Side Effects of Bicillin C-R (penicillin g benzathine/penicillin g procaine)

Bicillin C-R (penicillin g benzathine/penicillin g procaine injection) is a long-acting natural penicillin antibiotic used to treat a wide variety of bacterial infections. 

Common side effects of Bicillin C-R include

• pain at the injection site,
• nausea, and
• vomiting.

Serious side effects of Bicillin C-R include

• severe pain or peeling skin at injection site,
• joint or muscle pain,
• headache,
• shortness of breath,
• dizziness,
• vision changes,
• fast/slow/pounding heartbeat,
• numbness and tingling of arms or legs,
• pain/redness/swelling of arms or legs,
• change in skin color near injection site or on arms or legs,
• uncontrolled movements,
• inability to move,
• change in the amount of urine,
• new signs of infection (e.g., fever, persistent sore throat),
• easy bruising or bleeding,
• extreme tiredness,
• dark or cloudy urine,
• seizures,
• mental/mood changes (e.g., depression, agitation) and
• Clostridium difficile-associated diarrhea.

Drug interactions of Bicillin C-R include

• blood thinners,
• live bacterial vaccines,
• methotrexate,
• nonsteroidal anti-inflammatory drugs (NSAIDs),
• probenecid,
• tetracyclines,
• diuretics (water pills), and
• hormonal birth control.

During pregnancy, Bicillin C-R should be used only when clearly needed. Bicillin C-R passes into breast milk. Consult your doctor before breastfeeding.

Side effects associated with penicillin G benzathine treatment are:

• hypersensitivity or allergic reactions,
• upset stomach,
• neuropathy,
• cardiac or heart problems,
• dizziness,
• fatigue,
• headache,
• nervousness,
• pain,
• seizures,
• weakness,
• sexual dysfunction,
• injection site reactions,
• blurred vision,
• kidney problems, and
• others.

As with other penicillins, untoward reactions of the sensitivity phenomena are likely to occur, particularly in individuals who have previously demonstrated hypersensitivity to penicillins or in those with a history of allergy, asthma, hay fever, or urticaria.

The following have been reported with parenteral penicillin G:

General: Hypersensitivity reactions including the following:

• skin eruptions (maculopapular to exfoliative dermatitis),
• urticaria,
• laryngeal edema,
• fever,
• eosinophilia;
• other serum sickness-like reactions (including chills, fever, edema, arthralgia, and prostration); and
• anaphylaxis including shock and death.

Note: Urticaria, other skin rashes, and serum sickness-like reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids. Whenever such reactions occur, penicillin G should be discontinued unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to therapy with penicillin G. Serious anaphylactic reactions require immediate emergency treatment with epinephrine. Oxygen, intravenous steroids, and airway management, including intubation, should also be administered as indicated.

Gastrointestinal: Pseudomembranous colitis. Onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment.

Hematologic: Hemolytic anemia, leukopenia, thrombocytopenia.

Neurologic: Neuropathy.

Urogenital: Nephropathy.

The following adverse events have been temporally associated with parenteral administrations of penicillin G benzathine:

Body as a Whole: Hypersensitivity reactions including allergic vasculitis, pruritis, fatigue, asthenia, and pain; aggravation of existing disorder; headache.

Cardiovascular: Cardiac arrest; hypotension; tachycardia; palpitations; pulmonary hypertension; pulmonary embolism; vasodilation; vasovagal reaction; cerebrovascular accident; syncope.

Gastrointestinal: Nausea, vomiting; blood in stool; intestinal necrosis.

Hemic and Lymphatic: Lymphadenopathy.

Injection Site: Injection site reactions including pain, inflammation, lump, abscess, necrosis, edema, hemorrhage, cellulitis, hypersensitivity, atrophy, ecchymosis, and skin ulcer. Neurovascular reactions including warmth, vasospasm, pallor, mottling, gangrene, numbness of the extremities, cyanosis of the extremities, and neurovascular damage.

Metabolic: Elevated BUN, creatinine, and SGOT.

Musculoskeletal: Joint disorder, periostitis; exacerbation of arthritis; myoglobinuria; rhabdomyolysis.

Nervous System: Nervousness; tremors; dizziness; somnolence; confusion; anxiety; euphoria; transverse myelitis; seizures; coma. A syndrome manifested by a variety of CNS symptoms such as severe agitation with confusion, visual and auditory hallucinations, and a fear of impending death (Hoigne’s syndrome), has been reported after administration of penicillin G procaine and, less commonly, after injection of the combination of penicillin G benzathine and penicillin G procaine. Other symptoms associated with this syndrome, such as psychosis, seizures, dizziness, tinnitus, cyanosis, palpitations, tachycardia, and/or abnormal perception in taste, also may occur.

Respiratory: Hypoxia; apnea; dyspnea.

Skin: Diaphoresis.

Special Senses: Blurred vision; blindness.

Urogenital: Neurogenic bladder; hematuria; proteinuria; renal failure; impotence; priapism.

Tetracycline, a bacteriostatic antibiotic, may antagonize the bactericidal effect of penicillin, and concurrent use of these drugs should be avoided.

Concurrent administration of penicillin and probenecid increases and prolongs serum penicillin levels by decreasing the apparent volume of distribution and slowing the rate of excretion by competitively inhibiting renal tubular secretion of penicillin.

Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics:

Examples of Drugs Associated with Methemoglobinemia: