Piperacillin Side Effects
Some side effects of piperacillin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
Applies to piperacillin: injectable powder for injection
Hypersensitivity side effects have included anaphylactic/anaphylactoid reactions (some leading to shock and fatalities), fever, eosinophilia, edema, hypotension, and dyspnea.
Dermatologic side effects have included rash (1%), pruritus, vesicular eruptions, positive Coombs tests, erythema multiforme, urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome, petechial rash or purpura due to thrombocytopenia, exanthematous pustulosis, bullous dermatosis, erythema nodosum, exanthems, exfoliative dermatitis, vesiculation, Jarisch-Herxheimer reaction, purpura, and vasculitis. An increased incidence of rash has been reported in cystic fibrosis patients.
Local side effects have included thrombophlebitis (4%), and injection site pain, induration, and/or erythema (2%). Ecchymosis, deep vein thrombosis, and hematomas have been reported less frequently.
Gastrointestinal side effects have included diarrhea (2%), loose stools (2%), nausea, vomiting, bloody diarrhea, and pseudomembranous colitis. Clostridium difficile-associated diarrhea has also been reported.
Pseudomembranous colitis may occur during or after piperacillin therapy.
Hematologic side effects have included agranulocytosis, hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, eosinophilia, epistaxis, bleeding disorders, and hemorrhage. Piperacillin may cause platelet dysfunction and significantly prolong bleeding times in up to 43% of treated patients. Leukopenia has been reported in 23% of patients with liver disease receiving beta-lactam antibiotics.
Reversible bone marrow suppression is rare and most often occurs during prolonged therapy with piperacillin. Risk factors for piperacillin-induced increased bleeding time include age over 60 years, cytotoxic chemotherapy, thrombocytopenia, azotemia, doses of 12 grams per day or more, and therapy of 6 days' duration or longer.
Risk factors for reversible leukopenia (neutropenia) included prolonged therapy with high doses or concomitant drugs that cause this effect.
Drug-induced interstitial nephritis is a rare but potentially serious side effect of all penicillins.
Renal side effects have included elevations in serum creatinine and BUN, interstitial nephritis, and renal failure.
Nervous system side effects have included headache, fatigue, dizziness, seizures, neurotoxicity, and encephalopathy. Neuromuscular excitability and convulsions have been reported when higher than recommended doses were given intravenously.
Hepatic side effects have included elevated liver enzymes (LDH, AST, ALT), hyperbilirubinemia, hepatotoxicity, and cholestatic hepatitis.
Metabolic side effects have included hypokalemia, and decreases in serum potassium levels in patients who had liver disease or were receiving chemotherapy or diuretics along with high doses of piperacillin. Electrolyte and acid-base disturbances have been reported.
Musculoskeletal side effects have included prolonged muscle relaxation and paralysis.
Other side effects have included fever, edema, and superinfection with nonsusceptible organisms (including candidiasis). An increased incidence of fever has been reported in cystic fibrosis patients.
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