Ceftriaxone

J01D - Other beta-lactam antibacterials ATC J01DD04 Small molecule approved 1984 Parenteral Natural product

🧬 Cross-allergy: Cephalosporins

JFDA label: Triaxone Sterile Pow. For Inj IM

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Indications

Approved

Acute bacterial otitis media
Bacterial septicemia
Bone and joint infections
Intra-abdominal infections
Lower respiratory tract infections
Meningitis
Pelvic inflammatory disease
Skin and skin structure infections
Surgical prophylaxis
Uncomplicated gonorrhea (cervical/urethral and rectal)
Urinary tract infections (complicated and uncomplicated)

Off-label

Acute bacterial rhinosinusitis
Arthritis, septic (adults)
Bacterial enteric infections in HIV-infected patients (empiric treatment) (adolescents and adults)
Bite wounds (animal)
Brain abscess (adults)
Chancroid
Community-acquired pneumonia (children)
Endocarditis, prophylaxis
Endocarditis, treatment (adults)
Endocarditis, treatment (pediatric)
Epididymitis
Epiglottitis (children)
Gonococcal bacteremia, meningitis and endocarditis
Gonococcal conjunctivitis
Gonorrhea, disseminated infections (including arthritis and arthritis-dermatitis syndrome)
Gonorrhea, infant prophylaxis (due to untreated maternal gonococcal infection)
Gonorrhea, uncomplicated infections of the pharynx and vulvovaginitis
Lyme disease
Meningococcal disease, invasive, high-risk patient contacts (chemoprophylaxis)
Neurosyphilis in penicillin-allergic patients
Osteomyelitis, native vertebral
Proctitis, proctocolitis, enteritis
Prophylaxis against sexually transmitted diseases following sexual assault
Prosthetic joint infection (adults)
Salmonellosis in HIV-infected patients (adolescents and adults)
Shigellosis
Skin and soft tissue necrotizing infections due to Aeromonas hydrophilia or Vibrio vulnificus
Spontaneous bacterial peritonitis (prevention)
Surgical site infections
Syphilis (primary and secondary) in penicillin allergic patients
Typhoid fever
Whipple disease

Antimicrobial Spectrum

Expected / intrinsic spectrum (EUCAST breakpoints & labels) — not local resistance. Source: EUCAST v16 · curated · openfda-label.

Bacteria

Organism	Activity	MIC
Acinetobacter calcoaceticus	Active	—
Anaerobes	Susceptible	0.061 mg/L
Bacteroides fragilis	Active	—
Chlamydia trachomatis	Active	—
Citrobacter diversus	Active	—
Citrobacter freundii	Active	—
Clostridium difficile	Active	—
Enterobacter aerogenes	Active	—
Enterobacter cloacae	Active	—
Enterobacterales	Susceptible	1.0 mg/L
Escherichia coli	Susceptible	1.0 mg/L
Haemophilus influenzae	Susceptible	0.125 mg/L
Haemophilus influenzae	Susceptible	0.125 mg/L
Haemophilus parainfluenzae	Active	—
Klebsiella oxytoca	Active	—
Klebsiella pneumoniae	Susceptible	1.0 mg/L
Moraxella catarrhalis	Susceptible	1.0 mg/L
Morganella morganii	Active	—
Neisseria gonorrhoeae	Susceptible	0.125 mg/L
Neisseria gonorrhoeae	Susceptible	0.125 mg/L
Neisseria meningitidis	Susceptible	0.125 mg/L
Proteus mirabilis	Active	—
Proteus vulgaris	Active	—
Providencia rettgeri	Active	—
Pseudomonas aeruginosa	Active	—
Salmonella spp.	Susceptible	1.0 mg/L
Salmonella typhi	Active	—
Serratia marcescens	Active	—
Staphylococcus aureus	Active	—
Staphylococcus epidermidis	Active	—
Streptococcus agalactiae	Active	—
Streptococcus pneumoniae	Susceptible	0.5 mg/L
Streptococcus pneumoniae	Susceptible	0.5 mg/L
Streptococcus pyogenes	Active	—
Viridans group streptococci	Susceptible	0.5 mg/L
Escherichia coli	Resistant	2.0 mg/L
Klebsiella pneumoniae	Resistant	2.0 mg/L
Streptococcus pneumoniae	Resistant	2.0 mg/L

