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.

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.

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.

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.

Pseudomembranous colitis may occur during or after piperacillin therapy.

Hematologic

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.

Renal

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

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

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

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.

Musculoskeletal

Musculoskeletal side effects have included prolonged muscle relaxation and paralysis.

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.

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