Cefiderocol sulfate tosylate is available as a lyophilized powder in single-dose vials containing the equivalent of 1 g of cefiderocol.3531 Each vial also contains sucrose 900 mg, sodium chloride 216 mg, and sodium hydroxide to adjust the pH.3531
The contents of each 1-g vial of cefiderocol should be reconstituted with 10 mL of sodium chloride 0.9% or dextrose 5% and the vial should be shaken gently to dissolve the powder.3531 Vials should be allowed to stand until any foam that has been generated on the surface has disappeared (usually about 2 minutes).3531 The reconstituted solution must be diluted prior to infusion.3531
The manufacturer’s instructions for preparing various doses of cefiderocol from the reconstituted solution are as follows:3531
For a 2-g dose, withdraw the entire contents of 2 vials (i.e., approximately 11.2 mL per vial).
For a 1.5-g dose, withdraw the entire contents of 1 vial (i.e., approximately 11.2 mL) and 5.6 mL from a second vial.
For a 1-g dose, withdraw the entire contents of 1 vial (i.e., approximately 11.2 mL).
For a 0.75-g dose, withdraw 8.4 mL from 1 vial.
All doses should then be added to a 100-mL infusion bag containing sodium chloride 0.9% or dextrose 5%.3531 3544
The pH of the resulting solution that forms when 1 g of cefiderocol is dissolved in 10 mL of water is within the range of 5.2 to 5.8.3531
Cefiderocol sulfate tosylate 1.6 g is equivalent to 1 g of cefiderocol.3531
Each 1-g vial of cefiderocol contains approximately 176 mg of sodium.3531
Fetroja
Cefiderocol sulfate tosylate is administered by intravenous infusion over 3 hours following reconstitution and further dilution.3531
Cefiderocol sulfate tosylate is a white to off-white powder that forms a clear, colorless solution upon reconstitution and dilution.3531 Intact vials of cefiderocol sulfate tosylate should be stored at 2 to 8°C in the original carton until time of use to protect from light.3531
After reconstitution with an appropriate diluent as instructed, the drug may be stored for up to 1 hour at room temperature.3531 Following dilution, the drug is stable for 6 hours at room temperature.3531 The diluted solution for infusion also may be refrigerated at 2 to 8°C for up to 24 hours when protected from light; administration should be completed within 6 hours at room temperature following refrigerated storage.3531
Test Soln Name |
Mfr |
Mfr |
Conc/L or % |
Remarks |
Refs |
C/I |
Dextrose 5% |
SHI |
Stable for up to 6 hr at room temperature or up to 24 hr at 2 to 8°C protected from light; following refrigerated storage, complete administration within 6 hr at room temperature |
3531 |
C |
||
Sodium chloride 0.9% |
SHI |
Stable for up to 6 hr at room temperature or up to 24 hr at 2 to 8°C protected from light; following refrigerated storage, complete administration within 6 hr at room temperature |
3531 |
C |
Test Drug |
Mfr |
Conc |
Mfr |
Conc |
Remarks |
Refs |
C/I |
Acyclovir sodium |
AUB |
7 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Albumin human |
OCT |
250 mg/mL |
SHI |
20 mg/mLc |
Results of subvisual tests indicate high turbidity with or without particulate matter |
3662, 3670 |
I |
Amikacin sulfate |
SGT |
5 mg/mLa |
SHI |
20 mg/mLa |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Amikacin sulfate |
SGT |
5 mg/mLb |
SHI |
20 mg/mLb |
Results of subvisual tests indicate high counts of particles ≥2 and ≥10 μm when cefiderocol is added to amikacin; not observed when order of mixing was reversed |
3662 |
? |
Aminophylline |
HOS |
1 mg/mLa |
SHI |
20 mg/mLa |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Aminophylline |
HOS |
1 mg/mLb |
SHI |
20 mg/mLb |
Results of subvisual tests indicate high counts of particles ≥2 and ≥10 μm |
3662 |
I |
Amiodarone HCl |
WW |
4 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Amphotericin B |
XGN |
1 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Anidulafungin |
RR |
0.77 mg/mLc |
SHI |
20 mg/mLc |
Blue haze observed due to Tyndall effects of colloidal-size micelles scattering blue light; turbidity decreased upon mixing |
3662 |
? |
Azithromycin |
ATX |
2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Aztreonam |
BMS |
20 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Bumetanide |
WW |
0.25 mg/mL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Calcium gluconate |