Class profile

gramStatus	Both
spectrumBreadth	Broad
atypicalCoverage	No
isBactericidal	1
moaCategory	Cell wall synthesis inhibitor (beta-lactam, 3rd generation cephalosporin)
pdIndex	Time-dependent
postAntibioticEffect	None
mrsaCoverage	0
resistanceMechanisms	ESBL production,AmpC beta-lactamase

Contraindications

Source: Lexicomp

Hypersensitivity to ceftriaxone, any component of the formulation, or other cephalosporins Absolute
IV use of ceftriaxone solutions containing lidocaine Absolute
concomitant use with intravenous calcium-containing solutions/products in neonates (≤28 days) Absolute
do not use in hyperbilirubinemic neonates, particularly those who are premature since ceftriaxone is reported to displace bilirubin from albumin binding sites Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Hepatobiliary disorders (2)

Common Biliary sludge / pseudolithiasis · Increased serum transaminases

Renal and urinary disorders (1)

Common Increased blood urea nitrogen

Blood and lymphatic system disorders (5)

Common Eosinophilia · leukopenia · thrombocythemia

Uncommon Thrombocytopenia

Very Rare Haemolytic anaemia

Immune system disorders (1)

Uncommon Hypersensitivity

Gastrointestinal disorders (2)

Common Diarrhea · Diarrhoea

Skin and subcutaneous tissue disorders (3)

Very Common Skin tightness

Common Rash · Skin rash

Infections and infestations (1)

Uncommon Clostridioides difficile colitis

General disorders and administration site conditions (4)

Very Common Induration at injection site · warm sensation at injection site

Common Pain at injection site · tenderness at injection site

Dosing

Source: Lexicomp

Dosage range: IM, IV: Usual dose: 1 to 2 g every 12 to 24 hours, depending on the type and severity of infection Acute bacterial rhinosinusitis, severe infection requiring hospitalization (off-label use): IV: 1 to 2 g every 12 to 24 hours (Chow 2012) Arthritis, septic (off-label use): IV: 1 to 2 g once daily (Coiffier 2014; Dalla Vestra 2008; Harwood 2008; Raad 2004). Additional data may be necessary to further define the role of ceftriaxone in this condition. Bacterial enteric infections in HIV-infected patients (empiric treatment) (off-label use): IV: 1 g every 24 hours (HHS [OI adult 2016]) Bite wounds (animal) (off-label use): IV: 1 g every 12 hours in combination with clindamycin or metronidazole for anaerobic coverage (IDSA [Stevens 2014]) Brain abscess (off-label use): IV: 2 g every 12 hours in combination with other antibiotics (Brouwer 2014; Louvois 2000). Additional data may be necessary to further define the role of ceftriaxone in this condition. Chancroid (off-label use): IM: 250 mg as single dose (CDC [Workowski 2015]) Cholecystitis, mild-to-moderate: IV: 1 to 2 g every 12 to 24 hours for 4 to 7 days (provided source controlled) (Solomkin 2010). Note: The addition of anaerobic therapy is recommended if biliary-enteric anastomosis is present. Cystitis (acute, complicated): IV: 1 to 2 g once daily (Stamm 1993) Endocarditis, prophylaxis (off-label use): Dental and upper respiratory procedures (patients allergic to penicillins and/or unable to take oral): IM, IV: 1 g 30 to 60 minutes before procedure (AHA [Wilson 2007]). Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA. Endocarditis, treatment (off-label use) (AHA [Baddour 2015]): Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible or penicillin-susceptible/aminoglycoside resistant): IV: 2 g every 12 hours for 6 weeks with concomitant ampicillin HACEK organisms, native or prosthetic valve: IV, IM: 2 g once daily for 4 weeks (native valve) or 6 weeks (prosthetic valve) Viridans group Streptococcus (VGS) and S. bovis: IV, IM: Native valve: Highly penicillin-susceptible (MIC ≤0.12 mcg/mL): 2 g once daily for 4 weeks or for 2 weeks with concomitant gentamicin Prosthetic valve: Highly penicillin-susceptible (MIC ≤0.12 mcg/mL): 2 g once daily for 6 weeks (with or without concomitant gentamicin for the first 2 weeks) Prosthetic valve: Relatively or fully penicillin-resistant (

