Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

← Back to all medicines

Rocephin 250mg Powder for Solution for Injection

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Ceftriaxone sodium may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Ceftriaxone sodium

Equivalent medicines (same active substance, strength and form)

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for

Rocephin is an antibiotic given to adults and children (including newborn babies). It works by killing bacteria that cause infections. It belongs to a group of medicines called cephalosporins. Rocephin is used to treat infections of • the brain (meningitis). • the lungs. • the middle ear. • the abdomen and abdominal wall (peritonitis). • the urinary tract and kidneys. • bones and joints. • the skin or soft tissues. • the blood. • the heart. It can be given: • to treat specific sexually transmitted infections (gonorrhoea and syphilis). • to treat patients with low white blood cell counts (neutropenia) who have fever due to bacterial infection. • to treat infections of the chest in adults with chronic bronchitis. • to treat Lyme disease (caused by tick bites) in adults and children including newborn babies from 15 days of age. • to prevent infections during surgery.

1 uk-pil-Rocephin-clean-251111-1g-2g-250mg

2.

What you need to know before you take it

Rocephin

You must not be given Rocephin if: • You are allergic to ceftriaxone or any of the other ingredients of this medicine (listed in section 6). • You have had a sudden or severe allergic reaction to penicillin or similar antibiotics (such as cephalosporins, carbapenems or monobactams). The signs include sudden swelling of the throat or face which might make it difficult to breath or swallow, sudden swelling of the hands, feet and ankles, chest pain and a severe rash that develops quickly. • You are allergic to lidocaine and you are to be given Rocephin as an injection into a muscle. Rocephin must not be given to babies if: • The baby is premature. • The baby is newborn (up to 28 days of age) and has certain blood problems or jaundice (yellowing of the skin or the whites of the eyes) or is to be given a product that contains calcium into their vein. Warnings and precautions Talk to your doctor or pharmacist or nurse before you are given Rocephin if: • You have recently received or are about to receive products that contain calcium. • You have recently had diarrhoea after having an antibiotic medicine. You have ever had problems with your gut, in particular colitis (inflammation of the bowel). • You have liver or kidney problems (see section 4). • You have gall stones or kidney stones • You have other illnesses, such as haemolytic anaemia (a reduction in your red blood cells that may make your skin pale yellow and cause weakness or breathlessness). • You are on a low sodium diet. • You experience or have previously experienced a combination of any of the following symptoms: rash, red skin, blistering of the lips eyes and mouth, skin peeling, high fever, flu-like symptoms, increased levels of liver enzymes seen in blood tests and an increase in a type of white blood cell (eosinophilia) and enlarged lymph nodes (signs of severe skin reactions, see also section 4 "Possible side effects"). If you need a blood or urine test If you are given Rocephin for a long time, you may need to have regular blood tests. Rocephin can affect the results of urine tests for sugar and a blood test known as the Coombs test. If you are having tests: • Tell the person taking the sample that you have been given Rocephin. If you are diabetic or need to have your blood glucose level monitored you should not use certain blood glucose monitoring systems which may estimate blood glucose incorrectly while you are receiving ceftriaxone. If you use such systems check the instructions for use and tell your doctor, pharmacist or nurse. Alternative testing methods should be used if necessary. Children Talk to your doctor or pharmacist or nurse before your child is administered Rocephin if: • He/She has recently been given or is to be given a product that contains calcium into their vein. Other medicines and Rocephin Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular, tell your doctor or pharmacist if you are taking any of the following medicines: • A type of antibiotic called an aminoglycoside. • An antibiotic called chloramphenicol (used to treat infections, particularly of the eyes). Pregnancy and breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. 2 uk-pil-Rocephin-clean-251111-1g-2g-250mg

The doctor will consider the benefit of treating you with Rocephin against the risk to your baby. Driving and using machines Rocephin can cause dizziness. If you feel dizzy, do not drive or use any tools or machines. Talk to your doctor if you experience these symptoms. Rocephin contains sodium Rocephin 2 g powder for solution for injection or infusion contains 169.1 mg sodium (main component of cooking/table salt) in each 2 g bottle. This is equivalent to 8.5% of the recommended maximum daily dietary intake of sodium for an adult. Rocephin 1 g powder for solution for injection or infusion contains 85.4 mg sodium (main component of cooking/table salt) per 1g vial, equivalent to 4.3% of the recommended maximum daily dietary intake of sodium for an adult. Rocephin 250 mg powder for solution for injection contains less than 1 mmol sodium (23 mg) per 250 mg vial, i.e. is essentially "sodium free".

3.

How to take it

Rocephin is usually given by a doctor or nurse. It can be given as

  • a drip (intravenous infusion) or as an injection directly into a vein or
  • into a muscle. Rocephin is made up by the doctor, pharmacist or nurse and will not be mixed with or given to you at the same time as calcium-containing injections. The usual dose Your doctor will decide the correct dose of Rocephin for you. The dose will depend on the severity and type of infection; whether you are on any other antibiotics; your weight and age; how well your kidneys and liver are working. The number of days or weeks that you are given Rocephin depends on what sort of infection you have. Adults, older people and children aged 12 years and over with a body weight greater than or equal to 50 kilograms (kg): • 1 to 2 g once a day depending on the severity and type of infection. If you have a severe infection, your doctor will give you a higher dose (up to 4 g once a day). If your daily dose is higher than 2 g, you may receive it as a single dose once a day or as two separate doses. Newborn babies, infants and children aged 15 days to 12 years with a body weight of less than 50 kg: • 50-80 mg Rocephin for each kg of the child's body weight once a day depending on the severity and type of infection. If you have a severe infection, your doctor will give you a higher dose up to 100 mg for each kg of body weight to a maximum of 4 g once a day. If your daily dose is higher than 2 g, you may receive it as a single dose once a day or as two separate doses. • Children with a body weight of 50 kg or more should be given the usual adult dose. Newborn babies (0-14 days) • 20 – 50 mg Rocephin for each kg of the child's body weight once a day depending on the severity and type of infection. • The maximum daily dose is not to be more than 50 mg for each kg of the baby's weight.

