Piperacillin / tazobactam Side Effects
Some side effects of piperacillin / tazobactam may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to piperacillin / tazobactam: intravenous powder for solution, intravenous solution
Along with its needed effects, piperacillin / tazobactam may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking piperacillin / tazobactam:More common
- Bladder pain
- bloating or swelling of the face, arms, hands, lower legs, or feet
- blurred vision
- burning upper abdominal or stomach pain
- changes in urination
- chest pain
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- fever or sweating
- inflammation or swelling at the injection site
- lower back or side pain
- nausea or vomiting
- pain, tenderness, or swelling of the foot or leg
- pain, warmth, or burning in the fingers, toes, and legs
- problems with vision or hearing
- skin rash
- slow or fast heartbeat
- troubled breathing
- Abdominal or stomach cramps, pain, or tenderness
- bone pain
- cold sweats
- deep or fast breathing with dizziness
- diarrhea, watery and severe, which may also be bloody
- dry mouth
- itching of the vagina or genital area
- muscle pain or cramps
- muscle stiffness or twitching
- numbness or tingling in the hands, feet, or lips
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- sore throat
- sores, ulcers, or white spots on the lips, tongue, or inside the mouth
- swollen glands
- temporary blindness
- thick, white vaginal discharge with no odor or with a mild odor
- total body jerking
- unexplained weight loss
- unusual bleeding or bruising
- Back or leg pain
- blistering, peeling, or loosening of the skin
- high fever
- joint or muscle pain
- red skin lesions, often with a purple center
- yellow eyes or skin
Some side effects of piperacillin / tazobactam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Difficulty having a bowel movement (stool)
- trouble sleeping
- Acid or sour stomach
- cracks in the skin at the corners of the mouth
- irritation and redness of the skin
- runny nose
- stuffy nose
- white patches in the mouth or on the tongue
- Body aches or pain
- burning feeling in the chest or stomach
- change in taste or bad unusual or unpleasant (after) taste
- feeling of constant movement of self or surroundings
- sensation of spinning
- severe sleepiness
- tenderness in stomach area
- vision changes
- voice changes
For Healthcare Professionals
Applies to piperacillin / tazobactam: intravenous powder for injection, intravenous solution
In general, side effects have been described as transient and mild to moderate. In clinical trials, piperacillin-tazobactam was discontinued in 3.2% of patients due to dermatologic effects (including rash and pruritus; 1.3%), gastrointestinal effects (including diarrhea, nausea, and vomiting; 0.9%), and allergic reactions (0.5%). In nosocomial pneumonia trials, 11% of patients discontinued piperacillin-tazobactam due to a side effect.
Diarrhea associated with piperacillin-tazobactam was usually self-limited. There were case reports of pseudomembranous colitis in patients receiving piperacillin-tazobactam. The onset of pseudomembranous colitis symptoms has been reported during and after antibacterial therapy.
Very common (10% or more): Diarrhea (up to 20%)
Common (1% to 10%): Constipation (up to 8.4%), nausea (up to 6.9%), oral candidiasis (3.9%), vomiting (up to 3.3%), dyspepsia (up to 3.3%), abdominal pain (up to 1.8%)
Uncommon (0.1% to 1%): Pseudomembranous colitis (1% or less), stomatitis (1% or less)
Frequency not reported: Oral thrush/moniliasis, hiccough, stool changes, enlarged abdomen, flatulence, anorexia, duodenal ulcer, melena, gastrointestinal hemorrhage, gastritis, ileus, taste perversion, ulcerative stomatitis, colitis, dry mouth, dysphagia, glossitis, fecal incontinence, gastric ulcer, pancreatitis, Clostridium difficile-associated diarrhea
Neurotoxicity has been reported with piperacillin.
Piperacillin may have neuromuscular blocking properties, and has been noted to enhance the effect of neuromuscular blocking agents.
