Penicillin Procaine Injection

Penicillin Procaine Injection is a prescription medication used to treat bacterial infections such as Pneumonia, Streptococcal Infections (Group A), Staphylococcal Infections, Bacterial Endocarditis, Syphilis, Anthrax, Diphtheria, Vincent’s Infection (fusopirochetosis), Erysipeloid, Rat-Bite Fever and Whipple's disease.  

• Penicillin Procaine Injection is available under the following different brand names: Penicillin G Procaine.

Adult and pediatric dosage

Injectable suspension

• 600,000 units/1mL syringe
• 1.2 million units/2mL syringe

Pediatric general dosing:

• Infants/children: 25,000-50,000 units/kg/day IM
• Avoid use in neonates; higher risk of abscess and procaine toxicity

Pneumonia

Adult dosage

• 600,000-1,000,000 units IM once daily

Pediatric dosage

• Children weighing less than 60 lbs: 300,000 units IM once daily
• Children weighing over 60 lbs: As adults, 600,000 units IM once daily

Streptococcal Infections (Group A)

Adult dosage

• 600,000-1,000,000 units IM once daily for at least 10 days

Staphylococcal Infections

Adult dosage

• 600,000-1,000,000 units IM once daily

Bacterial Endocarditis

Adult dosage

• 600,000-1,000,000 units IM once daily

Syphilis

Adult dosage

• Primary, secondary, and latent: 600,000 units IM once daily for 8 days
• Late (tertiary and latent syphilis with positive spinal fluid): 600,000 units IM once daily for 10-15 days (total 6-9 million units)
• Neurosyphilis: 2.4 million units IM once daily for 10-14 days; administer with probenecid 500 mg orally four times daily (penicillin G aqueous preferred)

Pediatric dosage

• Congenital Syphilis: Children weighing less than 70 lbs 50,000 units/kg IM once daily for 10 days
• Primary, secondary, and latent (aged 12 years of older): As adults; 600,000 units IM once daily for 8 days

Anthrax

Adult dosage

• Cutaneous: 600,000-1,000,000 units IM once daily
• Inhaled (post-exposure): 1.2 million units IM every 12 hours for up to 2 weeks, then switch to oral treatment (total treatment 60 days)

Pediatric dosage

• Inhaled (post-exposure): 25,000 units/kg IM every 12 hours for up to 2 weeks; not to exceed 1.2 million units every 12 hours, then switch to orally treatment (total treatment 60 days).

Diphtheria

Adult dosage

• Adjunct with antitoxin: 300,000-600,000 units IM once daily
• Carrier state: 300,000 units IM once daily

Vincent’s Infection (fusospirochetosis)

Adult dosage

• 600,000-1,000,000 units IM once daily

Erysipeloid

Adult dosage

• 600,000-1,000,000 units IM once daily

Whipple's disease

Adult dosage

• 1.2 million units IM once daily for 10-14 days; co-administer with streptomycin, then 
• Trimethoprim/sulfamethoxazole or doxycycline orally for 1 year

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Penicillin Procaine Injection include:

• pain at the injection site, 
• vaginal itching or discharge, 
• white patches in the mouth or throat, 
• nausea, 
• vomiting, 
• blurred vision, 
• ringing in ears, 
• headache, 
• dizziness, and 
• mild skin rash

Serious side effects of Penicillin Procaine Injection include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• diarrhea that is watery or bloody, 
• peeling skin, 
• severe pain, 
• changes in skin color where the medicine was injected, 
• dizziness, 
• joint or muscle pain, 
• fast or pounding heartbeats, 
• numbness, tingling, pain, swelling, or redness in arms or legs, 
• confusion, 
• agitation, 
• depression, 
• unusual thoughts or behavior, 
• chest pain, 
• problems with vision or speech, 
• lightheadedness, 
• fever, 
• chills, 
• rapid breathing or heart rate, 
• uncontrolled muscle movements, 
• problems with balance or walking, 
• pale skin, 
• easy bruising, 
• unusual bleeding, 
• unusual weakness, 
• sore throat, 
• flu symptoms, 
• urinating less than usual or not at all, 
• rash or itching with swollen glands, 
• general ill feeling, 
• slow heart rate, 
• weak pulse, 
• fainting, and 
• slow breathing 

Rare side effects of Penicillin Procaine Injection include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result 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.

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

• Penicilling Procaine Injection has unknown severe interactions with other drugs. 
• Penicilling Procaine Injection has unknown serious interactions with other drugs.
• Penicilling Procaine Injection has unknown moderate interactions with other drugs.
• Penicilling Procaine Injection has unknown minor interactions with other drugs.

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

Long-Term Effects

• See “What Are Side Effects Associated with Using Penicillin Procaine Injection?”

Cautions

• For deep IM administration only; do not administer IV, SC, or IT
• Do not inject near nerve or artery
• No longer indicated for gonorrhea; should not be used for beta-lactamase producing organisms which include most strains of Neisseria gonorrhea
• Pseudomembranous colitis reported with antibacterial agents, including penicillin G
• Procaine reactions: Immediate toxic reactions to procaine reported, particularly when a large single dose is administered (4.8 million units); 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

Pregnancy and Lactation

Use may be acceptable in pregnancy.  

Excreted into breast milk, caution advised