Bicillin CR
Bicillin CR is a medication that contains two types of penicillin antibiotics. It's used to treat moderate-to-severe infections caused by streptococcus bacteria in people of all ages. These infections can happen in the throat (like strep throat), nose, lungs, skin, or soft tissues. Bicillin CR is given by a healthcare professional as an injection in your muscle. Bicillin CR can cause pain at the injection site as a side effect.
What is Bicillin CR?
What is Bicillin CR used for?
- Strep throat
- Upper respiratory tract infection caused by Streptococcus
- Pneumonia caused by certain Streptococcus bacteria
- Ear infection caused by certain Streptococcus bacteria
- Skin and soft tissue infection caused by Streptococcus
- Scarlet fever
- Erysipelas (infection of the outer layer of the skin)
How Bicillin CR works
Bicillin CR is made of two types of penicillin antibiotics. It contains penicillin G benzathine and penicillin G procaine. These antibiotics kill bacteria by blocking them from making their protective covering.
After it's injected into the muscle, Bicillin CR gets released slowly into the body. This allows you to get injections less often or even as a single dose.
Drug facts
Side effects of Bicillin CR
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Pain where the medication is injected
- Inflammation or swelling where the medication is injected
Less Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Shortness of breath
- Sweating
- Fainting
- Headache
- Nervousness
- Tremors
- Dizziness
- Sleepiness
- Numbness or tingling
- Itchiness
- Rash
- Changes in vision
- Low blood pressure
- Fast heart rate or a racing heart
Bicillin CR serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe allergic reaction: hives, trouble breathing, swelling in your face and neck, tight feeling in the throat
- Severe skin reaction: new painful rash, rash with fever, blisters, sores inside your mouth, peeling skin
- Blood problem (methemoglobinemia): pale, gray, or blue-colored skin; headache; lightheadedness; fast heartbeat; shortness of breath; tiredness
- Severe infectious diarrhea: very watery or loose stools, foul-smelling diarrhea, very frequent bowel movements, stomach cramps, fever
The following Bicillin CR side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Stop taking this medicine and get emergency help immediately if any of the following effects occur:
Less common
Fast or irregular breathing
joint pain
lightheadedness or fainting (sudden)
puffiness or swelling around the face
red, scaly skin
shortness of breath
Check with your doctor immediately if any of the following side effects occur:
Rare
Abdominal or stomach cramps and pain (severe)
abdominal tenderness
convulsions (seizures)
decreased amount of urine
diarrhea (watery and severe), which may also be bloody
mental depression
pain at place of injection
sore throat and fever
unusual bleeding or bruising
yellow eyes or skin
Rare
For penicillin G procaine only
Agitation or combativeness
confusion
fear of impending death
feeling, hearing, or seeing things that are not real
Some side effects 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:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Bicillin CR
Pros
- Good at fighting severe infections caused by strep bacteria
- Works for many days in the body, so injections are given less often or even just once
Cons
- Must be given as a deep muscle injection, generally in the buttock or thigh (for some children)
- Not a safe option for people with a penicillin allergy
- Not used for treating syphilis, gonorrhea, or yaws, bejel, and pinta infections
Pharmacist tips for Bicillin CR
- Bicillin CR can only treat infections caused by bacteria. It doesn't work to treat viral infections (like the common cold) or fungal infections. Your prescriber will make sure this medication is right for the kind of infection you have.
- Bicillin CR is an injection given by a trained healthcare professional at a medical office. How many injections you need depends on your infection and the medical office. You might need just one injection or you might need more than one injection that are given 1 or 2 days apart.
- Mark your calendar so you remember when to get your Bicillin CR injection(s). If you need more than one injection, it's important not to miss any to finish the whole treatment. You might feel better early on, but missing doses or not finishing treatment can cause the antibiotic to work less well. It can also cause your infection to come back or be harder to treat.
- Bicillin CR is injected deep into the muscle. For adults, it's injected into the top outer area of the buttock. For babies and young children, the healthcare professional will probably inject into the outer middle area of the thigh.
- You might have diarrhea as a side effect from Bicillin CR. If you do, be sure to drink plenty of fluids to stay hydrated. But call your prescriber if the diarrhea doesn't go away, gets worse, becomes watery, or starts to smell bad. Also call them if the diarrhea happens with stomach cramps or a fever. They can be signs of serious infectious diarrhea that needs to get treated right away.
Common questions about Bicillin CR
After Bicillin CR gets injected into the muscle, the medication gets absorbed into the body slowly. It stays in your body for about 7 days. That's why some infections only need a few injections, or sometimes just one, to treat it. Ask your prescriber if you have questions about how long Bicillin CR lasts.