Common (1% to 10%): Headache (up to 7.7%), insomnia (up to 6.6%)
Frequency not reported: Agitation, dizziness, tremor, convulsions, vertigo, syncope, central nervous system depression, grand mal convulsion, cerebrovascular accident, somnolence, tinnitus, hypertonia, stupor, deafness, tonic-clonic seizure, neurotoxicity, effect of neuromuscular blocking agents enhanced
A patient with mononucleosis developed a nonallergic rash after 3 weeks of treatment with piperacillin-tazobactam for osteomyelitis. He had no history of penicillin allergy. His Epstein-Barr virus IgG and IgM antibodies were positive. The rash resolved quickly after discontinuation of the piperacillin-tazobactam.
Piperacillin therapy has been associated with an increased incidence of rash in cystic fibrosis patients.
Petechial rash or purpura due to thrombocytopenia, exanthematous pustulosis, bullous dermatosis, erythema nodosum, exanthems, exfoliative dermatitis, urticaria, pruritus, vesiculation, Jarisch-Herxheimer reaction, Stevens-Johnson syndrome, purpura, and vasculitis have been reported with piperacillin.
Common (1% to 10%): Rash (including maculopapular, bullous, and urticarial; up to 4.2%), pruritus (up to 3.2%)
Frequency not reported: Erythematous rash, excoriations, sweating, diaphoresis, fungal dermatitis, exanthemous pustulosis, drug-induced petechial rash, eczematoid rash, petechial rash or purpura due to thrombocytopenia, bullous dermatosis, erythema nodosum, exanthems, exfoliative dermatitis, urticaria, vesiculation, Jarisch-Herxheimer reaction, purpura, vasculitis
Postmarketing reports: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
Common (1% to 10%): Fever (up to 3.2%), candidiasis (up to 1.8%)
Uncommon (0.1% to 1%): Rigors (1% or less), flushing (1% or less)
Frequency not reported: Pain, edema, generalized edema, peripheral edema, moniliasis, chest pain, back pain, malaise, asthenia, earache, xerosis, decreased drug level, false-positive tests for Aspergillus galactomannan antigenemia, Candidal superinfections
Piperacillin therapy has been associated with an increased incidence of fever in patients with cystic fibrosis.
A 51-year-old woman developed an acute onset of renal dysfunction after 6 days of therapy with piperacillin-tazobactam. The patient also had an elevated serum creatinine, lumbar pain, rash, fever, arthralgias, and eosinophiluria. The piperacillin-tazobactam was discontinued and the patient's symptoms improved to baseline after 21 days of prednisone.
Common (1% to 10%): Increased blood creatinine (1.8%), increased blood urea nitrogen (1.8%)
Uncommon (0.1% to 1%): Renal failure (1% or less)
Frequency not reported: Increased serum creatinine, acute onset of renal dysfunction (with elevated serum creatinine, lumbar pain, rash, fever, arthralgias, and eosinophiluria), acute kidney failure, abnormal kidney function
Postmarketing reports: Interstitial nephritis
Common (1% to 10%): Thrombocythemia (1.4%)
Uncommon (0.1% to 1%): Anemia (1% or less), thrombocytopenia (1% or less), eosinophilia (1% or less), purpura (1% or less)
Rare (less than 0.1%): Reversible bone marrow suppression
Frequency not reported: Leukopenia, hypochromic anemia, leukocytosis, decreased prothrombin, ecchymosis, decreased hemoglobin and hematocrit, increased platelet count, neutropenia, positive direct Coombs' test, prolonged prothrombin time, prolonged partial thromboplastin time, prolonged bleeding time, thrombocytosis, vitamin B12 deficiency anemia, bleeding disorders
Postmarketing reports: Hemolytic anemia, agranulocytosis, pancytopenia
Reversible bone marrow suppression was rare and usually limited to prolonged therapy with piperacillin.
Leukopenia/neutropenia was frequently associated with prolonged therapy (i.e., 21 days or longer) and appeared to be reversible. Leukopenia has been reported in 23% of patients with liver disease receiving beta-lactam antibiotics.
