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Rocephin and Wellcovorin

Determining the interaction of Rocephin and Wellcovorin and the possibility of their joint administration.

Check result:

Rocephin <> Wellcovorin

Relevance: 17.11.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

CefTRIAXone and calcium can form crystals when they are mixed together in solution or in the bloodstream. Life-threatening and fatal reactions have occurred when the crystals accumulated in the lung and kidneys of newborns. If you (or your child) require treatment with cefTRIAXone and leucovorin by injection directly into the veins, your healthcare providers can help prevent this interaction by taking a few simple precautions. You should tell your healthcare providers about all the medications that have been given to you (or your child) in the past two days, especially those given through the veins. Do not stop using any medications without first talking to your healthcare providers.

Professional:

CONTRAINDICATED: Coadministration of ceftriaxone with calcium-containing solutions, even via different infusion lines, may cause precipitation of ceftriaxone-calcium salt. There have been cases of fatal reactions involving the presence of these precipitates in the lung and kidneys of both term and premature neonates as well as infants up to 1 year of age. In some cases, separate infusion lines and times of administration of ceftriaxone and calcium-containing solutions were used. There have been no reports to date of intravascular or pulmonary precipitations in older patients. Two in vitro studies, one using adult plasma and the other neonatal plasma from umbilical cord blood, were conducted with varying ceftriaxone and calcium concentrations to assess the potential for precipitation when ceftriaxone and calcium-containing products are mixed in vials and in infusion lines. The results suggest that ceftriaxone-calcium precipitation occurs at a lower calcium concentration in neonatal plasma than in adult plasma.

MANAGEMENT: Ceftriaxone must not be mixed or administered simultaneously with intravenous calcium-containing solutions (e.g., Ringer's or Hartmann's solution; parenteral nutrition containing calcium) via a Y-site in any patient regardless of age. Concomitant use of ceftriaxone and intravenous calcium-containing products (or within 48 hours of each other) is considered contraindicated in neonates 28 days of age or younger, even when administered via different infusion lines at different sites. Ceftriaxone should not be used in neonates if they are receiving, or are expected to receive, calcium-containing intravenous products. In patients older than 28 days, ceftriaxone and calcium-containing products may be administered sequentially, provided the infusion lines are thoroughly flushed between infusions with a compatible fluid. No data or recommendations are available for concomitant use of intravenous ceftriaxone and oral calcium-containing products or intramuscular ceftriaxone and calcium-containing products (IV or oral).

References

CDER. Center for Drug Evaluation and Research. FDA. U.S. Food and Drug Admninistration "Information for health care professionals: ceftriaxone (marketed as Rocephin and its generics). Available from: URL: http://www.fda.gov/cder/drug/InfoSheets/HCP/ceftriaxone042009HCP.htm." ([2009 Apr 14]):
Bradley JS, Wassel RT, Lee L, Nambiar S "Intravenous Ceftriaxone and Calcium in the Neonate: Assessing the Risk for Cardiopulmonary Adverse Events." Pediatrics (2009):
"Product Information. Rocephin (ceftriaxone)." Roche Laboratories, Nutley, NJ.
Canadian Vigilance program "Notice to hospitals: Health Canada issued important safety informatin on ceftriaxone. Association of ceftriaxone with fatal outcome when administered intravenously with calcium-containing solutions. Available from: URL: http://www.hc-sc.gc.ca/dhp-mps/alt_" ([2008 Jul 31]):

Rocephin

Generic Name: ceftriaxone

Brand name: Rocephin, Rocephin IM Convenience Kit, Rocephin ADD-Vantage

Synonyms: Rocephin Injection

What is Rocephin?

Wellcovorin

Generic Name: leucovorin

Brand name: Wellcovorin

Synonyms: n.a.

What is Wellcovorin?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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