Ceftrex Special Precautions

Warnings: Serious and occasionally fatal hypersensitivity reactions (including anaphylactoid and severe cutaneous adverse reactions) have been reported in patients receiving therapy with beta-lactams. Before initiating therapy with CEFTREX, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, carbapenems or other beta-lactam agents. If an allergic reaction occurs, CEFTREX must be discontinued immediately and appropriate alternative therapy instituted.
In patients other than neonates, Ceftriaxone and calcium-containing solutions may be administered sequentially to one another if the infusion lines are thoroughly flushed between infusions with a compatible fluid.
Diluents containing calcium, such as Ringer's solution or Hartmann's solution, are not to be used to reconstitute Ceftriaxone vials or to further dilute a reconstituted vial for intravenous administration because a precipitate can form. Ceftriaxone must not be administered simultaneously with calcium-containing intravenous solutions, including continuous calcium-containing infusions such as parenteral nutrition via a Y-site, because precipitation of ceftriaxone-calcium can occur.
Precautions: As with other cephalosporins, anaphylactic shock cannot be ruled out even if a thorough patient history is taken. Anaphylactic shock requires immediate countermeasures such as intravenous epinephrine followed by a glucocorticoid. Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftriaxone.
Therefore, it is important to consider this diagnosis in patients with diarrhea subsequent to the administration of antibacterial agents. Superinfections with nonsusceptible microorganisms may occur with other antibacterial agents. Shadows which have been mistaken for gallstones have been detected on sonograms of the gallbladder, usually following doses higher than the standard recommended dose. These shadows are, however, precipitates of calcium ceftriaxone which disappear on completion or discontinuation of CEFTREX therapy. Rarely have these findings been associated with symptoms. In symptomatic cases, conservative non-surgical management is recommended. Discontinuation of treatment in symptomatic cases should be at the discretion of the physician.
Use in pregnancy: Although there is no experimental evidence of mutagenic or teratogenic effects, CEFTREX should not be used in pregnancy (particularly in the first trimester) unless absolutely indicated.
Use in lactation: Ceftriaxone is excreted in human milk, usually in low concentration. Caution should be exercised if CEFTREX is given to nursing mother.
Use in children: Safety and effectiveness of CEFTREX in neonates, infants and children have been established for the dosages described in the Dosage & Administration.
In vitro studies have shown that ceftriaxone, like some other cephalosporins, can displace bilirubin from serum albumin. CEFTREX should not be administered to hyperbilirubinemic neonates, especially prematures.