3 uk-pil-Rocephin-clean-251111-1g-2g-250mg

People with liver and kidney problems You may be given a different dose to the usual dose. Your doctor will decide how much Rocephin you will need and will check you closely depending on the severity of the liver and kidney disease. If you are given more Rocephin than you should If you accidentally receive more than your prescribed dose, contact your doctor or nearest hospital straight away. If you forget to use Rocephin If you miss an injection, you should have it as soon as possible. However, if it is almost time for your next injection, skip the missed injection. Do not take a double dose (two injections at the same time) to make up for a missed dose. If you stop using Rocephin Do not stop taking Rocephin unless your doctor tells you to. If you have any further questions on the use of this medicine, ask your doctor or nurse. 4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects may happen with this medicine: Treatment with ceftriaxone, particularly in elderly patients with serious kidney or nervous system problems may rarely cause decreased consciousness, abnormal movements, agitation and convulsions. Severe allergic reactions (not known, frequency cannot be estimated from the available data) If you have a severe allergic reaction, tell a doctor straight away. The signs may include: • Sudden swelling of the face, throat, lips or mouth. This can make it difficult to breathe or swallow. • Sudden swelling of the hands, feet and ankles. • Chest pain in the context of allergic reactions, which may be a symptom of allergy triggered cardiac infarction (Kounis syndrome). Severe skin reactions (not known, frequency cannot be estimated from the available data) If you get a severe skin reaction, tell a doctor straight away. The signs may include: • A severe rash that develops quickly, with blisters or peeling of the skin and possibly blisters in the mouth (Stevens-Johnson syndrome and toxic epidermal necrolysis which are also known as SJS and TEN). • A combination of any of the following symptoms: widespread rash, high body temperature, liver enzyme elevations, blood abnormalities (eosinophilia), enlarged lymph nodes and other body organs involvement (Drug Reaction with Eosinophilia and Systemic Symptoms which is also known as DRESS or drug hypersensitivity syndrome). • Jarisch-Herxheimer reaction which causes fever, chills, headache, muscle pain, and skin rash that is usually self-limiting. This occurs shortly after starting Rocephin treatment for infections with spirochete such as Lyme disease. Other possible side effects: Common (may affect up to 1 in 10 people) • Abnormalities with your white blood cells (such as a decrease of leucocytes and an increase of eosinophils) and platelets (decrease of thrombocytes). • Loose stools or diarrhoea. • Changes in the results of blood tests for liver functions. 4 uk-pil-Rocephin-clean-251111-1g-2g-250mg

•

Rash.

Uncommon (may affect up to 1 in 100 people) • Fungal infections (for example, thrush or genital fungal infections). • A decrease in the number of white blood cells (granulocytopenia). • Reduction in number of red blood cells (anaemia). • Problems with the way your blood clots. The signs may include bruising easily and pain and swelling of your joints. • Headache. • Dizziness. • Feeling sick or being sick. • Pruritis (itching). • Pain or a burning feeling where Rocephin has been given. Blisters, bruising, deep redness or rash, irritation, itching, hardening of the skin or swelling at the injection site. • A high temperature (fever). • Abnormal kidney function test (blood creatinine increased). Rare (may affect up to 1 in 1,000 people) • Inflammation of the large bowel (colon). The signs include diarrhoea, usually with blood and mucus, stomach pain and fever. • Difficulty in breathing (bronchospasm). • A lumpy rash (hives) that may cover a lot of your body, feeling itchy and swelling. • Blood or sugar in your urine. • Oedema (fluid build-up). • Shivering. • Infection at the site of injection. Not known (Frequency cannot be estimated from the available data) • A secondary infection that may not respond to the antibiotic previously prescribed. • Form of anaemia where red blood cells are destroyed (haemolytic anaemia). • Severe decrease in white blood cells (agranulocytosis). • Convulsions. • Vertigo (spinning sensation). • Inflammation of the pancreas (pancreatitis). The signs include severe pain in the stomach which spreads to your back. • Inflammation of the mucus lining of the mouth (stomatitis). • Inflammation of the tongue (glossitis). The signs include swelling, redness and soreness of the tongue. • Problems with your gallbladder and/or liver which may cause pain, nausea, vomiting, yellowing of the skin, itching, unusually dark urine and clay coloured stools. • A neurological condition that may occur in neonates with severe jaundice (kernicterus). • Kidney problems caused by deposits of calcium ceftriaxone. There may be pain when passing water (urine) or low output of urine. • A false positive result in a Coombs' test (a test for some blood problems). • A false positive result for galactosaemia (an abnormal build up of the sugar galactose). • Rocephin may interfere with some types of blood glucose tests – please check with your doctor. Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website:www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5 uk-pil-Rocephin-clean-251111-1g-2g-250mg

5.

How to store it

Rocephin

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and on the vial or bottle label after EXP. The expiry date refers to the last day of that month. Do not store above 30°C. Keep the vial or bottle in the outer carton in order to protect from light. Chemical and physical in-use stability of the reconstituted product has been demonstrated for at least 6 hours at or below 25°C or 24 hours at 2-8°C. From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would not be longer than the times stated above for the chemical and physical in-use stability. For single use only. Do not throw away any medicines via wastewater. Ask your pharmacist to throw away medicines you no longer use. These measures will help protect the environment. 6.

Contents of the pack and other information

What Rocephin contains Rocephin 2 g powder for solution for injection or infusion The active substance is ceftriaxone. Each bottle contains 2 g (grams) ceftriaxone as ceftriaxone sodium. There are no other ingredients. The displacement volume of 2 g of Rocephin is 1.37 ml in water for injections. This requires the offset of solvent volume, if only part of the total solution is measured and administered (i.e. in Newborn babies, infants and children aged 15 days to 12 years with a body weight of less than 50 kg). To prepare a final solution concentration of 50 mg/ml, reconstitute 2 g of Rocephin in 39 ml calciumfree infusion fluid. Rocephin 1 g powder for solution for injection or infusion The active substance is ceftriaxone. Each vial contains 1 g (grams) ceftriaxone as ceftriaxone sodium. There are no other ingredients. The displacement volume of 1 g of Rocephin is 0.71 ml in water for injections and 1% lidocaine hydrochloride solution. This requires the offset of solvent volume, if only part of the total solution is measured and administered (i.e. in Newborn babies, infants and children aged 15 days to 12 years with a body weight of less than 50 kg). •

To prepare a final intravenous solution concentration of 100 mg/ml, reconstitute 1 g of Rocephin in 9.4 ml of water for injections.

•

To prepare a final intramuscular solution concentration of 285 mg/ml, reconstitute 1 g of Rocephin in 2.9 ml of 1% lidocaine hydrochloride solution.

