Forgram Special Precautions

Use with caution with history of gastrointestinal disease, especially colitis. Sonographic abnormalities in the gallbladder of patients treated with ceftriaxone have been reported; some of these patients had symptoms of gallbladder disease. These abnormalities appear as an echo without acoustical shadowing suggesting sludge or as an echo with acoustical shadowing which may be misinterpreted as gallstones. Chemical nature of the sonographically detected material has been determined to be predominantly a ceftriaxone salt. Condition appears to be transient and reversible upon discontinuation of ceftriaxone and institution of conservative management. Therefore, discontinue ceftriaxone in patients who develop signs and symptoms suggestive of gallbladder disease and/or sonographic findings.
Superinfecion should always be considered a possibility in patient being treated with a broad-spectrum antimicrobial. Careful observation of the patient is essential. If superinfection occurs during therapy, institute appropriate measures.
Nephrotoxicity has been reported following concomitant administration of aminoglycosides and cephalosporins.
Rarely, alterations in prothrombin time have occurred in patients treated with ceftriaxone. Patients with impaired vitamin K synthesis or low vitamin K administration of 10 mg weekly may be necessary if prothrombin time is prolonged before or during therapy.
Use in pregnancy: Pregnancy Category B. Safely for use during pregnancy has not been established. Use only when clearly needed.
Use in lactation: Since ceftriaxone is excreted in human milk, exercise caution when administered to a nursing woman.
Use in children: In vitro studies show that ceftriaxone can displace bilirubin from serum albumin. Do not administer ceftriaxone to hyperbilirubinemic neonates, especially the premature ones.