CEFTRIAXONE LDP TORLAN 500 mg POWDER AND SOLUTION FOR INTRAMUSCULAR INJECTION

2. What you need to know before you start using Ceftriaxone LDP Torlan 500 mg Powder and Solution for Injection Intramuscular EFG

Do not use Ceftriaxone LDP Torlan 500 mg:

• if you are allergic (hypersensitive) to the active substance or to cephalosporins, penicillins, or any other antibiotic of the so-called β-lactamics or to any of the other components of Ceftriaxone LDP Torlan. If you have had a sudden or severe allergic reaction to penicillin or other similar antibiotics (such as cephalosporins, carbapenems, or monobactams); signs of such a reaction are sudden swelling of the throat or face that makes breathing or swallowing difficult, sudden swelling of hands, feet, and ankles, chest pain, or a severe and rapid skin rash.

• in newborns with jaundice (yellow skin color due to excess bilirubin) or hypoalbuminemia (deficit of a blood protein called albumin), or in premature babies due to the risk of developing hyperbilirubinemic encephalopathy (a disease that can cause brain damage due to bilirubin accumulation and be fatal).
• ceftriaxone must not be mixed or administered simultaneously with solutions or products containing calcium, even if different infusion routes are used, as precipitates may form.

Be cautious with Ceftriaxone LDP Torlan 500 mg

• If you have had any allergic reaction to ceftriaxone or any penicillin or have suffered from severe allergies or asthma, as ceftriaxone may cause allergic reactions that can be fatal (anaphylaxis). If this happens, contact your doctor immediately or go to the nearest hospital.
• If you experience severe and prolonged diarrhea during or after using this medicine, it may be due to a type of colitis (pseudomembranous colitis) that can be severe. In this case, your doctor will stop the administration of ceftriaxone and initiate appropriate treatment. Inform your doctor if you have had gastrointestinal diseases, particularly colitis.
• If you are undergoing prolonged treatment with ceftriaxone, other infections (superinfections) may appear due to the overgrowth of some organisms such as enterococci or candida.
• When undergoing prolonged treatments, your doctor should perform periodic blood tests.
• If, due to the sedimentation of ceftriaxone calcium, signs and symptoms of gallbladder disease appear, accompanied by alterations in gallbladder ultrasound. The risk of these alterations may increase in treatments lasting more than 14 days, in patients with renal failure, dehydration, or total parenteral nutrition, as well as in very young children. If this occurs, the medication with ceftriaxone should be suspended.
• Before starting treatment with Ceftriaxone LDP Torlan, if you have severe liver or kidney disease, as you may need a dose adjustment or if you are at risk of developing pancreatitis (inflammation of the pancreas).
• If you are going to undergo any diagnostic test (including blood tests, urine tests, skin tests that use allergens, etc.), inform your doctor that you are using this medicine, as it may alter the results.
• If you have liver or kidney problems (see section 4).

Use of other medicines

Inform your doctor or pharmacist if you are using or have recently used other medicines, even those purchased without a prescription.

Your doctor will be cautious during the simultaneous use of ceftriaxone with:

• Probenecid (a medicine used to treat gout)
• Other antibiotics (medicines used for infections)
• Hormonal contraceptives. It is recommended to take additional measures during the treatment period and in the following month.

Pregnancy and breastfeeding

Consult your doctor or pharmacist before using any medicine.

If you are pregnant or think you may be pregnant, inform your doctor before using this medicine, and he will decide whether to use it. The consumption of medicines during pregnancy can be dangerous for the embryo or fetus and must be monitored by your doctor.

Driving and using machines

It has not been proven that the use of Ceftriaxone LDP Torlan can affect your ability to drive vehicles or operate tools or machines, but you should take into account that Ceftriaxone LDP Torlan can occasionally cause dizziness.

Important information about some of the components of Ceftriaxone LDP Torlan 500 mg:

Patients on low-sodium diets should note that this medicine contains 82.8 mg (3.6 mmol) of sodium per dose.

3. How to use Ceftriaxone LDP Torlan 500 mg Powder and Solution for Injection Intramuscular EFG

Ceftriaxone is administered intramuscularly. Consult your doctor or pharmacist if you have any doubts.

Depending on your disease, age, weight, and response to treatment with Ceftriaxone LDP Torlan, your doctor will prescribe the most suitable dose and treatment duration.

If you think the effect of Ceftriaxone LDP Torlan is too strong or too weak, tell your doctor or pharmacist. Ceftriaxone LDP Torlan is administered by intramuscular injection.

You will continue to receive this medicine for at least 2 to 3 days after you have recovered from your illness or to prevent infections for a few days after your surgery.

Your doctor will tell you when to stop treatment. Do not prolong it on your own.

Ceftriaxone LDP Torlan must be reconstituted just before use. To do this, the powder in the vial must be dissolved in 2 ml of solvent from the accompanying ampoule (a lidocaine hydrochloride solution 20mg/2ml). Check that there are no foreign particles or that the solution is not cloudy.