6 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Rocephin 250 mg powder for solution for injection The active substance is ceftriaxone. Each vial contains 250 mg (milligrams) ceftriaxone as ceftriaxone sodium. Rocephin should not be mixed in the same syringe with any drug. The displacement volume of 250 mg of Rocephin is 0.18 ml in water for injections and 1% lidocaine hydrochloride solution. When adding 2.5 ml of water for injections, the final concentration of the reconstituted solution is 93.28 mg/ml. When adding 2 ml of 1% lidocaine hydrochloride solution, the final concentration of the reconstituted solution is 114.68 mg/ml. What Rocephin looks like and contents of the pack Rocephin 2 g powder for solution for injection or infusion Rocephin consists of a powder for solution for infusion Rocephin 1 g powder for solution for injection or infusion Rocephin consists of a powder for solution for injection or infusion Rocephin 250 mg powder for solution for injection Rocephin consists of a powder for solution for injection. The powder is white to yellowish-orange. Rocephin is available in packs of 1 vial or bottle. Marketing Authorisation Holder and Manufacturer Roche Products Limited 6 Falcon Way, Shire Park Welwyn Garden City AL7 1TW United Kingdom

This leaflet was last revised in October 2025

7 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Advice/medical education Antibiotics are used to cure bacterial infections. They are ineffective against viral infections. If your doctor has prescribed antibiotics, you need them precisely for your current illness. Despite antibiotics, some bacteria may survive or grow. This phenomenon is called resistance: some antibiotic treatments become ineffective. Misuse of antibiotics increases resistance. You may even help bacteria become resistant and therefore delay your cure or decrease antibiotic efficacy if you do not respect appropriate: • dosage • schedules • duration of treatment. Consequently, to preserve the efficacy of this drug: 1. Use antibiotics only when prescribed. 2. Strictly follow the prescription. 3. Do not re-use an antibiotic without medical prescription, even if you want to treat a similar illness. 4. Never give your antibiotic to another person; maybe it is not adapted to her/his illness. 5. After completion of treatment, return all unused drugs to your chemist's shop to ensure they will be disposed of correctly.

———————————————————————————————————————–The following information is intended for healthcare professionals only: Please refer to the Summary of Product Characteristics for full prescribing information. Solutions containing Rocephin should not be mixed with or added to solutions containing other agents. In particular, Rocephin is not compatible with calcium-containing solutions. Diluents containing calcium, (e.g. Ringer's solution or Hartmann's solution), should not be used to reconstitute ceftriaxone vials or to further dilute a reconstituted vial for intravenous administration because a precipitate can form. Precipitation of ceftriaxone-calcium can also occur when ceftriaxone is mixed with calciumcontaining solutions in the same intravenous administration line. Therefore, ceftriaxone and calciumcontaining solutions must not be mixed or administered simultaneously. Based on literature reports, ceftriaxone is not compatible with amsacrine, vancomycin, fluconazole and aminoglycosides. Posology The dose depends on the severity, susceptibility, site and type of infection and on the age and hepatorenal function of the patient. The doses recommended in the tables below are the generally recommended doses in these indications. In particularly severe cases, doses at the higher end of the recommended range should be considered. 8 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Adults and children over 12 years of age (≥ 50 kg) Ceftriaxone Dosage* 1-2 g

Treatment frequency** Once daily

2g

Once daily

2-4 g

Once daily

Indications Community acquired pneumonia Acute exacerbations of chronic obstructive pulmonary disease Intra-abdominal infections Complicated urinary tract infections (including pyelonephritis) Hospital acquired pneumonia Complicated skin and soft tissue infections Infections of bones and joints Management of neutropenic patients with fever that is suspected to be due to a bacterial infection Bacterial endocarditis Bacterial meningitis

  • In documented bacteraemia, the higher end of the recommended dose range should be considered. ** Twice daily (12 hourly) administration may be considered where doses greater than 2 g daily are administered. Indications for adults and children over 12 years of age (≥ 50 kg) that require specific dosage schedules: Acute otitis media A single intramuscular dose of Rocephin 1-2 g can be given. Limited data suggest that in cases where the patient is severely ill or previous therapy has failed, Rocephin may be effective when given as an intramuscular dose of 1-2 g daily for 3 days. Pre-operative prophylaxis of surgical site infections 2 g as a single pre-operative dose. Gonorrhoea 500 mg as a single intramuscular dose. Syphilis The generally recommended doses are 500 mg-1 g once daily increased to 2 g once daily for neurosyphilis for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on limited data. National or local guidance should be taken into consideration. Disseminated Lyme borreliosis (early [Stage II] and late [Stage III]) 2 g once daily for 14-21 days. The recommended treatment durations vary and national or local guidelines should be taken into consideration. Paediatric population Infants and children 15 days to 12 years of age (< 50 kg) For children with bodyweight of 50 kg or more, the usual adult dosage should be given. Ceftriaxone dosage* 50-80 mg/kg

Treatment frequency** Once daily

Indications Intra-abdominal infections 9 uk-pil-Rocephin-clean-251111-1g-2g-250mg

50-100 mg/kg (Max 4 g)

Once daily

Complicated urinary tract infections (including pyelonephritis) Community acquired pneumonia Hospital acquired pneumonia Complicated skin and soft tissue infections Infections of bones and joints Management of neutropenic patients with fever that is suspected to be due to a bacterial infection Bacterial meningitis

80-100 mg/kg Once daily (max 4 g) 100 mg/kg (max Once daily Bacterial endocarditis 4 g)

  • In documented bacteraemia, the higher end of the recommended dose range should be considered. ** Twice daily (12 hourly) administration may be considered where doses greater than 2 g daily are administered. Indications for, infants and children 15 days to 12 years (< 50 kg) that require specific dosage schedules: Acute otitis media For initial treatment of acute otitis media, a single intramuscular dose of Rocephin 50 mg/kg can be given. Limited data suggest that in cases where the child is severely ill or initial therapy has failed, Rocephin may be effective when given as an intramuscular dose of 50 mg/kg daily for 3 days. Pre-operative prophylaxis of surgical site infections 50-80 mg/kg as a single pre-operative dose. Syphilis The generally recommended doses are 75-100 mg/kg (max 4 g) once daily for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on very limited data. National or local guidance should be taken into consideration. Disseminated Lyme borreliosis (early [Stage II] and late [Stage III]) 50-80 mg/kg once daily for 14-21 days. The recommended treatment durations vary and national or local guidelines should be taken into consideration. Neonates 0-14 days Rocephin is contraindicated in premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age). Ceftriaxone dosage* 20-50 mg/kg

Treatment frequency Once daily

Indications

Intra-abdominal infections Complicated skin and soft tissue infections Complicated urinary tract infections (including pyelonephritis) Community acquired pneumonia Hospital acquired pneumonia Infections of bones and joints Management of neutropenic patients with fever that is suspected to be due to a bacterial infection 50 mg/kg Once daily Bacterial meningitis Bacterial endocarditis

  • In documented bacteraemia, the higher end of the recommended dose range should be considered. A maximum daily dose of 50 mg/kg should not be exceeded. 10 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Indications for neonates 0-14 days that require specific dosage schedules:

