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Zinacef Side Effects

Generic name: cefuroxime

Medically reviewed by Last updated on Oct 20, 2023.

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

Applies to cefuroxime: oral powder for suspension, oral tablet. Other dosage forms:

Serious side effects of Zinacef

Along with its needed effects, cefuroxime (the active ingredient contained in Zinacef) 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 immediately if any of the following side effects occur while taking cefuroxime:

More common

Less common


Incidence not known

Other side effects of Zinacef

Some side effects of cefuroxime 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:

Less common


Incidence not known

For Healthcare Professionals

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


This drug was generally well tolerated. The side effects most commonly reported with the parenteral formulation have included neutropenia, eosinophilia, transient liver enzyme/bilirubin elevations, and injection site reactions. The side effects most commonly reported with the oral formulations have included Candida overgrowth, eosinophilia, headache, dizziness, gastrointestinal disturbances, and transient liver enzyme elevations.[Ref]


Common (1% to 10%): Diarrhea/loose stools, nausea/vomiting, abdominal pain, nausea

Uncommon (0.1% to 1%): Abdominal cramps, flatulence, indigestion, mouth ulcers, swollen tongue, dyspepsia, gastrointestinal (GI) infection, ptyalism/excess salivation, GI disturbance, vomiting

Frequency not reported: Abdominal discomfort, dry mouth, Clostridioides difficile-associated diarrhea

Postmarketing reports: GI disturbances (including diarrhea, nausea, vomiting, abdominal pain), pseudomembranous colitis


-Frequency not reported: Vomiting, abdominal pain, colitis[Ref]

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


Common (1% to 10%): Transient increase in AST, transient increase in ALT, transient increase in liver enzyme levels

Uncommon (0.1% to 1%): Transient increase in bilirubin

Postmarketing reports: Hepatic dysfunction, hepatitis, cholestasis, jaundice (mainly cholestatic)


-Frequency not reported: Hepatic dysfunction (including cholestasis)[Ref]

Nervous system

Common (1% to 10%): Headache, dizziness

Uncommon (0.1% to 1%): Sleepiness, somnolence, hyperactivity

Postmarketing reports: Seizures, encephalopathy[Ref]

Cephalosporin-class antibiotics (including this drug) have been associated with seizures, especially in patients with renal dysfunction when the dose was not reduced.[Ref]


Common (1% to 10%): Delayed hypersensitivity reaction

Uncommon (0.1% to 1%): Hypersensitivity reactions (including rash, pruritus, urticaria)

Rare (0.01% to 0.1%): Severe hypersensitivity reactions

Frequency not reported: Serum sickness

Postmarketing reports: Anaphylaxis, serum sickness-like reaction[Ref]

Delayed hypersensitivity reaction to this drug has been reported in 2.9% of patients with history of delayed hypersensitivity to penicillin (but not a cephalosporin).

Rare cases of severe hypersensitivity reactions (including erythema multiforme, toxic epidermal necrolysis [exanthematic necrolysis], drug fever, serum sickness-like reaction, anaphylaxis, Stevens-Johnson syndrome) have been reported.[Ref]


Common (1% to 10%): Eosinophilia, decreased hemoglobin and hematocrit, neutropenia, decreased hemoglobin concentration

Uncommon (0.1% to 1%): Positive Coombs test, leukopenia, thrombocytopenia

Frequency not reported: Autoimmune granulocytopenia, increased coagulation time

Postmarketing reports: Hemolytic anemia, pancytopenia, increased prothrombin time


-Frequency not reported: Aplastic anemia, hemolytic anemia, hemorrhage, prolonged prothrombin time, pancytopenia, agranulocytosis, positive Coombs test[Ref]

Profound leukopenia has sometimes been profound with oral therapy.[Ref]


Acute renal failure has been reported. Renal function improved after this drug was stopped, and deteriorated upon rechallenge.[Ref]

Frequency not reported: Increased BUN, increased creatinine, decreased CrCl, acute renal failure

Postmarketing reports: Renal dysfunction, interstitial nephritis (including reversible fever, azotemia, pyuria, eosinophilia)


-Frequency not reported: Toxic nephropathy[Ref]


Common (1% to 10%): Vaginitis

Uncommon (0.1% to 1%): Vulvar itch, dysuria, vaginal candidiasis, vaginal discharge, vaginal itch, urethral pain/bleeding, kidney pain, urinary tract infection, vaginal irritation


-Frequency not reported: Vaginitis (including vaginal candidiasis)[Ref]


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.[Ref]

Common (1% to 10%): Diaper/nappy rash

Uncommon (0.1% to 1%): Rash, urticaria/hives, pruritus, erythema

Rare (0.01% to 0.1%): Erythema multiforme, toxic epidermal necrolysis (exanthematic necrolysis), Stevens-Johnson syndrome

Frequency not reported: Acute generalized exanthematous pustulosis

Postmarketing reports: Angioedema/angioneurotic edema, urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, cutaneous vasculitis

Beta-lactam antibiotics:

-Frequency not reported: Severe cutaneous adverse reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms [DRESS], acute generalized exanthematous pustulosis)[Ref]


Uncommon (0.1% to 1%): Anorexia


-Frequency not reported: Urine glucose false positive[Ref]


Common (1% to 10%): Transient increase in LDH, transient increase in alkaline phosphatase, Candida overgrowth, dislike of taste

Uncommon (0.1% to 1%): Chest pain/tightness, chills, thirst, viral illness, candidiasis, fever

Rare (0.01% to 0.1%): Drug fever

Frequency not reported: C difficile overgrowth, disulfiram reaction[Ref]


Uncommon (0.1% to 1%): Shortness of breath, sinusitis, cough, upper respiratory infection[Ref]


Uncommon (0.1% to 1%): Muscle cramps, muscle stiffness, muscle spasm of the neck, lockjaw-type reaction, joint swelling, arthralgia[Ref]


Uncommon (0.1% to 1%): Tachycardia

Frequency not reported: Kounis syndrome type I variant

Postmarketing reports: Acute myocardial ischemia (with or without myocardial infarction)[Ref]

A 90-year-old man, with no history of coronary artery disease, diabetes mellitus, hypertension, or hyperlipidemia, was administered 750 mg cefuroxime axetil IM 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 the drug. Five days after stopping the drug, the patient's symptoms had resolved.

Acute myocardial ischemia (with or without myocardial infarction) has occurred as part of an allergic reaction.[Ref]


Common (1% to 10%): Injection site reactions (including pain, thrombophlebitis), thrombophlebitis with IV administration, phlebitis, transient pain at injection site

Frequency not reported: Pain at IM injection site[Ref]


Common (1% to 10%): Jarisch-Herxheimer reaction[Ref]


Uncommon (0.1% to 1%): Irritable behavior


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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.