Published: September 2011

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Updated advice: ceftriaxone and calcium precipitation

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Prescriber Update 32(3): 26
September 2011

In February 2008, healthcare professionals were advised that ceftriaxone should not be mixed or administered with calcium containing solutions due to the risk of precipitation.

Following further investigation, the safety information for the use of ceftriaxone is now being updated with the following recommendations:

• Ceftriaxone must not be administered simultaneously with calcium containing intravenous solutions, including continuous calcium containing infusions via a Y site, because calcium precipitation can occur.
• Ceftriaxone is contraindicated in neonates if they require (or are expected to require) treatment with calcium containing intravenous solutions due to the risk of calcium precipitation.
• In patients over 28 days of age, ceftriaxone and calcium-containing solutions may be administered sequentially to one another if the infusion lines are flushed between infusions with a compatible fluid.

These recommendations follow Medsafe’s review of two in vitro studies to assess the potential for precipitation of ceftriaxone and calcium when mixed in infusion lines. The in vitro studies were conducted in neonatal and adult plasma; but only showed an increased risk in neonatal plasma.