Acute otitis media For initial treatment of acute otitis media, a single intramuscular dose of Rocephin 50 mg/kg can be given. Pre-operative prophylaxis of surgical site infections 20-50 mg/kg as a single pre-operative dose. Syphilis The generally recommended dose is 50 mg/kg once daily for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on very limited data. National or local guidance should be taken into consideration. Duration of therapy The duration of therapy varies according to the course of the disease. As with antibiotic therapy in general, administration of ceftriaxone should be continued for 48 – 72 hours after the patient has become afebrile or evidence of bacterial eradication has been achieved. Older people The dosages recommended for adults require no modification in older people provided that renal and hepatic function is satisfactory. Patients with hepatic impairment Available data do not indicate the need for dose adjustment in mild or moderate liver function impairment provided renal function is not impaired. There are no study data in patients with severe hepatic impairment. Patients with renal impairment In patients with impaired renal function, there is no need to reduce the dosage of ceftriaxone provided hepatic function is not impaired. Only in cases of preterminal renal failure (creatinine clearance < 10 ml/min) should the ceftriaxone dosage not exceed 2 g daily. In patients undergoing dialysis no additional supplementary dosing is required following the dialysis. Ceftriaxone is not removed by peritoneal- or haemodialysis. Close clinical monitoring for safety and efficacy is advised. Patients with severe hepatic and renal impairment In patients with both severe renal and hepatic dysfunction, close clinical monitoring for safety and efficacy is advised. Instructions for use For single use only. Any unused medicinal product or waste material should be disposed of in accordance with local requirements. The use of freshly prepared solutions is recommended. For storage conditions of the reconstituted medicinal product, see "How to store Rocephin" section. Rocephin is completely reconstituted in its respective solvent within 150 seconds. The reconstituted solution is a clear solution with a yellow to brownish-yellow colour.

11 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Rocephin should not be mixed in the same syringe with any drug other than 1% Lidocaine Hydrochloride solution (for intramuscular injection only). The infusion line should be flushed after each administration. Intravenous 2g infusion: Use in adults and children over 12 years of age (≥ 50 kg) 2g of Rocephin is be dissolved in 40 ml of one of the following calcium-free solutions: sodium chloride 0.9%, sodium chloride 0.45% + dextrose 2.5%, dextrose 5%, dextrose 10%, dextran 6% in dextrose 5%, water for injections. The bottle should be gently rolled between the palms, and visually inspected to ensure that reconstitution is complete and no particulate material is present. The infusion should be administered over at least 30 minutes. Use in the paediatric population Neonates, infants and children 15 days to 12 years of age (< 50 kg) The displacement volume of 2 g of Rocephin is 1.37 ml in water for injections. This requires the offset of solvent volume to facilitate weight-dependent dosing (primarily in children up to 12 years), if only part of the total solution is measured and administered. To prepare a final solution concentration of 50 mg/ml, reconstitute 2 g of Rocephin in 39 ml calcium-free infusion fluid. Intravenous 1g administration (injection or infusion): Use in adults and children over 12 years of age (≥ 50 kg) 1 g Rocephin is dissolved in 10 ml of Water for Injections. The vial should be gently rolled between the palms, and visually inspected to ensure that reconstitution is complete and no particulate material is present. For intravenous injection administer over 5 minutes, directly into the vein or via the tubing of an intravenous infusion. Alternatively, for intravenous infusion, the reconstituted solution should be transferred to 10 ml of one of the following calcium-free infusion fluids: sodium chloride 0.9%, sodium chloride 0.45% + dextrose 2.5%, dextrose 5%, dextrose 10%, dextran 6% in dextrose 5%, water for injections. The infusion should be administered over at least 30 minutes. Use in the paediatric population Neonates, infants and children 15 days to 12 years of age (< 50 kg) The displacement volume of 1 g of Rocephin is 0.71 ml in water for injections. This requires the offset of solvent volume to facilitate weight-dependent dosing (primarily in children up to 12 years), if only part of the total solution is measured and administered. To prepare a final solution concentration of 100 mg/ml, reconstitute 1 g of Rocephin in 9.4 ml of water for injections. Intramuscular 1g injection: Use in adults and children over 12 years of age (≥ 50 kg) 1g Rocephin is dissolved in 3.5 ml of 1% Lidocaine Hydrochloride solution. The vial should be gently rolled between the palms, and visually inspected to ensure that reconstitution is complete and no particulate material is present. The solution should be administered by deep intramuscular injection. Dosages greater than 1g should be divided and injected at more than one site. Use in the paediatric population Use in neonates, infants and children 15 days to 12 years of age (< 50 kg) The displacement volume of 1 g of Rocephin is 0.71 ml in 1% lidocaine hydrochloride solution. This requires the offset of solvent volume to facilitate weight-dependent dosing (primarily in children up to 12 uk-pil-Rocephin-clean-251111-1g-2g-250mg

12 years), if only part of the total solution is measured and administered. To prepare a final solution concentration of 285 mg/ml, reconstitute 1 g of Rocephin in 2.9 ml of 1% lidocaine hydrochloride solution. Solutions in Lidocaine should never be administered intravenously. Intravenous 250mg injection: Use in adults and children over 12 years of age (≥ 50 kg) 250 mg Rocephin is dissolved in 2.5 ml of Water for Injections or 1 g in 10 ml of Water for Injections. The vial should be gently rolled between the palms, and visually inspected to ensure that reconstitution is complete and no particulate material is present. The injection should be administered over 5 minutes, directly into the vein or via the tubing of an intravenous infusion. Use in the paediatric population Use in neonates, infants and children 15 days to 12 years of age (< 50 kg) The displacement volume of 250 mg of Rocephin is 0.18 ml in water for injections. When adding 2.5 ml of water for injections, the final concentration of the reconstituted solution is 93.28 mg/ml. When adding 2 ml of 1% lidocaine hydrochloride solution, the final concentration of the reconstituted solution is 114.68 mg/ml. Intramuscular 250mg injection: Use in adults and children over 12 years of age (≥ 50 kg) 250 mg Rocephin is dissolved in 2 ml of 1% Lidocaine Hydrochloride solution or 1 g in 3.5 ml of 1% Lidocaine Hydrochloride solution. The vial should be gently rolled between the palms, and visually inspected to ensure that reconstitution is complete and no particulate material is present. The solution should be administered by deep intramuscular injection. Dosages greater than 1 g should be divided and injected at more than one site. Use in neonates, infants and children 15 days to 12 years of age (< 50 kg) The displacement volume of 250 mg of Rocephin is 0.18 ml in 1% lidocaine hydrochloride solution. This requires the offset of solvent volume to facilitate weight-dependent dosing (primarily in children up to 12 years), if only part of the total solution is measured and administered. To prepare a final solution concentration of 125 mg/ml, reconstitute 250 mg of Rocephin in 1.9 ml of 1% lidocaine hydrochloride solution. Solutions in Lidocaine should never be administered intravenously.

