CEFTRIAXONE, Leaflet UK 125 x 590 mm

i_g cefTRIAXone 2_g

PACKAGE LEAFLET: INFORMATION FOR THE USER

Ceftriaxone 1 g powder for solution for injection

Ceftriaxone 2 g powder for solution for infusion

Ceftriaxone (as ceftriaxone sodium)

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

•    Keep this leaflet. You may need to read it again.

•    If you have any further questions, ask your doctor or nurse.

•    If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1.    What Ceftriaxone is and what it is used for

2.    What you need to know before you are given Ceftriaxon

3.    How Ceftriaxone is given

4.    Possible side effects

5.    How to store Ceftriaxone

6.    Contents of the pack and other information

1. WHAT CEFTRIAXONE IS AND WHAT IT IS USED FOR_

Ceftriaxone 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.

Ceftriaxone 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.

2. WHAT YOU NEED TO KNOW BEFORE YOU ARE GIVEN CEFTRIAXONE

You must not be given Ceftriaxone 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, and a severe rash that develops quickly.

•    You are allergic to lidocaine and you are to be given Ceftriaxone as an injection into a muscle.

Ceftriaxone 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 Ceftriaxone 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.

•    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.

If you need a blood or urine test

If you are given Ceftriaxone for a long time, you may need to have regular blood tests. Ceftriaxone 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 Ceftriaxone.

Children

Talk to your doctor or pharmacist or nurse before your child is administered Ceftriaxone if:

•    He/She has recently been given or is to be given a product that contains calcium into their vein.

Other medicines and Ceftriaxone

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.

The doctor will consider the benefit of treating you with Ceftriaxone against the risk to your baby.

Driving and using machines

Ceftriaxone 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.

Ceftriaxone contains sodium

Each gram of Ceftriaxone contains 3.6 mmol sodium. To be taken into consideration by patients on a controlled sodium diet.

3. HOW CEFTRIAXONE IS GIVEN

Ceftriaxone 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. Ceftriaxone 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 Ceftriaxone 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 Ceftriaxone 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 Ceftriaxone 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

THE FOLLOWING INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY:

Please refer to the Summary of Product Characteristics for full prescribing information. Method of administration

Ceftriaxone can be administered by intravenous infusion over at least 30 minutes (preferred route) or by slow intravenous injection over 5 minutes, or by deep intramuscular injection. 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. 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. 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.

If lidocaine is used as a solvent, the resulting solution should never be administered intravenously. The information in the Summary of Product Characteristics of lidocaine should be considered.

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.

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.

CEFTRIAXONE, Leaflet UK 125 x 590 mm

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.

•    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.

Newborn babies (0-14 days)

•    20-50 mg Ceftriaxone 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.

People with liver and kidney problems

You may be given a different dose to the usual dose. Your doctor will decide how much Ceftriaxone you will need and will check you closely depending on the severity of the liver and kidney disease.

If you are given more Ceftriaxone 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 Ceftriaxone

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 Ceftriaxone

Do not stop taking Ceftriaxone 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:

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.

Severe skin rashes (not known, frequency cannot be estimated from the available data)

If you get a severe skin rash, 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.

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.

•    Rash.

Uncommon (may affect up to 1 in 100 people)

•    Fungal infections (for example, thrush).

•    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 along the vein where Ceftriaxone has been given.

Pain where the injection was given.

•    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.

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, which may cause pain, feeling sick and being sick.

•    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).

•    Ceftriaxone 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 or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard

By reporting side effects you can help provide more information on the safety of this medicine.

5.    HOW TO STORE CEFTRIAXONE

Keep this medicine out of the sight and reach of children.Do not use Ceftriaxone after the expiry date which is stated on the carton and the vials after EXP The expiry date refers to the last day of that month.

Keep the vials in the outer carton in order to protect from light.

Reconstituted/diluted solution should be used immedialtely.

Only clear solutions should be used.

For single use only.

Discard any unused solution.

6.    CONTENTS OF THE PACK AND OTHER

INFORMATION_

What Ceftriaxone contains

•    The active substance is ceftriaxone sodium corresponding to 1 g ceftriaxone or 2 g ceftriaxone.

•    The product contains no other ingredients.

What Ceftriaxone looks like and contents of the pack

Ceftriaxone contains white to yellowish powder. The powder is supplied as a single dose vial packed in a carton box. Each carton box contains 10 vials.

Marketing Authorisation Holder

STRAGEN UK Limited 41 London Road Reigate Surrey RH29RJ

Manufacturer

Mitim S.R.L.

Via Cacciamali 34-38 25125 Brescia Italy

This leaflet was last revised in October 2014

Therefore, ceftriaxone and calcium-containing solutions must not be mixed or administered simultaneously.

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

Ceftriaxone must be dissolved immediately before administration.

The reconstituted solution should be inspected visually for particulate matter and discoloration prior to administration. The reconstituted solution is clear and colourless. For single use only.

Reconstitution of ceftriaxone:

Intravenous infusion:

1-2 g of ceftriaxone is dissolved in 20 ml (20 ml vial) or 20-40 ml (50 ml vial) of one of the following solutions for infusion (which do not contain calcium):

-    sodium chloride 9 mg/ml,

-    sodium chloride 4.5 mg/ml + glucose 2.5%,

-    glucose 5%

-    glucose 10%

-    water for injections.

Recommended concentration for the intravenous infusion: 50 mg/ml Intravenous injection:

1 g of ceftriaxone is dissolved in 10 ml of water for injections.

Recommended concentration for the intravenous injection: 100 mg/ml

Intramuscular injection:

1 g of ceftriaxone is dissolved in 3.5 ml and 500 mg of ceftriaxone in 2 ml of 1 % lidocaine solution.