Bleeding disorders, neutropenia, thrombocytopenia, and hemolytic anemia have been reported with piperacillin.
Hepatotoxicity has been reported with piperacillin.
Common (1% to 10%): Abnormal liver function test (1.4%)
Uncommon (0.1% to 1%): Increased aspartate aminotransferase (1% or less), increased alanine aminotransferase (1% or less)
Frequency not reported: Transient elevations of AST (SGOT), transient elevations of ALT (SGPT), transient elevations of bilirubin, increased gamma-glutamyltransferase, cholestatic jaundice, hepatotoxicity
Postmarketing reports: Hepatitis, jaundice
Common (1% to 10%): Phlebitis (1.3%), thrombophlebitis (up to 1.3%), hypotension (up to 1.3%)
Frequency not reported: Hypertension, cardiac arrest, supraventricular tachycardia, tachycardia, ventricular tachycardia, bradycardia, arrhythmia, atrial fibrillation, ventricular fibrillation, cardiac failure, circulatory failure, myocardial infarction, angina, sinus bradycardia, ventricular extrasystoles, mesenteric embolism
Uncommon (0.1% to 1%): Anaphylaxis (1% or less)
Frequency not reported: Allergic reactions
Postmarketing reports: Hypersensitivity reactions, anaphylactic/anaphylactoid reactions (including shock)
Hypersensitivity reactions have generally included urticarial rash, but rare reports of severe reactions( including anaphylaxis, Stevens-Johnson syndrome, dyspnea, hypotension, and edema) have been reported. Hypersensitivity reactions (including fever, rash, and eosinophilia) have been reported.
Hypersensitivity reactions and anaphylactic/anaphylactoid reactions (resulting in shock and fatalities) have been reported with piperacillin.
Electrolyte and acid-base disturbances have been reported with piperacillin.
Uncommon (0.1% to 1%): Hypoglycemia (1% or less), hypokalemia (1% or less), increased alkaline phosphatase (1% or less)
Frequency not reported: Transient elevations of alkaline phosphatase, symptomatic hypoglycemia, thirst, acidosis, dehydration, gout, hypernatremia, hypokalemia, hyponatremia, hypophosphatemia, hyperglycemia, decreased total protein or albumin, hypomagnesemia, abnormalities in electrolytes (e.g., increased and decreased sodium, potassium, and calcium), decreased blood glucose, fluid overload, electrolyte disturbances, acid-base disturbances
Uncommon (0.1% to 1%): Epistaxis (1% or less)
Frequency not reported: Pleural effusion, pneumothorax, rhinitis, dyspnea, pharyngitis, pulmonary edema, bronchospasm, coughing, pulmonary embolism, hyperventilation, respiratory disorder, increased cough, atelectasis, hemoptysis, hypoxia
Uncommon (0.1% to 1%): Injection site reaction (1% or less)
Frequency not reported: Injection site edema, injection site pain, inflammation at injection site, local reaction to procedure
Prolonged muscle relaxation has been reported with piperacillin.
Uncommon (0.1% to 1%): Myalgia (1% or less), arthralgia (1% or less)
Frequency not reported: Prolonged muscle relaxation
Frequency not reported: Anxiety, confusion, hallucination, aggressive reaction (combative), depression
Frequency not reported: Urinary tract infection, urinary incontinence, genital pruritus, balanoposthitis, leukorrhea, vaginitis, perineal irritation/pain, urinary retention, dysuria, oliguria, hematuria, urinary incontinence, urinary tract infection with trichomonas, yeast in urine, proteinuria, pyuria
Frequency not reported: Photophobia, diplopia, conjunctivitis
More about piperacillin/tazobactam
- Piperacillin and tazobactam
- Piperacillin and tazobactam Intravenous (Advanced Reading)
- Other brands: Zosyn
- Piperacillin Sodium and Tazobactam Sodium (AHFS Monograph)
- Piperacillin Sodium/Tazobactam Sodium (Wolters Kluwer)
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