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Piperacillin / tazobactam Side Effects

Medically reviewed by Last updated on Aug 19, 2023.

Applies to piperacillin / tazobactam: intravenous powder for solution, intravenous solution.

Serious side effects

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

Less common


Incidence not known

Other side effects

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

Less common


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. The most common side effects have included diarrhea, rash, erythema, pruritus, vomiting, allergic reactions, nausea, urticaria, superinfection, phlebitis, thrombophlebitis, dyspepsia, and insomnia. In clinical trials, this drug was discontinued in 3.2% of patients due to dermatologic effects (including rash, pruritus), gastrointestinal effects (including diarrhea, nausea, vomiting), and allergic reactions. In nosocomial pneumonia trials, 11% of patients discontinued this drug due to a side effect.[Ref]


Very common (10% or more): Diarrhea (up to 20%)

Common (1% to 10%): Constipation, nausea, oral candidiasis, vomiting, dyspepsia, abdominal pain, soft/loose stools

Uncommon (0.1% to 1%): Stomatitis

Rare (0.01% to 0.1%): Pseudomembranous colitis

Frequency not reported: Dry mouth, Clostridioides difficile-associated diarrhea , hiccough, stool changes, enlarged abdomen, flatulence, duodenal ulcer, melena, gastrointestinal hemorrhage, gastritis, ileus, taste perversion, ulcerative stomatitis, colitis, dysphagia, glossitis, fecal incontinence, gastric ulcer, pancreatitis[Ref]

Diarrhea associated with this drug was usually self-limited. There have been case reports of pseudomembranous colitis. The onset of pseudomembranous colitis symptoms has been reported during and after antibacterial therapy.[Ref]

Nervous system

Common (1% to 10%): Headache

Frequency not reported: Dizziness, convulsions, neuromuscular excitability, tremor, vertigo, syncope, central nervous system depression, grand mal convulsion, cerebrovascular accident, somnolence, tinnitus, hypertonia, stupor, deafness, tonic-clonic seizure

Postmarketing reports: Seizures


-Frequency not reported: Neurotoxicity, effect of neuromuscular blocking agents enhanced[Ref]

Neuromuscular excitability and convulsions have been reported when higher than recommended doses were given IV.[Ref]


Common (1% to 10%): Rash (including maculopapular, bullous, urticarial), pruritus

Uncommon (0.1% to 1%): Urticaria

Rare (0.01% to 0.1%): Purpura, eruption (including bullous dermatitis)

Frequency not reported: Increased sweating, eczema/eczematoid rash, exanthema, erythematous rash, excoriations, diaphoresis, fungal dermatitis, exanthematous pustulosis, drug-induced petechial rash

Postmarketing reports: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis, exfoliative dermatitis, maculopapular rash


-Frequency not reported: Petechial rash/purpura due to thrombocytopenia, exanthematous pustulosis, bullous dermatosis, erythema nodosum, exanthems, exfoliative dermatitis, urticaria, pruritus, vesiculation, Jarisch-Herxheimer reaction, Stevens-Johnson syndrome, purpura, vasculitis[Ref]

A patient with mononucleosis developed a nonallergic rash after using this drug for 3 weeks 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 drug.

Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.[Ref]


Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.[Ref]

Common (1% to 10%): Fever/pyrexia, candidiasis, decreased blood albumin, decreased total protein, increased blood alkaline phosphatase

Uncommon (0.1% to 1%): Flushing, chills

Rare (0.01% to 0.1%): Rigors

Frequency not reported: Transient elevations of alkaline phosphatase, edema, hot flushes, tiredness, pain, generalized edema, peripheral edema, moniliasis, chest pain, back pain, malaise, asthenia, earache, xerosis, decreased drug level, false-positive tests for Aspergillus galactomannan antigenemia

Postmarketing reports: Candida infection, candidal superinfection[Ref]


Common (1% to 10%): Increased blood creatinine, increased blood urea/BUN

Rare (0.01% to 0.1%): Renal failure, tubulointerstitial nephritis

Frequency not reported: Increased serum creatinine, nephrotoxicity, acute onset of renal dysfunction (with elevated serum creatinine, lumbar pain, rash, fever, arthralgias, eosinophiluria), acute kidney failure, abnormal kidney function

Postmarketing reports: Interstitial nephritis, acute renal injury[Ref]

In a randomized, multicenter, controlled trial in critically ill adults (n=1200), this drug was found to be a risk factor for renal failure and associated with delayed recovery of renal function as compared to other beta-lactam antibacterial agents.

