Medical Advisory: Bicillin® L-A Shortage and Use of Lentocilin® S 1200

Issued by: Dr. Angela Ma, MD, FRCPC, Associate Medical Officer of Health
Date: July 16, 2026

The national shortage of Bicillin® L-A (long-acting benzathine penicillin G), the recommended first-line treatment for syphilis, is expected to continue until at least February 2027. Health Canada has authorized the exceptional, temporary importation of Lentocilin® S 1200, a Portuguese-authorized product with the same active ingredient as Bicillin® L-A, as a replacement product.

What Health Care Providers Need to Know

• Public Health Agency of Canada (PHAC) recommends conserving supplies of Bicillin® L-A and Lentocilin® S 1200, as detailed below
• Patients requiring treatment with Lentocilin® S 1200 may be referred to Niagara Region Public Health’s Sexual Health Clinic

Product Differences Between Lentocilin® S 1200 and Bicillin®L-A

• Lentocilin® S 1200
  • Contains lidocaine and soy phospholipids.
    • Individuals with a soybean allergy may experience hypersensitivity reactions, including urticaria and anaphylaxis
  • Is supplied as a powder for injection and must be reconstituted using the co-packaged diluent containing 1.5% lidocaine hydrochloride, resulting in a final volume of 4 mL
• In contrast, Bicillin® L-A is supplied as a ready-to-use 2 mL suspension in a prefilled syringe and does not contain lidocaine
• The active ingredient, strength, and intramuscular route of administration are the same

Health Care Provider Action

During the shortage, health care providers should conserve supplies of Bicillin® L-A and Lentocilin®  S 1200, using alternative treatments for syphilis when appropriate, as indicated by guidance from PHAC.

Prioritize Bicillin® L-A or Lentocilin® S 1200 for:

• Pregnant individuals
• Non-pregnant individuals with syphilis when adherence to treatment or follow up is uncertain
• Sexual contacts of a person diagnosed with infectious syphilis within the 90 days before diagnosis who are:
  • Pregnant, or
  • Non-pregnant and unlikely to reliably adhere to treatment or follow up

Use oral doxycycline for:

• Non-pregnant individuals when adherence to treatment and follow-up is expected
• Recent sexual contacts of individuals with infectious syphilis while assessment and test results are pending

Office Staff Action

• Order syphilis medications online, or call 905-688-3817 or 1-800-263-5757, Monday to Friday, 8:30 a.m. – 4:30 p.m. and ask to talk to a nurse

More Information

• Nurses are available to provide consultation regarding positive syphilis test results, treatment recommendations, and case management
• Patients requiring treatment with Lentocilin® S 1200 may be referred to the Sexual Health Clinic
• For consultation or to discuss a referral, please contact the Sexual Health Program at 905-688-8248 ext. 7723