Don't confuse Bicillin CR with Bicillin L-A. They're not the same medication. Both are penicillin antibiotics that are injected into the muscle by a healthcare professional (HCP). But Bicillin CR has two types of penicillins in it, while Bicillin L-A has only one. Also, Bicillin L-A can be used to treat syphilis but Bicillin CR isn't approved for that. The doses for the two medications are also different. Talk to your HCP to learn more. They'll make sure you get the right antibiotic for your infection.
According to the manufacturer, no. Bicillin CR isn't FDA approved for treating syphilis or gonorrhea. Bicillin CR is not the same as Bicillin L-A, which can be used for syphilis. If you have a sexually transmitted infection (STI), talk to a healthcare professional about the right treatment for you.
Bicillin CR is the brand name for a type of penicillin antibiotic. It's a combination of penicillin G benzathine and penicillin G procaine. This medication is given as an injection into the muscle. There are other types of penicillins used to treat different bacterial infections. These include penicillin V potassium (Penicillin VK) and penicillin G potassium (Pfizerpen). Talk to a healthcare professional if you have more questions.
A healthcare professional will give you the Bicillin CR injection deep into your muscle. For adults, it's usually the top, outer part of the buttock. And for newborns, infants, and young children, it's usually given into the middle of the thigh. These spots are safest because serious problems can happen if the medication is given too close to a vein, artery, or nerve by mistake. Bicillin CR shouldn't be given in the upper arm muscle. It should also never be injected directly into a blood vessel.
Pain is a normal side effect from the Bicillin CR injection. But it usually hurts less with Bicillin CR than with Bicillin L-A (a similar penicillin antibiotic also given as an injection into the muscle). This is because Bicillin CR contains penicillin G procaine. Procaine is related to local anesthetics that numb areas to reduce pain. Before giving the Bicillin CR injection, the healthcare professional (HCP) will make sure the medication is at room temperature. This can help the injection hurt less. If the pain is very strong or unbearable, tell the HCP so they can check what's going on and help you feel better.
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Risks and warnings for Bicillin CR
Bicillin CR can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious or life-threatening problems when given incorrectly
The healthcare professional should always give the Bicillin CR injection deep into a large muscle. The safest place to inject it is the top, outer part of the buttock or thigh.
Bicillin CR should never be given into or near a vein or artery. It also shouldn't be mixed with other medications that go into the vein. If Bicillin CR is given into a vein by mistake, it might cause serious and fatal heart and lung problems. Also, giving the medication into or near an artery can cause serious damage and swelling to the area.
In addition, don't inject Bicillin CR into or near a nerve. This could lead to nerve damage, including permanent paralysis. Tell your care team if you have severe pain or swelling after getting the Bicillin CR injection.
Severe allergic reaction (anaphylaxis)
- Risk factors: Allergy to penicillin or cephalosporin antibiotics | History of multiple allergies | Sensitivity to procaine | History of asthma
Even though it's rare, Bicillin CR can cause a serious and sometimes life-threatening allergic reaction called anaphylaxis. Get medical help right away if you have hives, swelling in your face or neck, trouble breathing, or a tight feeling in the throat. These are signs of a serious allergic reaction that needs treatment as soon as possible.
Tell your prescriber about all your allergies to make sure Bicillin CR is safe for you. It might not be the safest option if you're allergic to penicillin or have many allergies. Allergic reactions might also happen if you've had a serious reaction to cephalosporin antibiotics like cephalexin.
Severe skin reaction
Although it's rare, some people taking penicillin antibiotics like Bicillin CR have had serious skin reactions. They can sometimes be life-threatening. Get medical help right away if you get a new painful rash, a rash with a fever, blisters or sores, or peeling skin.
Diarrhea from Clostridioides difficile infection
- Risk factors: Taking Bicillin CR for a long time | Recent use of other antibiotics
Antibiotics like Bicillin CR change the normal balance of bacteria in the gut. This raises the chance of an infection caused by an overgrowth of bacteria called Clostridioides difficile (C. diff) in the gut. C. diff infection can cause diarrhea that's sometimes very serious.
It's important to know the difference between regular diarrhea from antibiotics and C. diff diarrhea, which is a serious medical emergency. Watch for signs like a fast heart rate, fever, foul-smelling diarrhea, and very frequent bowel movements. Get medical help right away if you notice these symptoms so you can get treated. Note that C. diff diarrhea can even show up a few months after you finish taking Bicillin CR.
Methemoglobinemia (a type of blood problem)
- Risk factors: Genetic condition called glucose-6-phosphate dehydrogenase deficiency | History of methemoglobinemia | History of lung or heart conditions | Age 6 months or younger | Exposure to oxidizing agents like hydrogen peroxide or nitric acid | Taking other medications that can cause methemoglobinemia
One of the ingredients in Bicillin CR is penicillin G procaine, which is related to the local anesthetic procaine. Local anesthetics like procaine have been linked to rare cases of methemoglobinemia. It's a serious blood problem that causes too little oxygen to get to parts of your body. If it's not treated quickly, it can be dangerous.
