[Question #13161] Reconstituted Rocephin
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1 months ago
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Hello Doctors. I went and saw my doctor today and he gave me a 1 g injection of ceftriaxone. He mixed it with about 2.5 mL of lidocaine. You carefully try to get all of it out of the bottle into the syringe which it looked like he did. The issue that I'm questioning is the mixture in the syringe was cloudy yellow white after reconstituting it.and not clear like a lot of sites say you need to mix it. So he injected about 2.5 mL of total volume in my buttocks today.
1)He mixed it in front of me, but it was cloudy, white yellow that he put in me. Should the efficacy still be the same.?
2) is there a concern when it is injected and the powder is not fully dissolved?
3) maybe this is the way he does it that should there be any cost for concern as a failure rate of the medication when it is mixed cloudy versus clear or will the muscles absorb it the same?
Thank you
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1 months ago
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This is in response to question 13147. I followed up as you directed thank you.
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H. Hunter Handsfield, MD
1 months ago
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Welcome back. However, I reviewed your two recent discussions with Dr. Hook; I agree with his advice, and with his judgment that you are way into the weeds on all this.
Your current concerns are irrelevant. Ceftriaxone is routinely reconstituted in lidocaine to reduce injection pain. Certainly the amount of lidocaine solution used doesn't matter.
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To your specific questions: 1) Efficacy for treatment would not be affected. 2) I see no concern if the result was cloudy, whether or not that was the result of ceftriaxone not being fully dissolved. 3) Once the drug is injected, why would you assume solid undissolved drug would be any less effective? FYI, Dr. Hook and I were among the first researchers to study treatment of gonorrhea with ceftriaxone over 40 years ago. In the decades since then, millions upon millions of people have been so treated, undoubtedly often with variation in how the drug was reconstituted and injected. Since treatment was successful almost 100% of the time, clearly the things you describe about how the drug is reconstituted or other details of injection cannot possibly make any difference.
HHH, MD
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1 months ago
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So I spoke with my doctor and asked for clarification of his mixing. He diluted with 2% lidocaine and says it makes it turbid. I see where really 1% is the " approved" percentage.
1)do you think mixing with 2% lidocaine alters the efficacy? Some websites say it "may".
2) could a higher lidocaine Percentage destroy the rocephin drug?
3)he's been practicing for a long time so I'm sure he's done it MANY MANY times. Could he just be going off label?
4)he mixed and injected right away, so stability issues shouldn't be an issue?
5) I don't want to call him out, but do want to make sure he's reconstituting appropriately for me and other patients. I'm a physician too so I want to tip toe on this.
6) as long as drug injected with either percentage and no matter the dilution it should be highly efficacious?
Thank you
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H. Hunter Handsfield, MD
1 months ago
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1. " mixing with 2% lidocaine alters the efficacy?" No. Why does this even enter your mind?
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2. No.
3. What your doctor did is not off label.
4. No.
5. There is nothing to "call out".
6. We don't expect much of our questioners, but we do demand they read our replies; and if they don't understand, to feel free for ask for clarification -- but not to repeat questions already answered. For my comments above, there are three possibilities: You didn't read my reply; you didn't understand it; or you didn't believe it. Which is it?
This thread is over.
The forum does not permit repeated questions on the same topic or exposure. The last two of your three questions show your re resistant to the reasoned, science-based evaluations and advice you have had. Future questions on these topics and your inflated fears will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.
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