(For additional information see "Ceftriaxone: Pediatric drug information") Dosage range: Infants, Children, and Adolescents: Usual dose: IM, IV: Mild to moderate infections: 50 to 75 mg/kg/day in 1 to 2 divided doses every 12 to 24 hours (maximum: 2,000 mg daily); continue until at least 2 days after signs and symptoms of infection have resolved Serious infections: 80 to 100 mg/kg/day in 1 to 2 divided doses (maximum: 4,000 mg daily) Acute bacterial rhinosinusitis, severe infection requiring hospitalization (off-label use): IV: 50 mg/kg/day divided every 12 hours for 10 to 14 days (Chow 2012) Bacterial enteric infections in HIV-infected patients (empiric treatment) (off-label use): Adolescents: IV: Refer to adult dosing. Community-acquired pneumonia (CAP) (IDSA/PIDS [Bradley 2011]) (off-label dose): Infants >3 months and Children: IV: 50 to 100 mg/kg/day once daily or divided every 12 hours (maximum: 2,000 mg daily). Note: May consider addition of vancomycin or clindamycin to empiric therapy if community-acquired MRSA suspected. Use the higher end of the range for penicillin-resistant S. pneumoniae; in children ≥5 years, a macrolide antibiotic should be added if atypical pneumonia cannot be ruled out; preferred in patients not fully immunized for H. influenzae type b and S. pneumoniae, or significant local resistance to penicillin in invasive pneumococcal strains. Endocarditis, prophylaxis (off-label use): Dental and upper respiratory procedures (patients allergic to penicillins and/or unable to take oral): Infants, Children, and Adolescents: IM, IV: 50 mg/kg 30 to 60 minutes prior to procedure; maximum dose: 1,000 mg/dose (AHA [Wilson 2007]; Red Book [AAP 2015]). Note: AHA guidelines (Baltimore 2015) limit the use of prophylactic antibiotics to patients at the highest risk for infective endocarditis (IE) or adverse outcomes (eg, prosthetic heart valves, patients with previous IE, unrepaired cyanotic congenital heart disease, repaired congenital heart disease with prosthetic material or device during first 6 months after procedure, repaired congenital heart disease with residual defects at the site or adjacent to site of prosthetic patch or device, and heart transplant recipients with cardiac valvulopathy). Endocarditis, treatment (off-label use): Children and Adolescents: IV: 100 mg/kg/day divided every 12 hours or 80 mg/kg/dose every 24 hours; maximum daily dose: 4,000 mg/day, daily doses over 2,000 mg should be divided into 2 doses; treat for at least 4 weeks; longer durations may be necessary; may use in combination with other antibiotics based on organism (AHA [Baltimore 2015]) Epiglottis (off-label use): IV: 100 mg/kg/day as a single dose on day 1, then 50 mg/kg as a single dose on day 2 (Sawyer 1994) or 75 mg/kg once daily for 10 to 14 days (Low 2003). Additional data may be necessary to further define the role of ceftriaxone in this condition. Gonococcal infections: Bacteremia (off-label use) (CDC [Workowski 2015]): IM, IV: Children ≤45 k

Refer to adult dosing.

There are no dosage adjustments provided in the manufacturer’s labeling; however, in patients with concurrent renal and hepatic impairment, maximum daily dose should not exceed 2 g. ESRD requiring dialysis: Poorly dialyzed; no supplemental dose or dosage adjustment necessary, including patients on intermittent hemodialysis, peritoneal dialysis, or continuous renal replacement therapy (eg, CVVHD) (Aronoff 2007).