13 uk-pil-Rocephin-clean-251111-1g-2g-250mg

Frequently asked questions about Rocephin 250mg Powder for Solution for Injection

How do I take Rocephin 250mg Powder for Solution for Injection?

Rocephin 250mg Powder for Solution for Injection comes as injection containing 250mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Rocephin 250mg Powder for Solution for Injection?

The active substance in Rocephin 250mg Powder for Solution for Injection is ceftriaxone sodium.

Are there equivalent medicines to Rocephin 250mg Powder for Solution for Injection?

Medicines with the same active substance, strength and form include: Ceftriaxone 250mg powder for solution for injection vials. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Rocephin 250mg Powder for Solution for Injection, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Rocephin 250mg Powder for Solution for Injection without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Ceftriaxone sodium (15 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Rocephin is indicated for the treatment of the following infections in adults and children including term neonates (from birth):

Bacterial Meningitis

Community acquired pneumonia

Hospital acquired pneumonia

Acute otitis media

Intra-abdominal infections

Complicated urinary tract infections (including pyelonephritis)

Infections of bones and joints

Complicated skin and soft tissue infections

Gonorrhoea

Syphilis

Bacterial endocarditis

Rocephin may be used:

For treatment of acute exacerbations of chronic obstructive pulmonary disease in adults

For treatment of disseminated Lyme borreliosis (early (stage II) and late (stage III)) in adults and children including neonates from 15 days of age

For Pre-operative prophylaxis of surgical site infections

In the management of neutropenic patients with fever that is suspected to be due to a bacterial infection

In the treatment of patients with bacteraemia that occurs in association with, or is suspected to be associated with, any of the infections listed above

Rocephin should be co-administered with other antibacterial agents whenever the possible range of causative bacteria would not fall within its spectrum (see section 4.4).

Consideration should be given to official guidelines on the appropriate use of antibacterial agents.

4.2. Posology and method of administration

Posology

The dose depends on the severity, susceptibility, site and type of infection and on the age and hepato-renal function of the patient.

The doses recommended in the tables below are the generally recommended doses in these indications. In particularly severe cases, doses at the higher end of the recommended range should be considered.

Adults and children over 12 years of age (≥ 50 kg)

Ceftriaxone Dosage*

Treatment frequency**

Indications

1-2 g

Once daily

Community acquired pneumonia

Acute exacerbations of chronic obstructive pulmonary disease

Intra-abdominal infections

Complicated urinary tract infections (including pyelonephritis)

2 g

Once daily

Hospital acquired pneumonia

Complicated skin and soft tissue infections

Infections of bones and joints

2-4 g

Once daily

Management of neutropenic patients with fever that is suspected to be due to a bacterial infection

Bacterial endocarditis

Bacterial meningitis

* In documented bacteraemia, the higher end of the recommended dose range should be considered.

** Twice daily (12 hourly) administration may be considered where doses greater than 2 g daily are administered.

Indications for adults and children over 12 years of age (≥ 50 kg) that require specific dosage schedules:

Acute otitis media

A single intramuscular dose of Rocephin 1-2 g can be given.

Limited data suggest that in cases where the patient is severely ill or previous therapy has failed, Rocephin may be effective when given as an intramuscular dose of 1-2 g daily for 3 days.

Pre-operative prophylaxis of surgical site infections

2 g as a single pre-operative dose.

Gonorrhoea

500 mg as a single intramuscular dose.

Syphilis

The generally recommended doses are 500 mg-1 g once daily increased to 2 g once daily for neurosyphilis for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on limited data. National or local guidance should be taken into consideration.

Disseminated Lyme borreliosis (early [Stage II] and late [Stage III])

2 g once daily for 14-21 days. The recommended treatment durations vary and national or local guidelines should be taken into consideration.

Paediatric population

Neonates, infants and children 15 days to 12 years of age (< 50 kg)

For children with bodyweight of 50 kg or more, the usual adult dosage should be given.

Ceftriaxone dosage*

Treatment frequency**

Indications

50-80 mg/kg

Once daily

Intra-abdominal infections

Complicated urinary tract infections (including pyelonephritis)

Community acquired pneumonia

Hospital acquired pneumonia

50-100 mg/kg (Max 4 g)

Once daily

Complicated skin and soft tissue infections

Infections of bones and joints

Management of neutropenic patients with fever that is suspected to be due to a bacterial infection

80-100 mg/kg (max 4 g)

Once daily

Bacterial meningitis

100 mg/kg (max 4 g)

Once daily

Bacterial endocarditis

* In documented bacteraemia, the higher end of the recommended dose range should be considered.

** Twice daily (12 hourly) administration may be considered where doses greater than 2 g daily are administered.

Indications for infants and children 15 days to 12 years (< 50 kg) that require specific dosage schedules:

Acute otitis media

For initial treatment of acute otitis media, a single intramuscular dose of Rocephin 50 mg/kg can be given. Limited data suggest that in cases where the child is severely ill or initial therapy has failed, Rocephin may be effective when given as an intramuscular dose of 50 mg/kg daily for 3 days.

Pre-operative prophylaxis of surgical site infections 50-80 mg/kg as a single pre-operative dose.

Syphilis

The generally recommended doses are 75-100 mg/kg (max 4 g) once daily for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on very limited data. National or local guidance should be taken into consideration.

Disseminated Lyme borreliosis (early [Stage II] and late [Stage III])

50–80 mg/kg once daily for 14-21 days. The recommended treatment durations vary and national or local guidelines should be taken into consideration.

Neonates 0-14 days

Rocephin is contraindicated in premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age).

Ceftriaxone dosage*

Treatment frequency

Indications

20-50 mg/kg

Once daily

Intra-abdominal infections

Complicated skin and soft tissue infections

Complicated urinary tract infections (including pyelonephritis)

Community acquired pneumonia

Hospital acquired pneumonia

Infections of bones and joints

Management of neutropenic patients with fever that is suspected to be due to a bacterial infection

50 mg/kg

Once daily

Bacterial meningitis

Bacterial endocarditis

* In documented bacteraemia, the higher end of the recommended dose range should be considered.

A maximum daily dose of 50 mg/kg should not be exceeded.

Indications for infants and children 15 days to 12 years (< 50 kg) that require specific dosage schedules:

Acute otitis media

For initial treatment of acute otitis media, a single intramuscular dose of Rocephin 50 mg/kg can be given.

