Penicillin G Benzathine-Penicillin G Procaine

Penicillin G Benzathine-Penicillin G Procaine (Rx) is a combination medicine used for streptococcal group A and pneumococcal infections.

• Penicillin G Benzathine-Penicillin G Procaine is available under various brand names: Bicillin C-R, Bicillin C-R 900/300

Common side effects of Penicillin G Benzathine-Penicillin G Procaine include:

• nausea,
• vomiting,
• diarrhea,
• itching,
• sweating,
• allergic reaction,
• flushing (sudden warmth, redness, or tingly feeling),
• feeling anxious,
• nervousness,
• weakness,
• tiredness,
• headache,
• dizziness,
• drowsiness,
• muscle or joint pain, and
• pain, swelling, or bruising where an injection was given

Serious side effects of Penicillin G Benzathine-Penicillin G Procaine include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• joint pain,
• chills,
• pain, numbness, tingling, burning, or feeling cold,
• pale or mottled skin,
• blue-colored lips, fingers, or toes,
• severe pain, tingling, weakness, or swelling in the lower leg,
• weakness in your arms or legs,
• blistering, peeling, discoloration, or painful skin changes, where the medicine was injected,
• severe stomach pain,
• diarrhea that is watery or bloody (even if it occurs months after the last dose),
• lightheadedness,
• slow heart rate,
• weak pulse,
• fainting,
• slow breathing,
• pounding heartbeats,
• fluttering in the chest,
• confusion,
• agitation,
• hallucinations,
• extreme fear,
• seizure,
• warmth, redness, bleeding, a lump, or skin changes where the medicine was injected,
• easy bruising or bleeding,
• pale or yellowed skin,
• dark-colored urine,
• urination problems,
• fever,
• chills,
• mouth sores,
• warmth or redness under the skin, and,
• vaginal itching or discharge

Rare side effects of Penicillin G Benzathine-Penicillin G Procaine include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Injectable Suspension

• 600,000 units/600,000 units/2 mL (ie, 1.2 million units/2 mL)
• 900,000 units/300,000 units/2 mL (ie, 1.2 million units/2 mL)

Streptococcal Group A Infections

Adult dosage

• 2.4 million units IM x1; divided dosage administration into multiple sites
• Alternatively, administer 1.2 million units IM on day 1, then repeat the dose on day 3

Pediatric dosage

Bicillin C-R

• Less than 14 kg: 600,000 units IM x1
• 14-27 kg: 900,000-1,200,000 units IM x1
• 27 kg or more: As adults; 2.4 million units IM x1; divided dosage administration into multiple sites; alternatively, administer 1.2 million units IM on day 1, then repeat the dose on day 3

Bicillin C-R 900/300

• 900 units/300 units IM x1

Pneumococcal Infections

Adult dosage

• 1.2 million units IM; repeat q2-3 days until the temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection

Pediatric dosage

• Bicillin C-R: 600,000 units IM; repeat every 2-3 days until the temperature is normal for 48 hours; other penicillin forms (ie, IV) necessary for severe infection
• Bicillin C-R 900/300: 900 units/300 units IM; repeat every 2-3 days until the temperature is normal for 48 hours; other penicillin forms (ie, IV) necessary for severe infection

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Penicillin G Benzathine-Penicillin G Procaine has severe interactions with no other drugs.
• Penicillin G Benzathine-Penicillin G Procaine has serious interactions with the following drugs:
  • baricitinib
  • cholera vaccine
  • omadacycline
  • sarecycline
• Penicillin G Benzathine-Penicillin G Procaine has moderate interactions with the following drugs:
  • amifampridine
  • apalutamide
  • dienogest/estradiol valerate
  • dienogest/estradiol valerate
  • sodium picosulfate/magnesium oxide/anhydrous citric acid
• Penicillin G Benzathine-Penicillin G Procaine has minor interactions with no other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity; serious and occasionally fatal reactions have been reported

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Penicillin G Benzathine-Penicillin G Procaine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Penicillin G Benzathine-Penicillin G Procaine?”

Cautions

• For deep IM administration only; do not administer IV, SC, or IT
• Do not inject near nerve or artery
• Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) reported; discontinue therapy when SCAR suspected; consider an alternative treatment
• Pseudomembranous colitis reported with antibacterial agents, including penicillin G
• Procaine reactions: Immediate toxic reactions to procaine were reported, particularly when a large single dose is administered (4.8 million units); the reaction manifested by mental disturbances including anxiety, confusion, agitation, depression, weakness, seizures, hallucinations, combativeness, and fear
• Avoid use in neonates; increased risk for sterile abscess development and procaine toxicity
• Severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, and arthritis of pneumococcal etiology are better treated with penicillin G sodium or potassium during the acute stage
• When high, sustained serum levels are required, penicillin G sodium or potassium, either IM or IV, should be used
• NOT indicated for the treatment of venereal diseases, including syphilis, gonorrhea, yaws, bejel, and pinta
• Methemoglobinemia
  • Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
  • Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, nitroglycerin, nitroprusside, nitric oxide, nitrous oxide, cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase, dapsone, nitrofurantoin, para­aminosalicylic acid, sulfonamides, chloroquine, primaquine, phenobarbital, sodium valproate, acetaminophen, metoclopramide, quinine, sulfasalazine
  • Advise patients or caregivers to seek immediate medical attention if the patient experiences the following signs or symptoms: pale, gray, or blue-colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue the drug and any other oxidizing agents; depending on the severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen

Pregnancy & Lactation

• May be acceptable during pregnancy
• Lactation
  • Excreted into breast milk, caution advised