Amoxicillin Side Effects by Body System
Hypersensitivity
Hypersensitivity reactions are more likely in patients with a history of allergy, asthma, hay fever, or urticaria.
Hypersensitivity reactions have been reported in up to 10% of patients and have included anaphylaxis, urticarial rash, erythematous maculopapular rash, serum sickness-like reactions, erythema multiforme, urticaria, edema, hypotension, fever, eosinophilia, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis, angioedema, Stevens-Johnson syndrome, and dyspnea.
Dermatologic
Dermatologic side effects have included rash, fixed drug eruption, and bullous pemphigoid. Erythematous maculopapular rashes occur frequently in patients with infectious mononucleosis who take amoxicillin; these may be due to hypersensitivity.
Three out of four patients with infectious mononucleosis and an amoxicillin-associated rash displayed hypersensitivity to amoxicillin and ampicillin by skin tests and lymphocyte transformation tests. Two of these patients had side-chain-specific sensitization.
Gastrointestinal
Gastrointestinal side effects have included diarrhea, nausea, vomiting, generalized abdominal cramps, colitis, hemorrhagic colitis, pseudomembranous colitis (Clostridium difficile associated diarrhea), and black hairy tongue. Abdominal pain has also been reported.
Amoxicillin has been associated with hemorrhagic, sometimes inflammatory colitis, which typically affects the ascending colon. Clostridium difficile pseudomembranous colitis has been reported.
Renal
Renal side effects have included crystalluria and acute interstitial nephritis, often associated with fever, rash and eosinophilia.
Hematologic
A patient undergoing dental extraction and receiving warfarin anticoagulation therapy had prolonged bleeding times (PT and INR), and decreased hemoglobin and hematocrit. The bleeding was felt due to vitamin K deficiency as a result of depletion of intrinsic vitamin K-producing gut flora from use of amoxicillin for prophylaxis of subacute bacterial endocarditis.
Hematologic side effects associated with penicillins have included thrombocytopenia, anemia, leukopenia, thrombocytopenic purpura, agranulocytosis, hemolytic anemia, eosinophilia, and granulocytopenia. These effects are usually reversible and are believed to be due to hypersensitivity reactions.
Immunologic
Immunologic side effects have included mucocutaneous candidiasis and vulvovaginal mycotic infection.
Nervous system
Nervous system side effects have rarely included headache, somnolence, dizziness, reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral changes, and aseptic meningitis. Rare cases of psychosis associated with amoxicillin therapy have been reported but may have been due to underlying infection or concomitant medication.
Hepatic
Hepatic side effects have included moderate elevations of AST (SGOT) and/or ALT (SGPT) levels, cholestatic jaundice, hepatic cholestasis, and acute cytolytic hepatitis.
Other
Other side effects have rarely included brown, yellow, or gray tooth discoloration, primarily in pediatric patients. Brushing or dental cleaning reduced or eliminated the discoloration in most cases.
Respiratory
Respiratory side effects have included cough and rhinorrhea.
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