Tell your prescriber and pharmacist about all the medications you take before getting a Bicillin CR injection. Some medications can raise your risk of methemoglobinemia. Examples are nitroglycerin (Nitrostat), sulfasalazine (Azulfidine), and metoclopramide (Reglan).
Know the signs and symptoms of methemoglobinemia. They include pale, gray, or blue-colored skin; headache; trouble breathing; lightheadedness; and tiredness. These symptoms can happen right after the Bicillin CR injection or hours later. If you notice any of these symptoms, get medical help right away.
Bicillin CR dosage
Package| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10 syringes of 1.2 million units per 2ml | 1 package | $2,340.19 | $2,340.19 |
| 10 pediatric syringes of 1.2 million units per 2ml | 1 package | $2,340.19 | $2,340.19 |
Typical dosage for Bicillin CR
This medication is given as an injection into the muscle, usually in the buttock. For babies and young children, the thigh muscle might be a better spot. It's given by a healthcare professional (HCP) at a medical office.
-
Each injection contains 600,000 units of penicillin G benzathine and 600,000 units of penicillin G procaine.
-
Strep throat, upper respiratory tract infection, skin or soft tissue infection, scarlet fever, or erysipelas: Most times, the HCP will give the dose using multiple injection sites during the same visit. Another option is to split the dose in half and give it to you on day 1 and day 3.
- Adults and children over 60 lbs: The typical dose is 2,400,000 units injected into the muscle once as a single dose.
- Children weighing 30 lbs to 60 lbs: The typical dose is 900,000 to 1,200,000 units injected into the muscle once as a single dose.
- Children under 30 lbs: The typical dose is 600,000 units injected into the muscle once as a single dose.
-
Pneumonia or ear infection
- Adults: The typical dose is 1,200,000 units injected into the muscle, repeated every 2 or 3 days until your temperature is normal for 48 hours (2 days).
- Children: The typical dose is 600,000 units injected into the muscle, repeated every 2 or 3 days until your child's temperature becomes normal for 48 hours (2 days).
Bicillin C-R 900/300 (for children only)
-
Each injection contains 900,000 units of penicillin G benzathine and 300,000 units of penicillin G procaine.
-
Strep throat, upper respiratory tract infection, skin or soft tissue infection, scarlet fever, or erysipelas: The typical dose is 1 injection into the muscle once as a single dose.
-
Pneumonia or ear infection: The typical dose is 1 injection into the muscle, repeated every 2 or 3 days until your child's temperature is normal for 48 hours (2 days).
Interactions between Bicillin CR and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Amifampridine
- Amiodarone
- Avapritinib
- Axitinib
- Benzhydrocodone
- Brigatinib
- Buprenorphine
- Bupropion
- Capmatinib
- Chlortetracycline
- Cholera Vaccine, Live
- Clarithromycin
- Codeine
- Cyclosporine
- Daclatasvir
- Darunavir
- Deflazacort
- Demeclocycline
- Desogestrel
- Dienogest
- Dihydrocodeine
- Donepezil
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Doxycycline
- Dronedarone
- Drospirenone
- Elbasvir
- Encorafenib
- Entrectinib
- Eravacycline
- Erdafitinib
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Fedratinib
- Fentanyl
- Gestodene
- Glasdegib
- Grazoprevir
- Hemin
- Hydrocodone
- Lefamulin
- Lemborexant
- Levonorgestrel
- Lorlatinib
- Lumateperone
- Lurbinectedin
- Lymecycline
- Meclocycline
- Medroxyprogesterone
- Meperidine
- Mestranol
- Methacycline
- Methadone
- Methotrexate
- Minocycline
- Mycophenolate Mofetil
- Neratinib
- Nifedipine
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Olaparib
- Omadacycline
- Oxycodone
- Oxytetracycline
- Pemigatinib
- Pentazocine
- Perampanel
- Piperaquine
- Pretomanid
- Rimegepant
- Rolitetracycline
- Sarecycline
- Segesterone
- Selpercatinib
- Selumetinib
- Simeprevir
- Sufentanil
- Sulfasalazine
- Tacrolimus
- Tazemetostat
- Tetracycline
- Tigecycline
- Tramadol
- Ubrogepant
- Ulipristal
- Vancomycin
- Vecuronium
- Velpatasvir
- Venetoclax
- Venlafaxine
- Voclosporin
- Voxelotor
- Voxilaprevir
- Warfarin
- Zanubrutinib
How much does Bicillin CR cost?
$2,340.19
Bicillin CR contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Bicillin CR will not be safe for you to take.
- Allergy to any penicillin antibiotic
What are alternatives to Bicillin CR?
Bicillin CR images
