penicillin G procaine (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosing Form & Strengths

injectable suspension

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

Pneumonia

Indicated for moderately severe uncomplicated pneumococcal pneumonia

600,000-1,000,000 units IM qDay

Streptococcal Infections (Group A)

Indicated for moderately severe-to-severe tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue infections

600,000-1,000,000 units IM qDay for at least 10 days

Staphylococcal Infections

600,000-1,000,000 units IM qDay

Bacterial Endocarditis

Indicated only for treatment of extremely sensitive infections; not indicated for prophylaxis

600,000 -1,000,000 units IM qDay

Syphilis

Primary, secondary, and latent: 600,000 units IM qDay for 8 days

Late (tertiary and latent syphilis with positive spinal fluid): 600,000 units IM qDay for 10-15 days (total 6-9 million units)

Neurosyphilis: 2.4 million units IM qDay x10-14 days; administer with probenecid 500 mg PO QID (penicillin G aqueous preferred)

Anthrax

Cutaneous: 600,000-1,000,000 units IM qDay

Inhaled (post-exposure): 1.2 million units IM q12hr for up to 2 weeks, THEN switch to PO treatment (total treatment 60 days)

Diphtheria

Adjunct with antitoxin: 300,000-600,000 units IM qDay

Carrier state: 300,000 units IM qDay

Vincent’s Infection (fusospirochetosis)

600,000-1,000,000 units IM qDay

Erysipeloid

600,000-1,000,000 units IM qDay

Rat-Bite Fever

Indicated for Streptobacillus moniliformis and Spirillum minus (rat-bite fever)

600,000-1,000,000 units IM qDay

Whipple’s disease

1.2 million units IM qDay for 10-14 days; coadminister with streptomycin, THEN

Trimethoprim/sulfamethoxazole or doxycycline PO for 1 yr

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

Other Indications & Uses

Indicated for susceptible microorganisms that respond to low and persistent penicillin G serum levels (if high, sustained serum levels required, use aqueous penicillin G IV/IM)

Streptococci Groups A, C, G, H, L, and M are sensitive (Group D, ie, enterococcus is resistant); aqueous penicillin G recommended for streptococcal bacteremia

Moderate/severe respiratory tracts infection caused by pneumococci (use aqueous penicillin G for acute stage of severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, or arthritis)

Moderate/severe skin infections caused by susceptible staphylococci

Susceptible fusiform bacilli and spirochetes (fusospirochetosis)

Syphilis (all stages) caused by susceptible Treponema pallidum

Yaws, Bejel, Pinta

C diphtheriae carrier stage

Anthrax

Rat-bite fever caused by Streptobacillus moniliformis and Spirillum minus

Erysipeloid caused by Erysipelothrix rhusiopathiae

Subacute bacterial endocarditis, only in extremely sensitive infections caused by susceptible Group A streptococci

Dosing Form & Strengths

injectable suspension

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

General Dosing for Infections

Infants/children: 25,000-50,000 units/kg/day IM

Avoid use in neonates; higher risk of abscess and procaine toxicity

Pneumonia

Indicated for pneumonia caused by streptococcal Group A and staphylococcal infections

<60 pounds: 300,000 units IM qDay

60 pounds or greater: As adults; 600,000 units IM qDay

Syphilis

Congenital Syphilis: <70 pounds: 50,000 units/kg IM qDay for 10 days

Primary, secondary, and latent (aged 12 years or older): As adults; 600,000 units IM qDay for 8 days

Anthrax

Inhaled (post-exposure): 25,000 units/kg IM q12hr for up to 2 weeks; not to exceed 1.2 million units q12hr, THEN switch to PO treatment (total treatment 60 days)

Renal Impairment

Not defined in children; see adult recommendations

Other Indications & Uses

Indicated for susceptible microorganisms that respond to low and persistent penicillin G serum levels (if high, sustained serum levels required, use aqueous penicillin G IV/IM)

Streptococci Groups A, C, G, H, L, and M are sensitive (Group D, ie, enterococcus is resistant); aqueous penicillin G recommended for streptococcal bacteremia

Moderate/severe respiratory tracts infection caused by pneumococci (use aqueous penicillin G for acute stage of severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, or arthritis)

