuous calcium-containing infusions, such as parenteral nutrition in neonates; hypersensitivity to corn products (dextrose-containing solutions only).
Increased risk of nephrotoxicity. Bactericidal activity against certain pathogens may be enhanced. Monitor aminoglycoside concentrations and kidney function closely. If renal dysfunction develops, reduce the dosage or discontinue one or both drugs and use alternative agents.
Anticoagulants (eg, heparin, warfarin)
Risk of bleeding may be increased. Monitor coagulation parameters and adjust the anticoagulant dose as needed.
Calcium-containing IV solutions (including TPN)
Neonatal deaths have been reported due to pulmonary and renal precipitation with calcium-ceftriaxone; coadministration is contraindicated. In patients other than neonates, ceftriaxone and calcium-containing solutions may be administered sequentially if the infusion lines are flushed with a compatible fluid between infusions.
Elevated cyclosporine levels with increased risk of toxicity may occur. Monitor serum cyclosporine and creatinine concentrations. Adjust the cyclosporine dose as needed.
The effectiveness of live vaccines may be decreased. Concurrent use is not recommended.
IM: Ceftriaxone is completely absorbed. Tmax is 2 to 3 h.
Distribution: Vd is 5.78 to 13.5 L. Ceftriaxone is 85% to 95% protein bound (concentration dependent). Crosses the blood-placenta barrier.
Excretion: 33% to 67% is excreted in the urine as unchanged drug, and the remainder in the bile and ultimately in the feces as inactive compounds; half-life is 5.8 to 8.7 h. Plasma Cl is 0.58 to 1.45 L/h. Renal Cl is 0.32 to 0.73 L/h.