Pre-operative prophylaxis of surgical site infections

20-50 mg/kg as a single pre-operative dose.

Syphilis

The generally recommended dose is 50 mg/kg once daily for 10-14 days. The dose recommendations in syphilis, including neurosyphilis, are based on very limited data. National or local guidance should be taken into consideration.

Duration of therapy

The duration of therapy varies according to the course of the disease. As with antibiotic therapy in general, administration of ceftriaxone should be continued for 48 - 72 hours after the patient has become afebrile or evidence of bacterial eradication has been achieved.

Older people

The dosages recommended for adults require no modification in older people provided that renal and hepatic function is satisfactory.

Patients with hepatic impairment

Available data do not indicate the need for dose adjustment in mild or moderate liver function impairment provided renal function is not impaired.

There are no study data in patients with severe hepatic impairment (see section 5.2).

Patients with renal impairment

In patients with impaired renal function, there is no need to reduce the dosage of ceftriaxone provided hepatic function is not impaired. Only in cases of preterminal renal failure (creatinine clearance < 10 ml/min) should the ceftriaxone dosage not exceed 2 g daily.

In patients undergoing dialysis no additional supplementary dosing is required following the dialysis. Ceftriaxone is not removed by peritoneal- or haemodialysis. Close clinical monitoring for safety and efficacy is advised.

Patients with severe hepatic and renal impairment

In patients with both severe renal and hepatic dysfunction, close clinical monitoring for safety and efficacy is advised.

Method of administration

Intramuscular administration

Rocephin can be administered by deep intramuscular injection. Intramuscular injections should be injected well within the bulk of a relatively large muscle and not more than 1 g should be injected at one site.

As the solvent used is lidocaine, the resulting solution should never be administered intravenously (see section 4.3). The information in the Summary of Product Characteristics of lidocaine should be considered.

Intravenous administration

Rocephin can be administered by intravenous infusion over at least 30 minutes (preferred route) or by slow intravenous injection over 5 minutes. Intravenous intermittent injection should be given over 5 minutes preferably in larger veins. Intravenous doses of 50 mg/kg or more in infants and children up to 12 years of age should be given by infusion. In neonates, intravenous doses should be given over 60 minutes to reduce the potential risk of bilirubin encephalopathy (see section 4.3 and 4.4). Intramuscular administration should be considered when the intravenous route is not possible or less appropriate for the patient. For doses greater than 2 g intravenous administration should be used.

Ceftriaxone is contraindicated in neonates (≤ 28 days) if they require (or are expected to require) treatment with calcium-containing intravenous solutions, including continuous calcium-containing infusions such as parenteral nutrition, because of the risk of precipitation of ceftriaxone-calcium (see section 4.3).

Diluents containing calcium, (e.g. Ringer's solution or Hartmann's solution), should not be used to reconstitute ceftriaxone vials or to further dilute a reconstituted vial for intravenous administration because a precipitate can form. Precipitation of ceftriaxone-calcium can also occur when ceftriaxone is mixed with calcium-containing solutions in the same intravenous administration line. Therefore, ceftriaxone and calcium-containing solutions must not be mixed or administered simultaneously (see sections 4.3, 4.4 and 6.2).

For pre-operative prophylaxis of surgical site infections, ceftriaxone should be administered 30-90 minutes prior to surgery.

For instructions on reconstitution of the medicinal product before administration, see section 6.6.

4.3. Contraindications

Hypersensitivity to ceftriaxone, or to any other cephalosporin.

History of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams and carbapenems).

Ceftriaxone is contraindicated in:

Premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age)*

Full-term neonates (up to 28 days of age):

- with hyperbilirubinaemia, jaundice, or who are hypoalbuminaemic or acidotic because these are conditions in which bilirubin binding is likely to be impaired*

- if they require (or are expected to require) intravenous calcium treatment, or calcium-containing infusions due to the risk of precipitation of a ceftriaxone- calcium salt (see sections 4.4, 4.8 and 6.2).

* In vitro studies have shown that ceftriaxone can displace bilirubin from its serum albumin binding sites leading to a possible risk of bilirubin encephalopathy in these patients.

Contraindications to lidocaine must be excluded before intramuscular injection of ceftriaxone when lidocaine solution is used as a solvent (see section 4.4). See information in the Summary of Product Characteristics of lidocaine, especially contraindications.

Ceftriaxone solutions containing lidocaine should never be administered intravenously.

4.4. Special warnings and precautions for use

Hypersensitivity reactions

As with all beta-lactam antibacterial agents, serious and occasionally fatal hypersensitivity reactions have been reported (see section 4.8). Hypersensitivity reactions can also progress to Kounis syndrome, a serious allergic reaction that can result in myocardial infarction (see section 4.8). In case of severe hypersensitivity reactions, treatment with ceftriaxone must be discontinued immediately and adequate emergency measures must be initiated. Before beginning treatment, it should be established whether the patient has a history of severe hypersensitivity reactions to ceftriaxone, to other cephalosporins or to any other type of beta-lactam agent. Caution should be used if ceftriaxone is given to patients with a history of non-severe hypersensitivity to other beta-lactam agents.

Severe cutaneous adverse reactions (Stevens Johnson syndrome or Lyell's syndrome/toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms (DRESS)) which can be life-threatening or fatal have been reported in association of ceftriaxone treatment; however, the frequency of these events is not known (see section 4.8).

Interaction with calcium containing products

Cases of fatal reactions with calcium-ceftriaxone precipitates in lungs and kidneys in premature and full-term neonates aged less than 1 month have been described. At least one of them had received ceftriaxone and calcium at different times and through different intravenous lines. In the available scientific data, there are no reports of confirmed intravascular precipitations in patients, other than neonates, treated with ceftriaxone and calcium-containing solutions or any other calcium-containing products. In vitro studies demonstrated that neonates have an increased risk of precipitation of ceftriaxone-calcium compared to other age groups.

In patients of any age ceftriaxone must not be mixed or administered simultaneously with any calcium-containing intravenous solutions, even via different infusion lines or at different infusion sites. However, in patients older than 28 days of age ceftriaxone and calcium-containing solutions may be administered sequentially one after another if infusion lines at different sites are used or if the infusion lines are replaced or thoroughly flushed between infusions with physiological salt-solution to avoid precipitation. In patients requiring continuous infusion with calcium-containing total parenteral nutrition (TPN) solutions, healthcare professionals may wish to consider the use of alternative antibacterial treatments which do not carry a similar risk of precipitation. If the use of ceftriaxone is considered necessary in patients requiring continuous nutrition, TPN solutions and ceftriaxone can be administered simultaneously, albeit via different infusion lines at different sites. Alternatively, infusion of TPN solution could be stopped for the period of ceftriaxone infusion and the infusion lines flushed between solutions (see sections 4.3, 4.8, 5.2 and 6.2).

