Interaction between Leucovorin and Ceftriaxone
Major
Others
| ID | DDInter1041 and DDInter334 |
| Interaction |
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.
anaemia
aphasia
Aching joints
atelectasis
Clotting
candidiasis of mouth
transient ischaemic attack
chest pain
confusion
Bladder inflammation
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| 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 | |
| Alternative for Leucovorin |
V03A
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| Alternative for Ceftriaxone |
J01D
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.