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penicillin G benzathine (Rx)Brand and Other Names:Bicillin LA, Permapen

 
 
 

Dosing & Uses

AdultPediatric

Dosing Form & Strengths

injectable suspension

  • 600,000 units/1mL syringe
  • 1.2 million units/2mL syringe
  • 2.4 million units/4mL syringe

Group A Streptococcal Respiratory Infections

1.2 million units IM x1

Rheumatic Fever Prophylaxis

1.2 million units IM monthly following acute attack, OR

600,000 units IM q2Weeks

Syphilis

Primary or secondary (CDC Guidelines 2006)

  • 2.4 million units IM x1
  • If pregnant: Some specialists recommend 2.4 million units IM qWeek x2
  • If HIV+: Some specialists recommend 2.4 million units IM qWeek x 3

Early Latent: 2.4 million units IM x1

Neurosyphilis: 2.4 million units IM qWeek x 3

Yaw, Bejel, & Pinta

1.2 million units IM x1

Renal Impairment

CrCl 10-50 mL/min: Decrease dose by 25%

CrCl <10 mL/min: Decrease dose by 50-70%

Hemodialysis: Removed by hemodialysis; administer after dialysis

Dosing Form & Strengths

injectable suspension

  • 600,000 units/1mL syringe
  • 1.2 million units/2mL syringe
  • 2.4 million units/4mL syringe

Group A Streptococcal Infections

<27 kg: 600,000 unit IM x1 (AHA guidelines 2009)

27 kg or greater: 1.2 million units IM x1 (AHA guidelines 2009)

Rheumatic Fever, Prophylaxis

<27 kg: 600,000 units IM q4Weeks; high-risk patients q3Weeks (AHA guidelines 2009)

27 kg or greater: 1.2 million units IM q4Weeks; high-risk patients q3Weeks (AHA guidelines 2009)

Syphilis

Congenital (<2 years old): 50,000 units/kg IM x 1 dose

Early: 50,000 units/kg IM x 1 dose; not to exceed 2.4 million units/dose

>1 year duration: 50,000 units/kg qWeek x3 weeks; not to exceed 2.5 million units/dose

Renal Impairment

Not defined in children; see adult recommendations

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Adverse Effects

Frequency Not Defined

Skin rashes including maculopapular eruptions and exfoliative dermatitis

Urticaria

Serum-sicknesslike reactions (eg, chills, fever, edema, arthralgia, prostration)

Jarisch-Herxheimer reaction reported when treating syphilis

Pseudomembranous colitis

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Warnings

Black Box Warnings

Not for IV use

Do not inject IV or admix with other IV solutions

Reports of inadvertent IV administration associated with cardiorespiratory arrest and death

Prior to administration, carefully read the warnings, adverse reactions, and dosage and administration sections of the labeling

Contraindications

Hypersensitivity; serious and occasionally fatal reactions have been reported

Cautions

For deep IM administration only; do not administer IV, SC, or IT

Do not inject near nerve or artery

Pseudomembranous colitis reported with antibacterial agents, including penicillin G

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Pregnancy & Lactation

Pregnancy Category: B

Lactation: Excreted into breast milk, caution advised

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

more...
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Pharmacology

Half-Life: 20-30 minutes after hydrolysis to penicillin G

Absorption: IM, slow

Peak Plasma Concentration: 0.03-0.05 units/mL; levels persist for 5-14 days depending on dose

Protein Bound: 60%

Metabolism: ~30% in liver

Excretion: urine (60-90%)

Mechanism of Action

Interferes with cell wall mucopeptide synthesis during active multiplication, resulting in bactericidal activity against susceptible microorganisms

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Administration

IM Administration

Do not inject near artery or nerve (may result in permanent neurologic damage)

Neonates, infants, small children: Midlateral aspect of thigh preferable

Older children and adults: Deep IM injection in upper outer quadrant of buttock

Because of high concentration of suspended matter, needle may be blocked if injection is not made at slow, steady rate

Storage

Store refrigerated at 2-8 degrees C (36-46 degrees F)

Do not freeze

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Images

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Formulary

FormularyPatient Discounts

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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