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» LymeNet Flash » Questions and Discussion » Medical Questions » Rocephin 4g IV infusion - time between doses in your experience?

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Author Topic: Rocephin 4g IV infusion - time between doses in your experience?
LymeNet Contributor
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Hello everyone. For any who have experience with IV Rocephin (ceftriaxone), I'd be appreciative if you could let me know about how the dosages were spaced.

As many of you know, IV Rocephin is typically given for Lyme at a starting effective dose of 2 grams, once per day. This is a typical ILADS standard treatment. Some doctors feel that patients benefit from the increased dose of 4 grams daily. However, there seems to be some variation in dosing: either 2 grams twice per day, or 4 grams once a day.

I'm especially interested in those patients who have taken 4 grams a day either in a single dose, or with a relatively short amount of time (ie 1 to 4 hours etc..) between them. This dosing schedule would be much more convenient for me, if it is safe to do so.

I've been infusing 2g of IV Rocephin through a PAS-port (a peripherally located metaport) daily, packaged by an infusion company into pressurized "Eclipse balls" (I'm glad I requested these, they enable infusion without the necessity for gravity. Thus, you can place them in your pocket or whatnot with no effect on the time or success of infusion. No IV poles or high-hangars needed!). Each infusion takes about 30 minutes.

I am also taking Actigall to protect against gallbladder problems, 300mg BID. At the moment, my current oral antibiotics are: Azithromycin (300mg, BID), Bactrim DS (BID), and Nystatin (BID, not an antibiotic, but prophylactic antifungal). Probiotics: Prescrip-Assist Pro (1 capsule, daily), VSL#3 DS - 1/4 to 1/2 packet as a "booster" PRN. Organic kefir and frozen yogurt with live cultures consumed daily. Tons of supplements, other medications as well, more than worth listing here at the present time.

With the knowledge that IV Rocephin is effective with single daily dosing at 2 grams (as opposed to some other medicines that may need to be given Q12 or Q8 regardless of dosage), and that the 4 gram dosage itself is considered reasonably safe, the only question must be if giving all 4 grams in a short period of time is too taxing on the body. Unfortunately, I don't see much data available in this regard.

Some LLMDs that I've spoken with or who's opinions I've read, suggest that 4g a a single daily dosing is fine, provided that the patient isn't suffering particular renal or hepatic damage. Of course, some elevation in liver enzyme function is to be expected in patients regardless. I've read a few things that each 2g must include at least 100ml of fluid for optimal safety, which is no problem for me. I suspect that this is more applicable to those who do so via IV push. Others have said that they take the word of the infusion company pharmacy, who always insists on it being a divided dose.

Your input is appreciated. Thanks.

Posts: 685 | From East coast, USA | Registered: Jun 2006  |  IP: Logged | Report this post to a Moderator
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Hey Blackstone,

I have trouble doing even mini doses of anything, so even considering doing 4 gr of Rocephin at a time really knocks me off my rocker. Plus, I've never known anyone to do the 4 gr at one time, so have no suggestions/experience there either.

Also want you to see the 4 gr is recommend in the "pulsing dose regimen" in Dr. B's guidelines. I did a little, very little research, and went to Dr. B's guidelines, a more experienced resource. He said...

"One successful approach in the more ill patient, published in the early 1990s, is to use higher doses of ceftriaxone in a pulsed-dose regimen.

Since then, clinical experience has expanded upon this concept, and at the MLDA Lyme Congress in September, 2002, Cichon presented data on a pulsed, high dose regimen which supports and refines this concept. This regimen is now considered the current standard of care in the use of ceftriaxone.

Treatment with ceftriaxone is dosed at 4 grams daily- given either as 2 grams IV twice daily, or 4 grams slowly once a day, four days in a row each week, usually for 14 or more weeks.

Such a regimen is not only more effective in the Chronic Lyme patient, but regular interruptions in treatment lessen the potential complications of intensive antibiotic therapy with ceftriaxone, such as biliary sludging and colitis.

Hence a more effective, safer regimen that by virtue of the treatment breaks, is less costly and affords the patient a more acceptable lifestyle. IV access with a heparin lock becomes possible (and preferred)."

My personal opinion... if you are doing this just to make it a bit easier, and you have the "ball" to use making it even more easy, dividing the doses would make me feel it is safer for you. I had major trouble with the Rocephin burning my veins, something I am sure would have been worse with 4 grams per dose.

Also, note Dr. B said the 4 gr should be dripped SLOWLY. If I remember right, the ball delivery didn't allow for that. ?? (Could be mistaken, it was a long time ago that I used it.)

I can't and won't give you a specific right or wrong answer, not qualified to do that, but I wish you luck and hope that whatever you chose to do will help!

PS- Trying to remember when Dr. B retired- about 15 years ago? The other doc he mentioned is also retired I believe. Not sure Dr. B did a lot, if any of the 4 gram treatment himself? Just a consideration.


Posts: 20353 | From The Moon | Registered: Jun 2004  |  IP: Logged | Report this post to a Moderator
LymeNet Contributor
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I did 2g IV Rocephin once a day in the morning. For first two moths it was 7 days a week, then changed to 4 days on and 3 days off. First dose was at 5am before work, then at 6pm when I got home.

I used a 20cc push method at about 2cc's per minute.

Posts: 119 | From ground zero | Registered: Mar 2014  |  IP: Logged | Report this post to a Moderator

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