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Zinacef Side Effects

Generic Name: cefuroxime

Note: This page contains side effects data for the generic drug cefuroxime. It is possible that some of the dosage forms included below may not apply to the brand name Zinacef.

For the Consumer

Applies to cefuroxime: oral powder for suspension, oral tablet

As well as its needed effects, cefuroxime (the active ingredient contained in Zinacef) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking cefuroxime, check with your doctor immediately:

More common:
  • Chills
  • diarrhea
  • fever
  • general feeling of illness or discomfort
  • headache
  • itching of the vagina or genital area
  • pain during sexual intercourse
  • rigidity
  • sweating
  • thick, white vaginal discharge with no odor or with a mild odor
Less common:
  • Black, tarry stools
  • chest pain
  • cough
  • loose stools
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • Back, leg, or stomach pains
  • bladder pain
  • bleeding gums
  • bloody or cloudy urine
  • body aches or pain
  • burning while urinating
  • dark urine
  • difficulty with breathing
  • ear congestion
  • fast, pounding, or irregular heartbeat or pulse
  • frequent urge to urinate
  • general body swelling
  • loss of appetite
  • loss of voice
  • lower back or side pain
  • nasal congestion
  • nausea or vomiting
  • nosebleeds
  • pain or tenderness around the eyes and cheekbones
  • pale skin
  • pink or red urine
  • sneezing
  • stuffy or runny nose
  • swelling of the joints
  • swollen glands
  • tightness of chest or wheezing
  • white or brownish vaginal discharge
  • white patches in the mouth or throat or on the tongue
  • white patches with diaper rash
  • yellowing of the eyes or skin
Incidence not known:
  • Blistering, peeling, or loosening of the skin
  • bloody, black, or tarry stools
  • clay-colored stools
  • cough or hoarseness
  • coughing up blood
  • decrease in urine output or decrease in urine-concentrating ability
  • feeling of discomfort
  • fever with or without chills
  • general feeling of tiredness or weakness
  • high fever
  • hives
  • increased menstrual flow or vaginal bleeding
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • paralysis
  • prolonged bleeding from cuts
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red or black, tarry stools
  • red or dark brown urine
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • seizures
  • swollen lymph glands
  • swollen or painful glands
  • unpleasant breath odor
  • upper right abdominal or stomach pain
  • vomiting of blood

Minor Side Effects

Some cefuroxime side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common:
  • Bad, unusual, or unpleasant (after) taste
  • change in taste
  • diaper rash
  • Abdominal or stomach cramps
  • acid or sour stomach
  • belching
  • bloated
  • difficulty with moving
  • excess air or gas in the stomach or intestines
  • flushing or redness of the skin
  • full feeling
  • gas in the stomach
  • heartburn
  • indigestion
  • irritability
  • irritation or soreness of the mouth
  • itching skin
  • muscle pain or stiffness
  • muscle spasm of the neck
  • passing gas
  • restlessness
  • sleepiness or unusual drowsiness
  • stomach discomfort, upset, or pain
  • swelling of the tongue
  • thirst
  • trouble sitting still
  • unusually warm skin
  • watering of the mouth and drooling
  • weight loss
Incidence not known:
  • Hives or welts
  • redness of the skin

For Healthcare Professionals

Applies to cefuroxime: injectable powder for injection, intravenous solution, oral powder for reconstitution, oral tablet


Cefuroxime (the active ingredient contained in Zinacef) is generally well-tolerated.[Ref]

Side effects may be more likely and more severe in patients with liver disease and/or renal dysfunction.[Ref]


Pseudomembranous colitis has been reported in patients treated with cephalosporins, including cefuroxime (the active ingredient contained in Zinacef) and may occur during or after treatment. If diarrhea occurs and it is unresponsive to discontinuation of the drug and/or standard therapy, pseudomembranous colitis should be considered.[Ref]

Gastrointestinal side effects have included nausea and vomiting (1% to 3%), diarrhea/loose stools (1% to 8.6%), abdominal pain, abdominal cramps, flatulence, indigestion, mouth ulcers, and anorexia, dyspepsia, excess salivation, and pseudomembranous colitis.[Ref]


Hepatic side effects have included transient elevations of AST (2% to 4%), ALT (1.6% to 4%), and LDH (1%), alkaline phosphatase (2%, IV route), elevated bilirubin, hepatitis, cholestasis, and jaundice.[Ref]