Paediatric population

Safety and effectiveness of Rocephin in neonates, infants and children have been established for the dosages described under Posology and Method of Administration (see section 4.2). Studies have shown that ceftriaxone, like some other cephalosporins, can displace bilirubin from serum albumin.

Rocephin is contraindicated in premature and full-term neonates at risk of developing bilirubin encephalopathy (see section 4.3).

Immune mediated haemolytic anaemia

An immune mediated haemolytic anaemia has been observed in patients receiving cephalosporin class antibacterials including Rocephin (see section 4.8). Severe cases of haemolytic anaemia, including fatalities, have been reported during Rocephin treatment in both adults and children.

If a patient develops anaemia while on ceftriaxone, the diagnosis of a cephalosporin-associated anaemia should be considered and ceftriaxone discontinued until the aetiology is determined.

Long term treatment

During prolonged treatment complete blood count should be performed at regular intervals.

Colitis/Overgrowth of non-susceptible microorganisms

Antibacterial agent-associated colitis and pseudo-membranous colitis have been reported with nearly all antibacterial agents, including ceftriaxone, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea during or subsequent to the administration of ceftriaxone (see section 4.8). Discontinuation of therapy with ceftriaxone and the administration of specific treatment for Clostridium difficile should be considered. Medicinal products that inhibit peristalsis should not be given.

Superinfections with non-susceptible micro-organisms may occur as with other antibacterial agents.

Severe renal and hepatic insufficiency

In severe renal and hepatic insufficiency, close clinical monitoring for safety and efficacy is advised (see section 4.2).

Interference with serological testing

Interference with Coombs tests may occur, as Rocephin may lead to false-positive test results. Rocephin can also lead to false-positive test results for galactosaemia (see section 4.8).

Non-enzymatic methods for the glucose determination in urine may give false-positive results. Urine glucose determination during therapy with Rocephin should be done enzymatically (see section 4.8).

The presence of ceftriaxone may falsely lower estimated blood glucose values obtained with some blood glucose monitoring systems. Please refer to instructions for use for each system. Alternative testing methods should be used if necessary.

Sodium

Rocephin 2 g powder for solution for injection or infusion contains 169.1 mg sodium per 2 g bottle, equivalent to 8.5% of the WHO recommended maximum daily intake of 2 g sodium for an adult.

Rocephin 1 g powder for solution for injection or infusion contains 85.4 mg sodium per 1g vial, equivalent to 4.3% of the WHO recommended maximum daily intake of 2 g sodium for an adult.

Rocephin 250 mg powder for solution for injection contains less than 1 mmol sodium (23 mg) per 250 mg vial, i.e. is essentially “sodium free”.

Antibacterial spectrum

Ceftriaxone has a limited spectrum of antibacterial activity and may not be suitable for use as a single agent for the treatment of some types of infections unless the pathogen has already been confirmed (see section 4.2). In polymicrobial infections, where suspected pathogens include organisms resistant to ceftriaxone, administration of an additional antibiotic should be considered.

Use of lidocaine

In case a lidocaine solution is used as a solvent, ceftriaxone solutions must only be used for intramuscular injection. Contraindications to lidocaine, warnings and other relevant information as detailed in the Summary of Product Characteristics of lidocaine must be considered before use (see section 4.3). The lidocaine solution should never be administered intravenously.

Biliary lithiasis

When shadows are observed on sonograms, consideration should be given to the possibility of precipitates of calcium ceftriaxone. Shadows, which have been mistaken for gallstones, have been detected on sonograms of the gallbladder and have been observed more frequently at ceftriaxone doses of 1 g per day and above. Caution should be particularly considered in the paediatric population. Such precipitates disappear after discontinuation of ceftriaxone therapy. Rarely precipitates of calcium ceftriaxone have been associated with symptoms. In symptomatic cases, conservative nonsurgical management is recommended and discontinuation of ceftriaxone treatment should be considered by the physician based on specific benefit risk assessment (see section 4.8).

Biliary stasis

Cases of pancreatitis, possibly of biliary obstruction aetiology, have been reported in patients treated with Rocephin (see section 4.8). Most patients presented with risk factors for biliary stasis and biliary sludge e.g. preceding major therapy, severe illness and total parenteral nutrition. A trigger or cofactor of Rocephin-related biliary precipitation cannot be ruled out.

Renal lithiasis

Cases of renal lithiasis have been reported, which is reversible upon discontinuation of ceftriaxone (see section 4.8). In symptomatic cases, sonography should be performed. Use in patients with history of renal lithiasis or with hypercalciuria should be considered by the physician based on specific benefit risk assessment.

Jarisch-Herxheimer reaction (JHR)

Some patients with spirochete infections may experience a Jarisch-Herxheimer reaction (JHR) shortly after ceftriaxone treatment is started. JHR is usually a self – limiting condition or can be managed by symptomatic treatment. The antibiotic treatment should not be discontinued if such reaction occurs.

Encephalopathy

Encephalopathy has been reported with the use of ceftriaxone (see section 4.8), particularly in elderly patients with severe renal impairment (see section 4.2) or central nervous system disorders. If ceftriaxone-associated encephalopathy is suspected (e.g. decreased level of consciousness, altered mental state, myoclonus, convulsions), discontinuation of ceftriaxone should be considered.

4.5. Interaction with other medicinal products and other forms of interaction

Calcium-containing diluents, such as Ringer's solution or Hartmann's solution, should not be used to reconstitute Rocephin vials or to further dilute a reconstituted vial for intravenous administration because a precipitate can form. Precipitation of ceftriaxone-calcium can also occur when ceftriaxone is mixed with calcium-containing solutions in the same intravenous administration line. Ceftriaxone must not be administered simultaneously with calcium-containing intravenous solutions, including continuous calcium-containing infusions such as parenteral nutrition via a Y-site. However, in patients other than neonates, ceftriaxone and calcium-containing solutions may be administered sequentially of one another if the infusion lines are thoroughly flushed between infusions with a compatible fluid. In vitro studies using adult and neonatal plasma from umbilical cord blood demonstrated that neonates have an increased risk of precipitation of ceftriaxone-calcium (see sections 4.2, 4.3, 4.4, 4.8 and 6.2).

Concomitant use with oral anticoagulants may increase the anti-vitamin K effect and the risk of bleeding. It is recommended that the International Normalised Ratio (INR) is monitored frequently and the posology of the anti-vitamin K drug adjusted accordingly, both during and after treatment with ceftriaxone (see section 4.8).

