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Bicillin L-A
penicillin G benzathine
Black Box Warnings .
Not for IV Use
do not admin. IV or admix w/ other IV solution; cardioresp. arrest and death assoc. w/ inadvertent IV admin.
Prescribing Information
prescribers should be familiar w/ complete prescribing information before use
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 600,000 units per mL
syphilis
- [primary, secondary, or latent <1y]
- Dose: 2.4 million units IM x1; Info: may repeat dose x1 after 1wk in pregnant pts; 1st-line agent
- [latent >1y or unknown duration, or tertiary]
- Dose: 2.4 million units IM qwk x3wk; Info: 1st-line agent
pharyngitis/tonsillitis, streptococcal
- [1.2 million units IM x1]
rheumatic fever prophylaxis, secondary
- [1.2 million units IM q4wk]
- Info: may switch to q3wk if recurrent after q4wk regimen
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 600,000 units per mL
syphilis, congenital
- [neonates]
- Dose: 50,000 units/kg/dose IM x1; Max: 2.4 million units/dose; Info: for asymptomatic dz; 1st-line agent
- [infants/children]
- Dose: 50,000 units/kg/dose IM qwk for up to 3wk; Max: 2.4 million units/dose; Info: for asymptomatic dz; 1st-line agent
syphilis, acquired
- [primary or secondary or latent <1y, infants/children]
- Dose: 50,000 units/kg/dose IM x1; Max: 2.4 million units/dose
- [latent >1y or unknown duration, infants/children]
- Dose: 50,000 units/kg/dose IM qwk x3wk; Max: 2.4 million units/dose
pharyngitis/tonsillitis, streptococcal
- [<27 kg]
- Dose: 0.6 million units IM x1
- [>27 kg]
- Dose: 1.2 million units IM x1
rheumatic fever prophylaxis, secondary
- [<27 kg]
- Dose: 0.6 million units IM q4wk; Info: may switch to q3wk if recurrent after q4wk regimen
- [>27 kg]
- Dose: 1.2 million units IM q4wk; Info: may switch to q3wk if recurrent after q4wk regimen
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- IV use
- caution: hypersensitivity to beta-lactams
- caution: asthma
- caution: asthma hx
- caution: abx-associated colitis hx, recent
- caution: seizure disorder
- caution: renal impairment
Drug Interactions .
Overview
penicillin G
penicillin
- OAT1 substrate
- OAT3 substrate
- alters GI flora
- antiplatelet effects
- bactericidal activity requires bacterial growth
- impairs immunomodulatory bacterial infective agent
- lowers seizure threshold
Avoid/Use Alternative
- aldesleukin
- amifampridine
- BCG live intravesical
- cholera vaccine, live
- enoxaparin
- fecal microbiota, live
- fondaparinux
- iohexol
- methotrexate
- typhoid vaccine, live
Monitor/Modify Tx
- abrocitinib
- acalabrutinib
- ado-trastuzumab emtansine
- afatinib
- alteplase
- anacaulase topical
- anagrelide
- antithrombin
- apixaban
- argatroban
- asparaginase
- aspirin
- avapritinib
- axitinib
- bevacizumab
- binimetinib
- bivalirudin
- bromelain
- bromfenac ophthalmic
- bupropion
- cabazitaxel
- cabozantinib
- calaspargase
- cangrelor
- caplacizumab
- carfilzomib
- celecoxib
- cilostazol
- citalopram
- clopidogrel
- collagenase clostridium histolyticum
- cysteamine
- dabigatran
- dalteparin
- danshen
- daprodustat
- dasatinib
- deferasirox
- defibrotide
- desvenlafaxine
- deuruxolitinib
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- dimethyl fumarate
- diosmin
- dipyridamole
- diroximel fumarate
- duloxetine
- edoxaban
- encorafenib
- epoprostenol
- eptifibatide
- erlotinib
- escitalopram
- ethanol
- etodolac
- evening primrose oil
- fenoprofen
- fenugreek
- fluoxetine
- flurbiprofen
- flurbiprofen ophthalmic
- fluvoxamine
- fruquintinib
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- heparin
- hydrocortisone
- ibrutinib
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- iloprost inhaled
- imatinib
- indomethacin
- iopamidol
