NutriStack
Calcium and Ceftriaxone, contraindicated.
Ceftriaxone and calcium-containing IV fluids can form insoluble ceftriaxone-calcium precipitates in lung and kidney tissue, with fatal cases reported in neonates. The FDA contraindicates concurrent IV ceftriaxone and IV calcium-containing solutions in neonates under 28 days. In older patients and oral calcium supplementation, the risk is much lower, but the principle of avoidance still applies for IV co-administration.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Calcium and Ceftriaxone
- Pair type
- Contraindicated
- Evidence (highest tier)
- Strong
- Source citations
- 2 sources
- Stack Score effect
- −25 to your Stack Score (per scored contraindication row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Contraindicated · Strong evidence
Contraindicated
What is happening. Ceftriaxone and calcium-containing IV fluids can form insoluble ceftriaxone-calcium precipitates in lung and kidney tissue, with fatal cases reported in neonates. The FDA contraindicates concurrent IV ceftriaxone and IV calcium-containing solutions in neonates under 28 days. In older patients and oral calcium supplementation, the risk is much lower, but the principle of avoidance still applies for IV co-administration.
Mechanism. Ceftriaxone and calcium form insoluble ceftriaxone-calcium salt crystals that can precipitate in the lungs, kidneys, and IV line. Neonates are at highest risk due to immature renal clearance and high relative blood volume per dose.
Recommendation. Do not infuse IV ceftriaxone with calcium-containing IV solutions, especially in neonates. Oral calcium supplements are generally acceptable but should ideally be spaced from IV ceftriaxone doses. Discuss any IV co-administration with your clinical team.
Sources (2)
- Monte SV, Prescott WA, Johnson KK, Kuhman L, Paladino JA. Safety of ceftriaxone sodium at extremes of age. Expert Opin Drug Saf. 2008;7(5):515-23. PMID 18759704
- Nilsson N, Nezvalova-Henriksen K, Bøtker JP, et al. Co-administration of Intravenous Drugs: Rapidly Troubleshooting the Solid Form Composition of a Precipitate in a Multi-drug Mixture Using On-Site Raman Spectroscopy. Mol Pharm. 2023;20(6):2853-2863. PMID 37167030
Stack Score
How this pair moves the number.
Effect on the composite score
If both Calcium and Ceftriaxone are in the same stack, this pair applies −25 to your Stack Score (per scored contraindication row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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