Nervous system

Nervous system side effects have included headache, sleepiness, dizziness, somnolence, lockjaw-type reaction (less than 1%), and seizures. Cephalosporin class antibiotics, including cefuroxime (the active ingredient contained in Zinacef) have been associated with seizures, especially in renally impaired patients.[Ref]


Hypersensitivity reactions have included anaphylaxis, angioedema, rash, pruritus, serum sickness-like reaction, urticaria, drug fever, interstitial nephritis, toxic epidermal necrolysis, and Stevens-Johnson syndrome. At least one case of Kounis syndrome type I variant has been reported.[Ref]

Rare cases of erythema multiforme and Stevens-Johnson syndrome have been reported. There is a 10% to 20% incidence of allergy to cefuroxime in patients allergic to penicillin.

A case of occupational contact dermatitis due to cephalosporin allergy has been reported in a nurse who prepared cephalosporin solutions for administration to patients. The dermatitis resolved after the nurse stopped preparing the solutions.

A 90-year-old man, with no history of coronary artery disease, diabetes mellitus, hypertension, or hyperlipidemia, was administered 750 mg cefuroxime axetil intramuscularly for urinary tract infection. About 10 minutes after the injection, the patient developed chest pain and pruritic skin rashes. Kounis syndrome type I variant was diagnosed secondary to cefuroxime axetil. Five days after stopping cefuroxime axetil, the patient's symptoms had resolved.[Ref]


Rare cases of eosinophilia and positive direct Coombs' tests have been reported without other evidence of hypersensitivity.

Immune hemolytic anemia has been reported in a pediatric patient.[Ref]

Hematologic side effects have included eosinophilia (1.1%), positive Coombs' test (less than 1%), decreased hemoglobin and hematocrit (10%, IV route), transient neutropenia (less than 1%), leukopenia (0.1%), hemolytic anemia, pancytopenia, increased prothrombin time, thrombocytopenia, and autoimmune granulocytopenia. Cephalosporin class antibiotics have been associated with aplastic anemia, hemorrhage, neutropenia, and agranulocytosis.[Ref]


Acute renal failure has been reported in a patient treated with cefuroxime (the active ingredient contained in Zinacef) Renal function improved after cefuroxime was stopped, and deteriorated upon rechallenge.[Ref]

Renal side effects have included renal dysfunction (less than 1%) and acute renal failure. Cephalosporin class antibiotics have been associated with toxic nephropathy, increased BUN, increased creatinine, and interstitial nephritis. Reversible fever, azotemia, pyuria, and eosinophilia are the hallmarks of cephalosporin-induced interstitial nephritis.[Ref]


Genitourinary side effects have included vaginitis, vaginal candidiasis, vaginal discharge, vaginal itch, vulvar itch, dysuria, urethral pain and/or bleeding, and kidney pain in less than 1% of patients, and urinary tract infection (less than 1% of pediatric patients). Cephalosporin class antibiotics have been associated with false positive tests for urinary glucose.[Ref]


Dermatologic side effects have included rash, hives, pruritus, urticaria, and erythema in less than 1% of patients, diaper rash (3.4% of pediatric patients), acute generalized exanthematous pustulosis, erythema multiforme, and toxic epidermal necrolysis.[Ref]


Metabolic side effects have included thirst (less than 1%).[Ref]


Other side effects have included chest pain or tightness, chills, viral illness, gastrointestinal infection, swollen tongue, candidiasis, and fever in less than 1% of patients. At least one case of disulfiram reaction has been reported with cefuroxime (the active ingredient contained in Zinacef) axetil. Complaints about taste were reported in 5% of pediatric patients, leading to discontinuation in 1.4%.

The Jarisch-Herxheimer reaction has been reported in 5.6% of Lyme Disease patients.[Ref]


Respiratory side effects have included shortness of breath (less than 1%), and sinusitis, cough, and upper respiratory infection in less than 1% of pediatric patients.[Ref]


Musculoskeletal side effects have included muscle cramps, muscle stiffness, and muscle spasm of the neck in less than 1% of patients, and joint swelling and arthralgia in less than 1% of pediatric patients.[Ref]


Cardiovascular side effects have included tachycardia (less than 1%).[Ref]


Local side effects have included thrombophlebitis with intravenous administration (1.7%).[Ref]


Immunologic side effects have included cutaneous vasculitis (postmarketing experience).[Ref]


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

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.