Compatibility of IV calcium and CEFtriaxone administration

Now, it's okay to give these two drugs sequentially in patients older than 28 days, as long as the IV line is flushed with a compatible fluid....

As a hospital pharmacist, you should know that it's okay to give IV calcium and ceftriaxone immediately after one another in most patients. Health Canada originally warned NOT to give IV ceftriaxone and calcium solutions within 2 to 5 days of each other.

Several babies died when these drugs were given together due to precipitation of ceftriaxone and calcium in the lungs and kidneys. But new data show it's just a problem in neonates. Now, it's okay to give these two drugs sequentially in patients older than 28 days, as long as the IV line is flushed with a compatible fluid between infusions.

Continue to avoid giving ceftriaxone with calcium solutions via a Y-SITE. This includes IV solutions with calcium such as parenteral nutrition or Lactated Ringer's. Keep in mind there's no problem giving ORAL calcium at the same time as ceftriaxone for ANY patient. You can also give oral or IV calcium with INTRAMUSCULAR ceftriaxone.

References

Harder CK, Hawboldt JJ. Survey of Canadian Pharmacists' Responses to Warnings of Potential Interactions Between Ceftriaxone and Calcium in IV Solutions. Can J Hosp Pharm. 2009 Nov;62(6):483-9.
Gin A, Walker S. Notice to Hospitals Regarding Ceftriaxone-Calcium Incompatibility: What's a Clinician to Do?. Can J Hosp Pharm. 2009;62(2):157-158.