Moderate/severe skin infections caused by susceptible staphylococci

Susceptible fusiform bacilli and spirochetes (fusospirochetosis)

Syphilis (all stages) caused by susceptible Treponema pallidum

Yaws, Bejel, Pinta C diphtheriae carrier stage

Anthrax

Rat-bite fever caused by Streptobacillus moniliformis and Spirillum minus

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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

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

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

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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

Absorption: IM, slow absorption for up to 24 hr

Vd: 0.3-0.47 L/kg

Peak Plasma Time: 2-4 hr

Peak Plasma Concentration: 1.5 units/mL

Protein Bound: 60%

Metabolism: ~30% in liver

Excretion: urine (60-90% within 24-36 hr)

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

BRAND FORM. UNIT PRICE PILL IMAGE
penicillin G procaine intramuscular
-
1.2 million unit/2 mL solution
penicillin G procaine intramuscular
-
600,000 unit/mL solution
penicillin G procaine intramuscular
-
600,000 unit/mL solution
penicillin G procaine intramuscular
-
1.2 million unit/2 mL solution

Copyright © 2010 First DataBank, Inc.

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Patient Handout

Patient Education
penicillin G procaine intramuscular

PENICILLIN G PROCAINE - INJECTION

(pen-ih-SILL-in G PRO-cane)

COMMON BRAND NAME(S): Wycillin

USES: This medication is used to treat a wide variety of bacterial infections. This medication is known as a long-acting natural penicillin antibiotic. It works by stopping the growth of bacteria.This medication should not be used to treat gonorrhea.

HOW TO USE: This medication is given by injection into a large muscle as directed by your doctor.The dosage is based on your medical condition and response to treatment. For children, the dosage may also be based on weight.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, follow your doctor's directions for when to receive this antibiotic, and make sure to not miss any doses.Continue to receive this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition persists or worsens.

SIDE EFFECTS: Pain at the injection site may occur. If this effect persists or worsens, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: joint/muscle pain, severe pain/peeling skin at injection site, numbness/tingling of arms/legs, pain/redness/swelling of arms or legs, change in skin color near injection site or on arms/legs, uncontrolled movements, inability to move, signs of kidney problems (such as change in the amount of urine), new signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, dark/cloudy urine, seizures, mental/mood changes (e.g., depression, agitation).Get medical help right away if you have any serious side effects, including: chest pain, trouble speaking, vision changes, fainting.This medication has rarely caused a very serious (possibly fatal) blood disorder (methemoglobinemia). This effect is more likely if you have breathing problems, certain diseases of the blood, or if you smoke (see also Precautions section). The symptoms of this disorder may occur within minutes to a couple of hours after using this medication. Stop using this medication and get medical help right away if you develop any symptoms of methemoglobinemia, including: headache, confusion, dizziness, shortness of breath, tiredness, pale/bluish/gray skin, fast heartbeat.If used to treat syphilis, this medication may cause a condition known as Jarisch-Herxheimer reaction. This condition may occur 1 to 2 hours after you receive the medication and can last up to 24 hours. Notify your doctor right away if you experience any of these symptoms: fever/chills, muscle pain, worsening of skin sores, fast heartbeat, fast breathing, dizziness, flushing.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to penicillin or cephalosporin antibiotics; or to procaine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, breathing problems (such as asthma, bronchitis, emphysema, smoking history), heart disease, certain blood disorders (G6PD deficiency, pyruvate kinase deficiency, hemoglobin-M disease, NADH-methemoglobin reductase deficiency).This medication may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Older adults may be at greater risk for side effects while using this drug.Newborns/infants may be at greater risk for side effects while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: "blood thinners" (e.g., warfarin), methotrexate, NSAIDs (e.g., aspirin, indomethacin), tetracyclines.Low-dose aspirin should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually 81-162 milligrams a day). Ask your doctor or pharmacist for more details.This medication may interfere with certain laboratory tests (including certain urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures, confusion, mental/mood changes (e.g., agitation).

NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., kidney function, complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

STORAGE: Store in the refrigerator between 36-46 degrees F (2-8 degrees C). Do not freeze. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

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.
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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.
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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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.