A 51-year-old woman developed an acute onset of renal dysfunction after 6 days of therapy with this drug. The patient also had an elevated serum creatinine, lumbar pain, rash, fever, arthralgias, and eosinophiluria. The drug was discontinued and the patient's symptoms improved to baseline after 21 days of prednisone.[Ref]


Common (1% to 10%): Thrombocythemia, thrombocytopenia, positive direct Coombs test, prolonged activated partial thromboplastin time

Uncommon (0.1% to 1%): Leukopenia, neutropenia, prolonged prothrombin time

Rare (0.01% to 0.1%): Anemia, eosinophilia, agranulocytosis, bleeding manifestations, prolonged bleeding time

Very rare (less than 0.01%): Disturbed thrombocyte function, prolonged partial thromboplastin time

Frequency not reported: Decreased hemoglobin, decreased hematocrit, increased platelet count, hypochromic anemia, leukocytosis, decreased prothrombin, ecchymosis, vitamin B12 deficiency anemia

Postmarketing reports: Hemolytic anemia, pancytopenia, thrombocytosis


-Rare (0.01% to 0.1%): Reversible bone marrow suppression

-Frequency not reported: Bleeding disorders, neutropenia, thrombocytopenia, hemolytic anemia[Ref]

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.

Reversible bone marrow suppression was rare and usually limited to prolonged therapy with piperacillin.[Ref]


Common (1% to 10%): Abnormal liver function test, increased AST, increased ALT

Uncommon (0.1% to 1%): Increased blood bilirubin

Rare (0.01% to 0.1%): Increased GGT

Frequency not reported: Transient elevations of AST, transient elevations of ALT, transient elevations of bilirubin

Postmarketing reports: Hepatitis, jaundice


-Frequency not reported: Hepatotoxicity[Ref]


Common (1% to 10%): Phlebitis, thrombophlebitis, hypotension

Frequency not reported: Cardiac arrest, supraventricular tachycardia, tachycardia, ventricular tachycardia, bradycardia, arrhythmia, atrial fibrillation, ventricular fibrillation, cardiac failure, circulatory failure, myocardial infarction, hypertension, angina, sinus bradycardia, ventricular extrasystoles, mesenteric embolism[Ref]


Frequency not reported: Anaphylaxis, allergic reactions

Postmarketing reports: Hypersensitivity, anaphylactic reaction, anaphylactoid reaction, anaphylactic shock, anaphylactoid shock


-Frequency not reported: Hypersensitivity reactions, anaphylactic/anaphylactoid reactions (resulting in shock and fatalities)[Ref]

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.[Ref]


Common (1% to 10%): Insomnia

Frequency not reported: Hallucination, anxiety, confusion, aggressive reaction (combative), depression, agitation

Postmarketing reports: Delirium[Ref]


Hypokalemia has been reported when high doses of piperacillin were administered to patients with liver disease and patients using cytotoxic therapy or diuretics.[Ref]

Uncommon (0.1% to 1%): Hypokalemia, decreased blood glucose

Frequency not reported: Hypoglycemia, electrolyte abnormalities (e.g., increased and decreased sodium, potassium, calcium), hyperglycemia, symptomatic hypoglycemia, thirst, anorexia, acidosis, dehydration, gout, hypernatremia, hyponatremia, hypophosphatemia, hypomagnesemia, fluid overload


-Frequency not reported: Electrolyte disturbances, acid-base disturbances[Ref]


Rare (0.01% to 0.1%): Epistaxis

Frequency not reported: Pleural effusion, pneumothorax, rhinitis, dyspnea, pharyngitis, pulmonary edema, bronchospasm, coughing, pulmonary embolism, hyperventilation, respiratory disorder, increased cough, atelectasis, hemoptysis, hypoxia

Postmarketing reports: Eosinophilic pneumonia[Ref]


Common (1% to 10%): Injection site reaction

Uncommon (0.1% to 1%): Injection site pain, injection site inflammation

Frequency not reported: Injection site edema, local reaction to procedure[Ref]


Uncommon (0.1% to 1%): Myalgia/muscle pain, arthralgia

Frequency not reported: Muscular weakness, prolonged muscle relaxation


-Frequency not reported: Prolonged muscle relaxation[Ref]


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[Ref]


Frequency not reported: Photophobia, diplopia, conjunctivitis[Ref]


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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.