FRK |
20 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Caspofungin acetate |
GLA |
0.5 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Cefazolin sodium |
HOS |
20 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Cefepime HCl |
QI |
40 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Ceftaroline fosamil |
FOR |
12 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Ceftazidime–avibactam sodium |
GSK |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
|
Ceftolozane sulfate–tazobactam sodium |
SPA |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
|
Ciprofloxacin |
CLA |
2 mg/mLl |
SHI |
20 mg/mLa |
Results of subvisual tests indicate increased turbidity |
3662, 3670 |
I |
Ciprofloxacin |
CLA |
2 mg/mLl |
SHI |
20 mg/mLb |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Cisatracurium besylate |
ABV |
0.4 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Clindamycin phosphate |
SGT |
10 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Colistimethate sodium |
XE |
4.5 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Daptomycin |
GLA |
20 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Dexamethasone sodium phosphate |
FRK |
1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Dexmedetomidine HCl |
AUB |
4 mcg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Digoxin |
SZ |
250 mcg/mL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Diltiazem HCl |
AKN |
5 mg/mL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Diphenhydramine HCl |
WW |
50 mg/mL |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662, 3670 |
I |
Dobutamine HCl |
HOS |
4 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Doxycycline hyclate |
FRK |
1 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Epinephrinek |
SIN |
16 mcg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Ertapenem sodium |
PAR |
20 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Esomeprazole sodium |
MYL |
0.8 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Famotidine |
WW |
4 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Fentanyl citrate |
HOS |
50 mcg/mL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Fluconazole |
HOS |
2 mg/mLl |
SHI |
20 mg/mLc |
Results of subvisual tests indicate increased counts of particles <5 μm; counts of particles ≥10 and ≥25 μm within limits. No significant changes in turbidity |
3662 |
? |
Furosemide |
BA |
3 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Gentamicin sulfate |
FRK |
5 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Heparin sodium |
HOS |
1000 units/mL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Hydrocortisone sodium succinate |
PF |
1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Hydromorphone HCl |
AKN |
1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Imipenem–cilastatin sodium |
FRK |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
|
Insulin, regular |
LI |
1 unit/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Iron dextran |
ALL |
25 mg/mLc |
SHI |
20 mg/mLc |
Opaque dark red solution; turbidity decreased upon mixing |
3662 |
? |
Iron sucrose |
AMR |
20 mg/mL |
SHI |
20 mg/mLc |
Opaque dark red solution with significant turbidity |
3662, 3670 |
I |
Labetalol HCl |
AVG |
5 mg/mL |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662, 3670 |
I |
Levofloxacin |
AUR |
5 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Lidocaine HCl |
HIK |
8 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Linezolid |
FRK |
2 mg/mLl |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Lorazepam |
HOS |
1 mg/mLc |
SHI |
20 mg/mLc |
Results of subvisual tests indicate lightly hazy to hazy solutions with or without increased turbidity and a high count of particles ≥2 μm |
3662 |
I |
Magnesium sulfate |
FRK |
100 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Mannitol |
HOS |
20%c |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Meropenem |
AMB |
10 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Meropenem– vaborbactam |
FAC |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
|
Methylprednisolone acetate |
PF |
20 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Metoclopramide HCl |
HOS |
0.2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Metronidazole |
HOS |