There are no dosage adjustments provided in the manufacturer’s labeling; however, in patients with concurrent renal and hepatic impairment, maximum daily dose should not exceed 2 g.

Warnings & Precautions

Source: Lexicomp

Hypersensitivity

Serious and sometimes fatal hypersensitivity has been reported. Use caution in patients with a history of any allergy (particularly drugs), penicillin allergy or beta-lactam sensitivity. If severe hypersensitivity occurs, discontinue immediately and institute supportive emergency measures.

Elevated INR

May be associated with increased INR (rarely), especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease. Monitor INR during treatment if patient has impaired synthesis or low stores of vitamin K; supplementation may be needed if clinically indicated.

Hemolytic anemia

Severe cases (including some fatalities) of immune-related hemolytic anemia have been reported in patients receiving cephalosporins, including ceftriaxone.

Pancreatitis

Secondary to biliary obstruction, pancreatitis has been reported rarely. Most patients had biliary stasis or sludge risk factors (eg, preceding major surgery, sever illness, TPN).

Superinfection

Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment. Disease-related concerns:

Gallbladder pseudolithiasis

Abnormal gallbladder sonograms have been reported, possibly due to ceftriaxone-calcium precipitates; probability is greatest in pediatric patients. Discontinue in patients who develop signs and symptoms and/or sonographic evidence of gallbladder disease.

Gastrointestinal disease

Use with caution in patients with a history of GI disease, especially colitis.

Drug-drug interactions

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Neonates

Use extreme caution in neonates due to risk of hyperbilirubinemia, particularly in premature infants (contraindicated in hyperbilirubinemic neonates and neonates Other warnings/precautions:

Precipitation

Ceftriaxone may complex with calcium causing precipitation. Fatal lung and kidney damage associated with calcium-ceftriaxone precipitates has been observed in premature and term neonates. Due to reports of precipitation reaction in neonates, do not reconstitute, admix, or coadminister with calcium-containing solutions (eg, LR, Hartmann’s solution, parenteral nutrition), even via separate infusion lines/sites or at different times in any neonate. Ceftriaxone should not be diluted or administered simultaneously with any calcium-containing solution via a Y-site in any patient. However, ceftriaxone and calcium-containing solutions may be administered sequentially of one another for use in patients other than neonates if infusion lines are thoroughly flushed (with a compatible fluid) between infusions.

Pregnancy & Lactation

Pregnancy

FDA category B

Adverse events have not been observed in animal reproduction studies. Ceftriaxone crosses the placenta. Pregnancy was found to influence the single dose pharmacokinetics of ceftriaxone when administered prior to delivery (Popović 2007). The pharmacokinetics of ceftriaxone following multiple doses in the third trimester are similar to those of nonpregnant patients (Bourget Fernandez 1993). Ceftriaxone is recommended for use in pregnant women for the treatment of gonococcal infections, Lyme disease, and may be used in certain situations prior to vaginal delivery in women at high risk for endocarditis (consult current guidelines) (ACOG 120, 2011; CDC [Workowski 2015]; Wormser 2006).

Lactation

RID 1.2%

Ceftriaxone is excreted into breast milk. The relative infant dose (RID) of ceftriaxone is 1.2% to 2.4% when calculated using the highest breast milk concentration located and compared to a therapeutic infant dose of 50 to 100 mg/kg/day. In general, breast-feeding is considered acceptable when the relative infant dose is The elimination half-life in breast milk following administration of a single dose of ceftriaxone 1 g was 12.8 hours and 17.3 hours with IV and IM administration, respectively

Monitoring

Efficacy	Culture and susceptibility testing; clinical resolution (temperature, WBC, CRP, procalcitonin)
Toxicity	Renal function (dose adjustment in renal impairment); hepatic function for hepatically cleared agents; signs of C. difficile infection (diarrhoea)
Clinical pearl	Culture results guide de-escalation to narrower-spectrum therapy. Review antibiotic appropriateness at 48–72 h (antimicrobial stewardship).
Counseling	Complete the full course. Report persistent diarrhoea, rash, or lack of improvement after 48–72 h.