Adults and children over 12 years:2 to 4 vials (1 to 2 grams of ceftriaxone) every 24 hours, which means 1-2 grams/day; in severe cases, the dose may be increased to 4 grams/day.

Newborns, infants, and children under 12 years:The following doses are recommended, administered once a day: in newborns (up to 14 days), 20 to 50 mg/Kg of weight; do not exceed this dose. In infants and children (from 15 days to 12 years), a daily dose of 20-80 mg/Kg of weight. For children weighing 50 Kg or more, it should be administered by infusion over at least 30 minutes. The duration of therapy varies with the course of the disease. As with antibiotic therapy in general, the administration of ceftriaxone will continue for a minimum of 48 to 72 hours after the disappearance of fever or after evidence of eradication of bacteria is obtained.

Elderly patients:In the case of elderly patients, it is not necessary to modify the recommended doses for adults.

Treatment of bacterial meningitis (infants and children):It starts with a dose of 100 mg/Kg (not exceeding 4 grams) once a day. As soon as the causal microorganism is identified and its sensitivity is determined, the dose can be reduced.

Gonococcal disease:For the treatment of gonorrhea, a single intramuscular dose of 250 mg is recommended.

Perioperative prophylaxis:2 to 4 vials (1 to 2 grams of ceftriaxone) administered 30-90 minutes before the intervention.

Patients with renal or hepatic impairment:In cases of patients with altered renal function, it is not necessary to reduce the dose of Ceftriaxone LDP Torlan, as long as liver function remains normal. Only in cases of pre-terminal renal failure (creatinine clearance less than 10 ml/min) should the dose not exceed 2 grams daily.

Treatment of patients on dialysis:no additional supplementary dose is necessary after dialysis, however, serum concentrations will be monitored to determine if dose adjustments are necessary, as the elimination rate in these patients may be reduced.

If you use more Ceftriaxone LDP Torlan 500 mg than you should

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount used.

If you forget to use Ceftriaxone LDP Torlan 500 mg

If you interrupt treatment with Ceftriaxone LDP Torlan 500 mg

Do not stop treatment before finishing it, as the desired effect will not be achieved. It is very important to treat infections for the recommended time; otherwise, it may worsen.

If you have any other questions about the use of this product, ask your doctor or pharmacist.

4. Possible side effects

Ceftriaxone must not be mixed or administered simultaneously with solutions or products containing calcium, even if different infusion routes are used.

Cases of reactions that have caused the death of newborns and premature babies due to the formation of precipitates of ceftriaxone calcium in the lungs and kidneys of these patients have been described. In some cases, the infusion routes and administration times of ceftriaxone and calcium-containing solutions were different.

Like all medicines, Ceftriaxone LDP Torlan can have side effects, although not everyone gets them.

If you think any of the side effects you are experiencing is serious, or if you notice any side effects not mentioned in this leaflet, inform your doctor or pharmacist.

Infections and infestations

• Rare (between 1 and 10 per 10,000 patients): vulvovaginitis (infections of the female genital tract caused by bacteria).

Blood and lymphatic system disorders

• Rare (between 1 and 10 per 10,000 patients): anemia (decrease in hemoglobin concentration in blood), leukopenia (decrease in the number of white blood cells in blood), granulocytopenia (decrease in the number of granulocytes in blood), thrombocytopenia (decrease in the number of platelets in blood), and eosinophilia (increase in a certain group of white blood cells).
• Very rare (in less than 1 per 10,000 patients): coagulation disorders, agranulocytosis (decrease or absence of white blood cells in the blood), especially after 10 days of treatment or after high doses.

Immune system disorders

• Rare (between 1 and 10 per 10,000 patients): anaphylactic (allergic) or anaphylactoid reactions and urticaria (generalized itching of the skin).
• Frequency not known: Chest pain in the context of allergic reactions, which can be a symptom of a heart attack triggered by the allergy (Kounis syndrome).

Nervous system disorders

• Rare (between 1 and 10 per 10,000 patients): headache and dizziness.

Gastrointestinal disorders

• Frequent (between 1 and 10 per 100 patients): diarrhea, nausea, stomatitis (inflammation of the mouth mucosa), and glossitis (inflammation of the tongue).
• Very rare (in less than 1 per 10,000 patients): pseudomembranous colitis (severe diarrhea caused by a superinfection by a bacterium), pancreatitis, gastrointestinal bleeding.

Hepatobiliary disorders

• Rare (between 1 and 10 per 10,000 patients): symptomatic precipitation of ceftriaxone calcium in the gallbladder and increased liver enzymes (parameters detected in blood tests).
• Frequency not known: problems with the gallbladder or liver, which can cause pain, nausea, vomiting, yellowing of the skin, itching, abnormal dark urine, and clay-colored stools.

Skin and subcutaneous tissue disorders

• Uncommon (between 1 and 10 per 1,000 patients): exanthema (skin rash), allergic dermatitis (skin inflammation), rash (exanthema), edema (fluid accumulation in tissues), and erythema multiforme.
• Very rare (in less than 1 per 10,000 patients): Stevens-Johnson syndrome, toxic epidermal necrolysis, or Lyell syndrome (skin destruction with epidermal detachment that starts with blister formation but without inflammation).

