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Bicillin l-a

Generic Name: penicillin G benzathine (PEN i SILL in G BEN za theen)
Brand Name: Bicillin L-A
Physician reviewed Bicillin L-A patient information - includes Bicillin L-A description, dosage and directions.
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Drug Information:
Bicillin L-A is a slow-onset antibiotic that is used to treat many types of mild to moderate infections caused by bacteria, including strep infections or syphilis. This medicine is also used to prevent the symptoms of rheumatic fever. Bicillin L-A may also be used for purposes not listed in this medication guide. You should not be treated with Bicillin L-A if you are allergic to penicillin. You should not be treated with this medicine if you are allergic to penicillin. Tell your doctor if you have ever had: Learn more

Bicillin l-a Side Effects

Bicillin L-A Side Effects

Note: This document contains side effect information about penicillin g benzathine. Some of the dosage forms listed on this page may not apply to the brand name Bicillin L-A.

For the Consumer

Applies to penicillin g benzathine: parenteral injection, parenteral powder for im or iv use, parenteral suspension for im injection


  • Penicillin G benzathine (Bicillin® L-A, Permapen®) penicillin G procaine, and fixed combination of penicillin G benzathine and penicillin G procaine (Bicillin® C-R, Bicillin® C-R 900/300), are administered by deep IM injection only and should not be injected IV or admixed with other IV solutions.

  • Inadvertent IV administration of penicillin G benzathine has been associated with cardiorespiratory arrest and death.

  • Prior to administration of penicillin G benzathine, penicillin G procaine, or fixed combination of penicillin G benzathine and penicillin G procaine, carefully read the warnings, adverse reactions, and dosage and administration sections of the prescribing information.

Side effects include:

Hypersensitivity reactions (rash, urticaria, serum sickness); local effects.

For Healthcare Professionals

Applies to penicillin g benzathine: intramuscular suspension


Frequency not reported: Injection site reactions (including pain, inflammation, lump, abscess, necrosis, edema, hemorrhage, cellulitis, hypersensitivity, atrophy, ecchymosis, skin ulcer), neurovascular reactions (including warmth, vasospasm, pallor, mottling, gangrene, numbness of the extremities, cyanosis of the extremities, neurovascular damage)


Frequency not reported: Hypersensitivity reactions (including skin eruptions [maculopapular to exfoliative dermatitis], urticaria, laryngeal edema, fever, eosinophilia, hypersensitivity myocarditis, other serum sickness-like reactions [including chills, fever, edema, arthralgia, prostration], anaphylactic/anaphylactoid reaction [including shock, death], allergic vasculitis, pruritus, fatigue, asthenia, pain)


Frequency not reported: Cardiac arrest, hypotension, tachycardia, palpitations, pulmonary hypertension, pulmonary embolism, vasodilation, vasovagal reaction, cerebrovascular accident, cyanosis

Nervous system

Severe reactions (including myoclonus, seizures, auditory and visual hallucinations, decreased mentation) have been reported with high-dose penicillin therapy or in patients with renal dysfunction. Severe neurologic reactions were most often seen with penicillin doses of 18 million to 80 million units daily. These reactions frequently abated after discontinuation of penicillin. In several cases, penicillin was restarted at a lower dose with no further sequelae. In 1 review, the authors found that cerebral spinal fluid (CSF) penicillin levels were higher in patients with seizures than in those without. CSF penicillin levels ranged from 12 to 61 units/mL in the seizure group with the highest CSF concentrations, compared to 7.8 units/mL in the group without seizures. Neurologic reactions occurred frequently in patients with renal dysfunction.

A syndrome characterized by various central nervous system symptoms (e.g., severe agitation with confusion, visual and auditory hallucinations, fear of impending death [Hoigne's syndrome]) has been reported after administration of this drug. Other symptoms associated with this syndrome have included psychosis, seizures, dizziness, tinnitus, cyanosis, palpitations, tachycardia, and abnormal taste perception.

Frequency not reported: Syncope, neuropathy, headache, tremors, dizziness, somnolence, abnormal taste perception, tinnitus, transverse myelitis, seizures, aseptic meningitis, coma, neurovascular reactions (including warmth, vasospasm, pallor, mottling, gangrene, numbness of the extremities, cyanosis of the extremities, neurovascular damage), myoclonus, decreased mentation, neurologic reactions


Onset of pseudomembranous colitis symptoms have been reported during or after antibacterial therapy.

Frequency not reported: Clostridium difficile-associated diarrhea, pseudomembranous colitis, nausea, vomiting, intestinal necrosis, blood in the stool


Frequency not reported: Hemolytic anemia, leukopenia, thrombocytopenia, lymphadenopathy


A 28-year-old female developed jaundice, fever, epidermolysis, abnormal liver function tests, and cholestasis several days after receiving a single dose of penicillin IM. Her liver dysfunction continued for up to 18 months. She had taken acetaminophen concurrently but denied alcohol use.

Frequency not reported: Increased AST, jaundice, cholestasis, abnormal liver function tests


Frequency not reported: Joint disorder, periostitis, myoglobinuria, rhabdomyolysis, exacerbation of arthritis, quadriceps femoris fibrosis and atrophy

Quadriceps femoris fibrosis and atrophy have been reported after repeated IM injections into the anterolateral thigh.


Frequency not reported: Increased BUN, increased creatinine, renal failure, nephropathy, acute interstitial nephritis


Frequency not reported: Hypoxia, apnea, dyspnea


Frequency not reported: Nervousness, confusion, anxiety, euphoria, auditory and visual hallucinations, agitation, fear of impending death, psychosis


Frequency not reported: Blurred vision, blindness


Frequency not reported: Neurogenic bladder, hematuria, proteinuria, impotence, priapism


Frequency not reported: Diaphoresis, rash, peeling, mucosal ulceration, urticaria, epidermolysis

Beta-lactam antibiotics:

-Frequency not reported: Severe cutaneous adverse reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms [DRESS syndrome], acute generalized exanthematous pustulosis)


Frequency not reported: Fatigue, asthenia, pain, aggravation of existing disorder, Hoigne's syndrome


The Jarisch-Herxheimer reaction has been reported during syphilis treatment.

Frequency not reported: Jarisch-Herxheimer reaction

Editorial References and Review

Medically reviewed by BestRx Medical Team Last updated on 1/1/2020.

Source: Drugs.com Bicillin L-a