Chemistry & Properties

Formula	C18H18N8O7S3
Molecular weight	554.59 g/mol
IUPAC name	(6R,7R)-7-[[(2Z)-2-(2-amino-1,3-thiazol-4-yl)-2-methoxyiminoacetyl]amino]-3-[(2-methyl-5,6-dioxo-1H-1,2,4-triazin-3-yl)sulfanylmethyl]-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid
CAS	73384-59-5
PubChem CID	5479530
InChIKey	`VAAUVRVFOQPIGI-SPQHTLEESA-N`
logP	-1.2 (XLogP -1.3)
Polar surface area	215.22 Å²
H-bond acceptors / donors	15 / 4
Drug-likeness (QED)	0.13
Lipinski violations	2

SMILES

CO/N=C(\C(=O)N[C@@H]1C(=O)N2C(C(=O)O)=C(CSc3nc(=O)c(O)nn3C)CS[C@H]12)c1csc(N)n1

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrant	Yes

Enzyme interactions

Enzyme	Role	Detail
CYP2C9	Substrate	—

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MDR1 (Inhibitor)MRP1 (Inhibitor)MRP2 (Inhibitor)MRP3 (Inhibitor)MRP4 (Inhibitor)OAT1 (Inhibitor)OAT2 (Inhibitor)OAT3 (Inhibitor)OAT4 (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)PEPT1 (Inhibitor)PEPT2 (Inhibitor)MDR1 (Substrate)P-gp (Substrate)PEPT1 (Substrate)

Drug–drug interactions (20, DDInter)

Interacting drug	Severity	Management
Calcium chloride	major
Calcium glucoheptonate	major
Calcium gluconate	major
Leucovorin	major
Levoleucovorin	major
Amikacin	moderate
Amikacin (liposome)	moderate
Chloramphenicol	moderate
Cyclosporine	moderate
Dicoumarol	moderate
Ethinylestradiol	moderate
Gentamicin	moderate
Kanamycin	moderate
Mycophenolic acid	moderate
Neomycin	moderate
Picosulfuric acid	moderate
Streptomycin	moderate
Warfarin	moderate
Diclofenac	minor
Heparin	minor

