Piperacillin Side Effects

It is possible that some side effects of piperacillin may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Applies to piperacillin: injectable powder for injection

Hypersensitivity

Hypersensitivity side effects have included anaphylactic/anaphylactoid reactions (some leading to shock and fatalities), fever, eosinophilia, edema, hypotension, and dyspnea.[Ref]

Dermatologic

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.[Ref]

Local

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.[Ref]

Gastrointestinal

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.[Ref]

Pseudomembranous colitis may occur during or after piperacillin therapy.[Ref]

Hematologic

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.[Ref]

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.[Ref]

Renal

Renal side effects have included elevations in serum creatinine and BUN, interstitial nephritis, and renal failure.[Ref]

Drug-induced interstitial nephritis is a rare but potentially serious side effect of all penicillins.[Ref]

Nervous system

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.[Ref]

Hepatic

Hepatic side effects have included elevated liver enzymes (LDH, AST, ALT), hyperbilirubinemia, hepatotoxicity, and cholestatic hepatitis.[Ref]

Metabolic

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.[Ref]

Musculoskeletal

Musculoskeletal side effects have included prolonged muscle relaxation and paralysis.[Ref]

Other

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.[Ref]

References

1. Abate G, Godbole K, Springston C "Piperacillin/tazobactam-induced petechial rash." Ann Pharmacother 44 (2010): 1345-6

2. Pleasants RA, Walker TR, Samuelson WM "Allergic reactions to parenteral beta-lactam antibiotics in patients with cystic fibrosis." Chest 106 (1994): 1124-8

3. "Product Information. Pipracil (piperacillin)." Lederle Laboratories, Wayne, NJ.

4. Winston DJ, Murphy W, Young LS, Hewitt WL "Piperacillin therapy for serious bacterial infections." Am J Med 69 (1980): 255-61

5. Strandvik B "Adverse reactions to piperacillin in patients with cystic fibrosis." Lancet 06/16/84 (1984): 1362

6. Eliopoulos GM, Moellering RC "Azlocillin, mezlocillin, and piperacillin: new broad-spectrum penicillins." Ann Intern Med 97 (1982): 755-60

7. Cabanas R, Munoz L, LopezSerrano C, Contreras J, Padial A, Caballero T, MorenoAncillo A, Barranco P "Hypersensitivity to piperacillin." Allergy 53 (1998): 819-20

8. Stead RJ, Kennedy HG, Hodson ME, Batten JC "Adverse reactions to piperacillin in cystic fibrosis." Lancet 04/14/84 (1984): 857

9. Ramakrishnan K, Scheid DC "Diagnosis and management of acute pyelonephritis in adults." Am Fam Physician 71 (2005): 933-42

10. Lutz B, Mogabgab W, Holmes B, et al "Clinical evaluation of the therapeutic efficacy and tolerability of piperacillin." Antimicrob Agents Chemother 22 (1982): 10-4

11. Mandell GL "In vitro microbiology and pharmacokinetics of piperacillin." Clin Ther 7 (1985): 37-44

12. Link AS, Jr "Efficacy and safety of ticarcillin plus clavulanic acid and piperacillin in patients with lower respiratory tract infections." Am J Med 79 (1985): 86-7

13. Moore M, McNamara TR, Johnson J "Elevated bleeding time and epistaxis associated with piperacillin therapy." South Med J 78 (1985): 363

14. Singh N, Yu VL, Mieles LA, Wagener MM "Beta-lactam antibiotic-induced leukopenia in severe hepatic dysfunction: risk factors and implications for dosing in patients with liver disease." Am J Med 94 (1993): 251-6

15. Gentry LO, Jemsek JG, Natelson EA "Effects of sodium piperacillin on platelet function in normal volunteers." Antimicrob Agents Chemother 19 (1981): 532-3

16. Kirkwood CF, Lasezkay GM "Neutropenia associated with mezlocillin and piperacillin." Drug Intell Clin Pharm 19 (1985): 112-4

17. Yan MT, Chu HY, Chau T, Lin SH "Profound thrombocytopenia associated with piperacillin in a hemodialysis patient." Clin Nephrol 72 (2009): 240-3

18. Bressler RB, Huston DP "Piperacillin-induced anemia and leukopenia." South Med J 79 (1986): 255-6

19. Fass RJ, Copelan EA, Brandt JT, Moeschberger ML, Ashton JJ "Platelet-mediated bleeding caused by broad-spectrum penicillins." J Infect Dis 155 (1987): 1242-8

20. Lee M, Stobnicki M, Sharifi R "Hemorrhagic complications of piperacillin therapy." J Urol 136 (1986): 454-5

21. Parkmatsumoto YC, Tazawa T "Piperacillin-induced encephalopathy." J Neurol Sci 140 (1996): 141-2

22. Malanga CJ, Kokontis L, Mauzy S "Piperacillin-induced seizures." Clin Pediatr (Phila) 36 (1997): 475-6

23. Mackie K, Pavlin EG "Recurrent paralysis following piperacillin administration." Anesthesiology 72 (1990): 561-3

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