U.S. flag An official website of the United States government
  1. Home
  2. Drug Databases
  3. Drug Safety-related Labeling Changes

Drug Safety-related Labeling Changes (SrLC)

Get Email Alerts | Guide

BICILLIN C-R (NDA-050138)

(PENICILLIN G BENZATHINE; PENICILLIN G PROCAINE)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

Download Data

Expand all

12/10/2020 (SUPPL-242)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

Newly added information (following Anaphylaxis):

Severe cutaneous adverse reactions

Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome (SJS), toxic

epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS),

and acute generalized exanthematous pustulosis (AGEP) have been reported in patients taking

beta-lactam antibiotics. When SCAR is suspected, Bicillin C-R should be discontinued

immediately and an alternative treatment should be considered.

12/08/2020 (SUPPL-243)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

Method of Administration

Injection into or near a nerve may result in permanent neurological damage.

Additions and/or revisions underlined:

Inadvertent intravascular administration, including inadvertent direct intra-arterial injection or injection

immediately adjacent to arteries, of Bicillin C-R and other penicillin preparations has resulted in severe

neurovascular damage, including transverse myelitis with permanent paralysis, gangrene requiring

amputation of digits and more proximal portions of extremities, and necrosis and sloughing at and

surrounding the injection site consistent with the diagnosis of Nicolau syndrome. Such severe effects …

6 Adverse Reactions

Additions and/or revisions underlined:

Body as a Whole: Hypersensitivity reactions including allergic vasculitis, pruritus, fatigue,

asthenia, and pain; aggravation of existing disorder; headache, Nicolau syndrome.

08/26/2019 (SUPPL-241)

Approved Drug Label (PDF)

5 Warnings and Precautions

PRECAUTIONS

(revisions are underlined)

Examples of Drugs Associated with Methemoglobinemia:

Antineoplastic agents                  cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase

04/30/2019 (SUPPL-240)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

(additions underlined)

Method of Administration

FOR DEEP INTRAMUSCULAR INJECTION ONLY. There have been reports of inadvertent intravenous administration of penicillin G benzathine which has been associated with cardiorespiratory arrest and death. Therefore, do not inject intravenously or admix with other intravenous solutions.

 

Administer by DEEP INTRAMUSCULAR INJECTION ONLY in the upper, outer quadrant of the buttock (dorsogluteal) or the ventrogluteal site. Quadriceps femoris fibrosis and atrophy have been reported following repeated intramuscular injections of penicillin preparations into the anterolateral thigh. Therefore, administration in the anterolateral thigh is not recommended.

11/05/2018 (SUPPL-239)

Approved Drug Label (PDF)

5 Warnings and Precautions

PRECAUTIONS

Information for Patients

Newly added information:

Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue …

Drug Interactions

Newly added information:

Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics:

Examples of Drugs Associated with Methemoglobinemia: Newly added table; please see label for complete information.

WARNINGS

Newly added information following Anaphylaxis:

Methemoglobinemia

Cases of methemoglobinemia have been reported in association with local anesthetic use. Although all patients are at risk for methemoglobinemia, 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. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.

Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood. Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system (CNS) and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Discontinue Bicillin C-R and any other oxidizing agents. Depending on the severity of the signs and symptoms, patients may respond to supportive care, i.e., oxygen therapy, hydration. A more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen …