Cefiderocol Sulfate Tosylate

AHFS 8:12.06.28

in ASHP® Injectable Drug Information™
Free access

Products

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

pH

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

Equivalency

Cefiderocol sulfate tosylate 1.6 g is equivalent to 1 g of 
cefiderocol.3531

Sodium Content

Each 1-g vial of cefiderocol contains approximately 176 mg of sodium.3531

Trade Name(s)

Fetroja

Administration

Cefiderocol sulfate tosylate is administered by intravenous infusion over 3 hours following reconstitution and further 
dilution.3531

Stability

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

Compatibility Information

Solution Compatibility

Cefiderocol sulfate tosylate

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

Y-Site Injection Compatibility (1:1 Mixture)

Cefiderocol sulfate tosylate

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

40 mg/mLc d

SHI

20 mg/mLc

Physically compatible for up to 4 hr at 21 to 25°C

3662, 3670

C

Ceftolozane sulfate–tazobactam sodium

SPA

10 mg/mLc e

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

5 mg/mLc f

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

8 mg/mLc g

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

1 mg/mLc h

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

a Tested in dextrose 5%.

b Tested in sodium chloride 0.9%

c Tested in both dextrose 5% and sodium chloride 0.9%.

d Ceftazidime component. Ceftazidime in a 4:1 fixed-ratio concentration with avibactam.

e Ceftolozane component. Ceftolozane in a 2:1 fixed-ratio concentration with tazobactam.

f Imipenem component. Imipenem in a 1:1 fixed-ratio concentration with cilastatin.

g Meropenem component. Meropenem in a 1:1 fixed-ratio concentration with vaborbactam.

h Trimethoprim component. Trimethoprim in a 1:5 fixed-ratio concentration with sulfamethoxazole.

i Test performed using the formulation WITH edetate disodium.

j Test performed using the formulation WITHOUT edetate disodium.

k Salt not specified.

l Tested as the premixed infusion solution.

Selected Revisions July 31, 2021. © Copyright, May 2020. American Society of Health-System Pharmacists, Inc.