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- lenvatinib
- levomilnacipran
- lifileucel
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methyl salicylate topical
- milnacipran
- mitotane
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- naproxen
- nattokinase
- nepafenac ophthalmic
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nusinersen
- omega-3-acid
- oxaliplatin
- oxaprozin
- pacritinib
- paroxetine
- pazopanib
- pegaspargase
- pentosan polysulfate sodium
- pentoxifylline
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- ponatinib
- porfimer
- pralsetinib
- prasugrel
- ramucirumab
- ranibizumab
- regorafenib
- resveratrol
- reteplase
- rivaroxaban
- salsalate
- saw palmetto
- selpercatinib
- selumetinib
- sertraline
- sirolimus albumin-bound
- sorafenib
- sotatercept
- sulindac
- sunitinib
- tenecteplase
- ticagrelor
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tolmetin
- tovorafenib
- trametinib
- trazodone
- treprostinil
- upadacitinib
- vadadustat
- valproic acid
- vandetanib
- venlafaxine
- vilazodone
- vinpocetine
- vorapaxar
- vortioxetine
- warfarin
- willow bark
- zanubrutinib
- ziv-aflibercept
Therapeutic Advantage
- amikacin
- gentamicin
- probenecid
- streptomycin
- tobramycin
Caution Advised
- acetazolamide
- brivaracetam
- busulfan
- cannabidiol
- carbamazepine
- cenobamate
- chlorambucil
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- demeclocycline
- diazepam
- doxycycline
- eravacycline
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fosphenytoin
- gabapentin
- ganaxolone
- hydroxychloroquine
- lacosamide
- lactulose
- lamotrigine
- levetiracetam
- lindane topical
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- minocycline
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rufinamide
- sarecycline
- sodium benzoate
- sodium phenylacetate
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tetracycline
- tiagabine
- topiramate
- tramadol
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- anaphylaxis
- hypersensitivity rxn, immediate or delayed
- serum sickness-like rxn
- cutaneous rxn, severe
- Nicolau syndrome
- exfoliative dermatitis
- Stevens-Johnson syndrome
- drug rxn w/ eosinophilia and systemic sx
- toxic epidermal necrolysis
- acute generalized exanthematous pustulosis
- superinfection
- C. difficile-assoc. diarrhea
- hemolytic anemia
- leukopenia
- thrombocytopenia
- nephrotoxicity
- interstitial nephritis
- seizures
- neuropathy
Common Reactions
- rash
- urticaria
- fever
- pruritus
- fatigue
- asthenia
- headache
- nausea
- vomiting
- diarrhea
- injection site rxn
- sterile abscess
- BUN or Cr elevated
Safety/Monitoring .
Monitoring Parameters
Cr at baseline
Look/Sound-Alike Drug Names
Bicillin LA confused with: Bicillin CR
penicillin G benzathine confused with: penicillAMINE; penicillin G procaine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; drug of choice for syphilis during pregnancy; no known risk of fetal harm based on human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm, though possible risk of infant diarrhea, rash, urticaria, thrush, and somnolence based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: unknown
Excretion: urine; Half-life: unknown
Subclass: Beta-Lactams ; Penicillins, Natural
Mechanism of Action
binds to peptidoglycan, inhibiting cell wall synthesis
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Pfizer Inc.
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/bicillin-l-a
intramuscular suspension:
- 1.2 million units per 2 mL (1 package, 10 syringes): $1,766.00
- 2.4 million units per 4 mL (3 package, 10 syringes): $10,805.00
intramuscular suspension:
- 600,000 units per mL (1 package, 10 pediatric syringes): $1,001.00
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