penicillin G benzathine/penicillin G procaine (Rx)

Brand and Other Names:Bicillin C-R, Bicillin C-R 900/300
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Dosing & Uses

AdultPediatric

Dosing Form & Strengths

penicillin G benzathine/penicillin G procaine

injectable suspension

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

Streptococcal Group A Infections

Indicated for moderately severe-to-severe infections of upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections caused by streptococcal Group A

2.4 million units IM x1; divided dosage administration into multiple site

Alternatively, administer 1.2 million units IM on day 1, then repeat dose on day 3

Pneumococcal Infections

NOT for pneumococcal meningitis

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

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

penicillin G benzathine/penicillin G procaine

injectable suspension

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

Streptococcal Group A Infections

Indicated for moderately severe-to-severe infections of upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections caused by streptococcal Group A

Bicillin C-R

  • <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 site; alternatively, administer 1.2 million units IM on day 1, then repeat dose on day 3

Bicillin C-R 900/300

  • 900 units/300 units IM x1

Pneumococcal Infections

NOT for pneumococcal meningitis

Bicillin C-R: 600,000 units IM; repeat q2-3 days until temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection

Bicillin C-R 900/300: 900 units/300 units IM; repeat q2-3 days until temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection

Renal Impairment

Not defined in children; see adult recommendations

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Interactions

Interaction Checker

and penicillin G benzathine/penicillin G procaine

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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

            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

            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 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
            • Advise patients or caregivers to seek immediate medical attention if 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 drug and any other oxidizing agents; depending on 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
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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.

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            Pharmacology

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

            Absorption: IM, slow

            Peak Plasma Time: 3 hr

            Peak Plasma Concentration: 1-1.3 units/mL

            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

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            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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.