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Pipracil Side Effects

Generic Name: piperacillin

Note: This document contains side effect information about piperacillin. Some of the dosage forms listed on this page may not apply to the brand name Pipracil.

Applies to piperacillin: injectable powder for injection


This drug was generally well tolerated. Local side effects (after IV or IM injection) were most common.[Ref]


Common (1% to 10%): Diarrhea, loose stools
Frequency not reported: Nausea, vomiting, bloody diarrhea, pseudomembranous colitis, Clostridium difficile-associated diarrhea[Ref]

The onset of pseudomembranous colitis symptoms has been reported during or after antimicrobial therapy.[Ref]


Common (1% to 10%): Rash, pruritus
Frequency not reported: Vesicular eruptions/vesiculation, erythema multiforme, urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome, drug reactions with eosinophilia and systemic symptoms (DRESS), petechial rash/purpura, exanthematous pustulosis, bullous dermatosis, erythema nodosum, exanthems, exfoliative dermatitis, Jarisch-Herxheimer reaction[Ref]

An increased incidence of rash has been reported in cystic fibrosis patients.

DRESS has been reported, particularly with piperacillin-tazobactam.

Petechial rash or purpura due to thrombocytopenia has been reported.[Ref]


Common (1% to 10%): Thrombophlebitis, injection site pain, injection site induration, injection site erythema
Frequency not reported: Ecchymosis, deep vein thrombosis, hematomas[Ref]

Thrombophlebitis was more likely when insufficiently diluted solution was injected into the vein.[Ref]


Common (1% to 10%): Drug fever
Frequency not reported: Fever, edema, fatigue, decreased serum potassium levels, superinfection (including candidiasis), hemorrhagic manifestations[Ref]

An increased incidence of fever has been reported in cystic fibrosis patients.

Patients with liver disease or those receiving cytotoxic therapy or diuretics have reported decreased serum potassium levels with high doses of this drug.[Ref]


Frequency not reported: Anaphylactic/anaphylactoid reactions (some leading to shock and fatalities)[Ref]


Frequency not reported: Agranulocytosis, hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, eosinophilia, bleeding disorders, positive Coombs tests, hemorrhage/bleeding, decreased prothrombin time, platelet dysfunction, prolonged bleeding times[Ref]

Risk factors for reversible leukopenia (neutropenia) included prolonged therapy with high doses or concomitant drugs that cause this effect.[Ref]

Nervous system

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

Frequency not reported: Headache, dizziness, seizures/convulsions, prolonged muscle relaxation, paralysis, neurotoxicity, encephalopathy, neuromuscular excitability[Ref]


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

Frequency not reported: Elevated serum creatinine, elevated BUN, interstitial nephritis, renal failure[Ref]


Frequency not reported: Elevated liver enzymes (LDH, AST, ALT), hyperbilirubinemia, hepatotoxicity, cholestatic hepatitis[Ref]


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


Frequency not reported: Epistaxis


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

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

7. 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

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

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

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

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

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

15. 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

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

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

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

20. 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

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

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

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

Some side effects of Pipracil may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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