5 mg/mLl |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Micafungin sodium |
ASP |
4 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Midazolam HCl |
HOS |
2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Milrinone lactate |
HIK |
0.2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Morphine sulfate |
HOS |
15 mg/mLa |
SHI |
20 mg/mLa |
Results of subvisual tests indicate high counts of particles ≥25 and ≥50 μm when cefiderocol is added to morphine; not observed when order of mixing was reversed |
3662 |
? |
Morphine sulfate |
HOS |
15 mg/mLb |
SHI |
20 mg/mLb |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Multivitamins |
SZ |
0.02 mL/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Mycophenolate mofetil HCl |
GEN |
6 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Naloxone HCl |
MYL |
0.04 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Nicardipine HCl |
HIK |
0.1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Nitroglycerin |
AMR |
0.4 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Norepinephrine bitartrate |
TE |
0.128 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Octreotide acetate |
TE |
4 mcg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Ondansetron HCl |
HOS |
0.16 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Pantoprazole sodium |
AURi |
0.4 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Phenylephrine HCl |
WW |
1 mg/mLa |
SHI |
20 mg/mLa |
Results of subvisual tests indicate high counts of particles ≥2, ≥10, ≥25, and ≥50 μm when phenylephrine is added to cefiderocol; not observed when order of mixing was reversed |
3662 |
? |
Phenylephrine HCl |
WW |
1 mg/mLb |
SHI |
20 mg/mLb |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Phenytoin sodium |
WW |
10 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Polymyxin B sulfate |
XE |
1250 units/mLa |
SHI |
20 mg/mLa |
Results of subvisual tests indicate high turbidity |
3662 |
I |
Polymyxin B sulfate |
XE |
1250 units/mLa |
SHI |
20 mg/mLb |
Slight haze forms and gas bubbles evolve |
3662 |
I |
Posaconazole |
MSD |
2 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Potassium chloride |
HOS |
0.1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Potassium phosphates |
HOS |
0.3 mmol/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Propofol |
SGTj |
10 mg/mL |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662, 3670 |
I |
Ranitidine HCl |
CDL |
2.5 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Rocuronium bromide |
XGN |
5 mg/mLc |
SHI |
20 mg/mLc |
Visually incompatible upon mixing |
3662 |
I |
Sodium bicarbonate |
HOS |
1 mEq/mL |
SHI |
20 mg/mLa |
Results of subvisual tests indicate a high count of particles ≥25 μm when sodium bicarbonate is added to cefiderocol; not observed when order of mixing was reversed |
3662, 3670 |
I |
Sodium bicarbonate |
HOS |
1 mEq/mL |
SHI |
20 mg/mLb |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
Sodium nitroprusside |
HOS |
0.4 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Sodium phosphates |
FRK |
0.5 mmol/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Succinylcholine chloride |
CDL |
2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Tedizolid phosphate |
PNN |
0.8 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Tigecycline |
LEK |
1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Tobramycin sulfate |
FRK |
10 mg/mL |
SHI |
20 mg/mLc |
Results of subvisual tests indicate the presence of white particles |
3662, 3670 |
I |
Trimethoprim– sulfamethoxazole |
MYL |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662, 3670 |
C |
|
Vancomycin HCl |
GLA |
5 mg/mLa |
SHI |
20 mg/mLa |
Visually incompatible upon mixing |
3662 |
I |
Vancomycin HCl |
GLA |
5 mg/mLb |
SHI |
20 mg/mLb |
Results of subvisual tests indicate the presence of cloudiness with white particles |
3662 |
I |
Vasopressin |
PAR |
1 unit/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Vecuronium bromide |
TE |
1 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Voriconazole |
PF |
2 mg/mLc |
SHI |
20 mg/mLc |
Physically compatible for up to 4 hr at 21 to 25°C |
3662 |
C |
Selected Revisions July 31, 2021. © Copyright, May 2020. American Society of Health-System Pharmacists, Inc.
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