Renal and urinary disorders

• Rare (between 1 and 10 per 10,000 patients): oliguria (decreased urine production), increased serum creatinine (parameter detected in blood tests).
• Very rare (in less than 1 per 10,000 patients): renal precipitation of ceftriaxone sodium in pediatric patients, hematuria (presence of blood in urine).

General disorders and administration site conditions

• Rare (between 1 and 10 per 10,000 patients): fever and chills, phlebitis (vein inflammation) that can be even less frequent if administered by slow injection over a period of 2-4 minutes.

Treatment with ceftriaxone, particularly in elderly patients with severe kidney problems or nervous system problems, can rarely cause decreased consciousness, abnormal movements, agitation, and convulsions.

Reporting of side effects:

If you experience any type of side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines (Website: www.notificaRAM.es). By reporting side effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Ceftriaxone LDP Torlan 500 mg Powder and Solution for Injection Intramuscular EFG

Keep out of the reach and sight of children.

This medicine does not require special temperature storage conditions.

Keep the vial in the outer packaging to protect it from light.

Once reconstituted, the solution is stable for 3 hours at 25°C and for 24 hours in the refrigerator (2-8°C).

Do not use Ceftriaxone LDP Torlan after the expiration date shown on the packaging after "CAD". The expiration date is the last day of the month indicated.

Do not use Ceftriaxone LDP Torlan if you observe particles or turbidity.

Medicines should not be disposed of via wastewater or household waste. Place the packaging and medicines you no longer need in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Container Contents and Additional Information

Composition of Ceftriaxone LDP Torlan 500 mg Powder and Solution for Intramuscular Injectable Solution EFG

The active ingredient is ceftriaxone (as ceftriaxone sodium).

Each vial contains 500 mg of ceftriaxone (as ceftriaxone sodium).

The other components are: 2 ml of lidocaine hydrochloride solution (20mg/2ml).

Product Appearance and Container Contents

Ceftriaxone LDP Torlan is presented in a glass vial, closed with a rubber stopper and sealed with a flip-off cap, and a 2 ml ampoule of lidocaine, in a box with 1 vial + 1 ampoule of 2 ml of lidocaine hydrochloride solution (20mg/2ml), and in a package of 100 vials + 100 ampoules.

Each ampoule of solution contains 2 ml of lidocaine hydrochloride (20mg/2ml).

Other Presentations

Ceftriaxone LDP Torlan 500 mg Powder and Solvent for Intravenous Injectable Solution EFG: Box with 1 vial + 1 ampoule of 5 ml of water for injectable preparations. Package of 100 vials + 100 ampoules.

Ceftriaxone LDP Torlan 1 g Powder and Solvent for Intravenous Injectable Solution EFG: Box with 1 vial + 1 ampoule of 10 ml of water for injectable preparations. Package of 100 vials + 100 ampoules.

Ceftriaxone LDP Torlan 2 g Powder for Solution for Perfusion: Box with 1 vial. Package with 10 vials. Package of 50 vials.

Ceftriaxone LDP Torlan 250 mg Powder and Solvent for Intravenous Injectable Solution EFG: Box with 1 vial + 1 ampoule of 5 ml of water for injectable preparations. Package of 100 vials + 100 ampoules.

Ceftriaxone LDP Torlan 1 g Powder and Solution for Intramuscular Injectable Solution EFG: Box with 1 vial + 1 ampoule of 3.5 ml of lidocaine hydrochloride solution (35mg/3.5ml). Package of 100 vials + 100 ampoules.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

LDP-Laboratorios Torlan, S.A.

Ctra. Barcelona 135 B

08290-Cerdanyola del Vallès (Barcelona)

Spain

This leaflet was revised in:May 2024

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Warning: To be used exclusively by a healthcare professional

This information is intended only for doctors or healthcare professionals:

Solutions containing ceftriaxone should not be mixed or added with other agents. In particular, diluents containing calcium (e.g., Ringer's solution, Hartmann's solution) should not be used to reconstitute ceftriaxone vials or to dilute reconstituted vials when administered intravenously, as they may form precipitates.

Ceftriaxone should not be mixed or administered simultaneously with solutions containing calcium (see sections 4.2, 4.3, 4.4, and 4.8 of the technical sheet and section 6 of the leaflet).

Ceftriaxone LDP Torlan 500 mg must be reconstituted before use. The reconstituted solution is for single use. Discard any remaining solution.

The reconstituted solution is clear and yellow or slightly yellowish. During the storage of prepared solutions, an increase in the intensity of the color may occur without affecting the potency of the drug.

How to Prepare this Medication

Once reconstituted with 2 ml of lidocaine hydrochloride solution, the concentration of the solution is 250 mg of ceftriaxone (as ceftriaxone sodium) per ml.

The solution should be examined before injection for any particles or turbidity. If foreign particles are observed, the solution should be discarded.

The dose and administration schedule used depends on the patient's age and weight, as well as the severity of the infection.

The solution should not be mixed with solutions containing other antibiotics or in other solutions different from those mentioned above.