Registered Products (46)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
EPICEPHIN IV Injection	Powder for Injection 1 g	1 amp pack varies	Reda Jardaneh Drug Store	1.660
Epicephin IM Injection	Powder for Injection 1 g	1 amp	Reda Jardaneh Drug Store	1.660
Megion Powder for Injection	Powder for Injection 0.25 g	One Vial	Nabulsi Drug Store	2.570
Longacef 500mg I.V. Injection	Powder for Injection 500 mg	1 vial pack varies	UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN	2.630
Longacef I.M. Injection	Powder for Injection 500 mg	1 vial pack varies	UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN	2.630
Axone Powder 0.5 g for IM injection + 5 ml Lidocaine HCL	Powder for Injection (sodium) 0.5 g, 1 %	1 glass vial + LDPE Ampoule	Pharma International Company/ Jordan	3.000
Samixon 500 IM Injection	Powder for Injection 500 mg, 1 %	1 amp	Hikma Pharmaceuticals Co.Ltd/Jordan	3.000
Samixon 500 IV Injection	Powder for Injection 500 mg	1 vial pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	3.000
Vaxcel Ceftriaxone	Powder for Injection 500 mg	1 vial	AL Rahma Drug Store	3.080
Lebacef 0.5	Vial 0.5 g, - -	One vial of sterile powder and one ampoule of lidocaine solvent + One syringe+ 2 Needles +Swab +Band	Adonis Drug Store	3.850
VERACOL VIAL IM	Vial 1 g	1 ampoule pack varies	Al Hilal Drug Store	3.850
VERACOL VIAL IV	Vial 1 g	1 ampoule pack varies	Al Hilal Drug Store	3.980
Lebacef	Ampoule 1 g	1 ampoule pack varies	Adonis Drug Store	4.340
Lebacef	Ampoule 1 g	1 syringe pack varies	Adonis Drug Store	4.340
TRIAXONE INJ -IV	Powder for Injection 1 g	1 vial	Sukhtian Group	4.340
Megion Powder for Injection	Powder for Injection 0.5 g	15 ml	Nabulsi Drug Store	4.380
Megion Powder for Injection	Powder for Injection 1 g	10 ml	Nabulsi Drug Store	4.440
Enoxirt 0.5g IM Injection	Powder for Injection 0.5 g, 1 %	1 vial	Professional Drug Store	4.850
Triaxone 0.5g IM	Vial 500 mg, (Solvent) 1 %w/v	1 vial	Sukhtian Group	4.860
Triaxone Sterile Pow. For Inj IM	Powder for Injection 1 g	5 ml	Sukhtian Group	4.860
Enoxirt 1.0 g IM Injection	Powder for Injection 1 g	1 vial	Professional Drug Store	4.970
Ceftra IM/IV	Vial 1000 mg	1 vial	MAS Pharmaceutical Industries	5.360
Axone 1gm Powder For IV Injection + 10ml WFI	Powder for Injection 1 g	1 glass Vial+1 plastic amp	Pharma International Company/ Jordan	6.070
Axone Powder and solvent for IM Injection	Powder for Injection 1 g, 1 %	1 amp	Pharma International Company/ Jordan	6.070
Longacef I.M. Injection	Powder for Injection 1 g	3.5 ml pack varies	UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN	6.070
Longacef I.V Injection	Powder for Injection 1 g	10 ml pack varies	UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN	6.070
Samixon 1000 IM Injection	Powder for Injection As Sodium 1000 mg, 1 %	1 amp pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	6.070
Samixon 1000 IV Injection	Powder for Injection (Sodium)1000 mg	1 vial pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	6.070
ROCEPHIN IM	Solution 250 mg	2 ml	Shawi & Rushedat Drug Store	7.370
Rocephin IM	Ampoule 1 g	1 amp pack varies	Shawi & Rushedat Drug Store	7.370
Rocephin IV	Ampoule 1 g	1 amp pack varies	Shawi & Rushedat Drug Store	7.370
EPICEPHIN IV Injection	Powder for Injection 1 g	10 vial pack varies	Reda Jardaneh Drug Store	14.350
Enoxirt	Vial 2.000 g	1 vial	Professional Drug Store	14.560
Axone Powder 0.5 g for IV/IM injection	Powder for Injection (sodium) 0.5 g	10 vial	Pharma International Company/ Jordan	27.000
Samixon 500 IV Injection	Powder for Injection 500 mg	10 vial pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	27.000
Lebacef	Vial 0.5 g	10 vial	Adonis Drug Store	33.280
VERACOL VIAL IM	Vial 1 g	10 ampoule pack varies	Al Hilal Drug Store	35.820
VERACOL VIAL IV	Vial 1 g	10 ampoule pack varies	Al Hilal Drug Store	35.840
Lebacef	Vial 1 g	10 vial pack varies	Adonis Drug Store	39.060
Axxon	Tablet 1 g	10 tab	IBN CINA DRUG STORE	44.640
Axone Powder 1g for IV/IM injection	Powder for Injection (sodium) 1 g	10 vial	Pharma International Company/ Jordan	54.630
Samixon 1000 IM Injection	Powder for Injection As Sodium 1000 mg, 1 %	1 amp pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	54.630
Samixon 1000 IV Injection	Powder for Injection (Sodium)1000 mg	10 vial pack varies	Hikma Pharmaceuticals Co.Ltd/Jordan	54.630
Megion	Vial 2 g	10 vial	Nabulsi Drug Store	140.290
VERACOL VIAL IM	Vial 1 g	50 ampoule pack varies	Al Hilal Drug Store	169.140
VERACOL VIAL IV	Vial 1 g	50 ampoule pack varies	Al Hilal Drug Store	169.250