There is conflicting evidence regarding a potential increase in renal toxicity of aminoglycosides when used with cephalosporins. The recommended monitoring of aminoglycoside levels (and renal function) in clinical practice should be closely adhered to in such cases.

In an in-vitro study antagonistic effects have been observed with the combination of chloramphenicol and ceftriaxone. The clinical relevance of this finding is unknown.

There have been no reports of an interaction between ceftriaxone and oral calcium-containing products or interaction between intramuscular ceftriaxone and calcium-containing products (intravenous or oral).

In patients treated with ceftriaxone, the Coombs' test may lead to false-positive test results.

Ceftriaxone, like other antibiotics, may result in false-positive tests for galactosaemia.

Likewise, non-enzymatic methods for glucose determination in urine may yield false-positive results. For this reason, glucose level determination in urine during therapy with ceftriaxone should be carried out enzymatically.

No impairment of renal function has been observed after concurrent administration of large doses of ceftriaxone and potent diuretics (e.g. furosemide).

Simultaneous administration of probenecid does not reduce the elimination of ceftriaxone.

4.6. Fertility, pregnancy and lactation

Pregnancy

Ceftriaxone crosses the placental barrier. There are limited amounts of data from the use of ceftriaxone in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to embryonal/foetal, perinatal and postnatal development (see section 5.3). Ceftriaxone should only be administered during pregnancy and in particular in the first trimester of pregnancy if the benefit outweighs the risk.

Breastfeeding

Ceftriaxone is excreted into human milk in low concentrations but at therapeutic doses of ceftriaxone no effects on the breastfed infants are anticipated. However, a risk of diarrhoea and fungal infection of the mucous membranes cannot be excluded. The possibility of sensitisation should be taken into account. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from ceftriaxone therapy, taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman.

Fertility

Reproductive studies have shown no evidence of adverse effects on male or female fertility.

4.7. Effects on ability to drive and use machines

During treatment with ceftriaxone, undesirable effects may occur (e.g. dizziness), which may influence the ability to drive and use machines (see section 4.8). Patients should be cautious when driving or operating machinery.

4.8. Undesirable effects

The most frequently reported adverse reactions for ceftriaxone are eosinophilia, leucopenia, thrombocytopenia, diarrhoea, rash, and hepatic enzymes increased.

Data to determine the frequency of ceftriaxone ADRs was derived from clinical trials.

The following convention has been used for the classification of frequency:

Very common (≥ 1/10)

Common (≥ 1/100 - < 1/10)

Uncommon (≥ 1/1000 - < 1/100)

Rare (≥ 1/10000 - < 1/1000)

Not known (cannot be estimated from the available data)

System Organ Class

Common

Uncommon

Rare

Not Known a

Infections and infestations

Genital fungal infection

Pseudo-membranous colitisb

Superinfectionb

Blood and lymphatic system disorders

Eosinophilia

Leucopenia

Thrombocytopenia

Granulocytopenia

Anaemia

Coagulopathy

Haemolytic anaemiab

Agranulocytosis

Immune system disorders

Anaphylactic shock

Anaphylactic reaction

Anaphylactoid reaction

Hypersensitivityb

Jarisch-Herxheimer reactionb

Nervous system disorders

Headache

Dizziness

Encephalopathy

Convulsion

Ear and labyrinth disorders

Vertigo

Cardiac disorders

Kounis syndrome

Respiratory, thoracic and mediastinal disorders

Bronchospasm

Gastrointestinal disorders

Diarrhoeab

Loose stools

Nausea

Vomiting

Pancreatitisb

Stomatitis

Glossitis

Hepatobiliary disorders

Hepatic enzyme increased

Gall bladder precipitationb

Kernicterus

Hepatitisc

Hepatitis cholestaticb,c

Skin and subcutaneous tissue disorders

Rash

Pruritus

Urticaria

Stevens Johnson Syndromeb

Toxic epidermal necrolysisb

Erythema multiforme

Acute generalised exanthematous pustulosis

Drug reaction with eosinophilia and systemic symptoms (DRESS)b

Renal and urinary disorders

Haematuria

Glycosuria

Oliguria

Renal precipitation (reversible)

General disorders and administration site conditions

Phlebitis

Injection site reactions

Pyrexia

Oedema

Chills

Investigations

Blood creatinine increased

Coombs test false positiveb

Galactosaemia test false positiveb

Non enzymatic methods for glucose determination false positiveb

a Based on post-marketing reports. Since these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency which is therefore categorised as not known.

b See section 4.4

c Usually reversible upon discontinuation of ceftriaxone

Description of selected adverse reactions

Infections and infestations

Reports of diarrhoea following the use of ceftriaxone may be associated with Clostridium difficile. Appropriate fluid and electrolyte management should be instituted (see section 4.4).

Ceftriaxone-calcium salt precipitation

Rarely, severe, and in some cases, fatal, adverse reactions have been reported in pre-term and full-term neonates (aged < 28 days) who had been treated with intravenous ceftriaxone and calcium. Precipitations of ceftriaxone-calcium salt have been observed in lung and kidneys post-mortem. The high risk of precipitation in neonates is a result of their low blood volume and the longer half-life of ceftriaxone compared with adults (see sections 4.3, 4.4, and 5.2).

Cases of ceftriaxone precipitation in the urinary tract have been reported, mostly in children treated with high doses (e.g. ≥ 80 mg/kg/day or total doses exceeding 10 grams) and who have other risk factors (e.g. dehydration, confinement to bed). This event may be asymptomatic or symptomatic, and may lead to ureteric obstruction and postrenal acute renal failure, but is usually reversible upon discontinuation of ceftriaxone (see section 4.4).

Precipitation of ceftriaxone calcium salt in the gallbladder has been observed, primarily in patients treated with doses higher than the recommended standard dose. In children, prospective studies have shown a variable incidence of precipitation with intravenous application - above 30 % in some studies. The incidence appears to be lower with slow infusion (20 - 30 minutes). This effect is usually asymptomatic, but the precipitations have been accompanied by clinical symptoms such as pain, nausea and vomiting in rare cases. Symptomatic treatment is recommended in these cases. Precipitation is usually reversible upon discontinuation of ceftriaxone (see section 4.4).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

In overdose, the symptoms of nausea, vomiting and diarrhoea can occur. Ceftriaxone concentrations cannot be reduced by haemodialysis or peritoneal dialysis. There is no specific antidote. Treatment of overdose should be symptomatic.

💬 Ask about this leaflet

Ask anything about Rocephin 250mg Powder for Solution for Injection. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.

Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.

Pharmacies in major towns and cities — see the list
Pharmacies by county and region — see the full list

Browse all 2,009 towns and cities →