Benzathine Penicillin in Nigeria: One Registration in the Greenbook, and It Lapsed in June

We keep a dated copy of the public NAFDAC Greenbook, the register of medicines approved for sale in Nigeria, and we count things in it. This week we counted penicillins. Our copy, taken on 1 October 2026, holds 11,724 records. Forty-nine of them are penicillins. Thirty-seven of those are Active. Exactly one is benzathine benzylpenicillin, the long-acting injection that treats syphilis and keeps rheumatic fever from coming back, and its registration expired on 23 June 2026. It is marked Inactive.

Update, 1 October 2026: refreshed against the October copy of the register. Two penicillins lapsed since the August copy — Rocapen Injection (04-4034, Embassy), a fortified procaine penicillin, and Phenopen-V 250 mg (A11-0448, Daily-Need), an oral phenoxymethylpenicillin — so the Active count is now 37 of 49, and fortified procaine 17 of 20. The benzathine registration, A4-9168, is unchanged: still the only one, still Inactive.

That is the whole finding, and it is worth a post because of what the drug is.

Why this one injection matters

Benzathine benzylpenicillin is not an ordinary antibiotic. It is a depot formulation: one deep intramuscular injection releases penicillin slowly for weeks. That single property makes it the recommended treatment for syphilis at every stage, including in pregnancy, where it is the only treatment shown to prevent the infection passing to the baby. It is also the drug given every three to four weeks, for years, to people who have had rheumatic fever, to stop the recurrences that scar heart valves. Nigeria carries one of the world's larger burdens of rheumatic heart disease, and syphilis screening is part of routine antenatal care here.

The World Health Organization lists it as an essential medicine. It has also been in and out of global shortage for a decade: WHO surveyed a widespread shortage in the mid-2010s, and from 2023 the largest producers again could not meet demand, to the point that the United States allowed emergency importation of a French product. Few companies make it, the margins are thin, and the sterile manufacturing is hard. None of that is new. What is new to us is what the Nigerian register looks like right now.

The register, line by line

Here is the one record, as it stands in our copy:

Product: Bentarpen Injection, benzathine benzylpenicillin 2,400,000 IU, powder for intramuscular injection, packed 1 × 50 vials.
NAFDAC number: A4-9168. You can look it up on our NAFDAC checker, which reports it as found with its status, rather than pretending it never existed.
Applicant: Sterling Drugs Limited. Manufacturer: Inject Care Parenterals Pvt. Ltd, India.
Approved: 24 June 2021. Registration expired: 23 June 2026. Status in our copy: Inactive.

It is the only record in the register under the ATC code for benzathine benzylpenicillin, J01CE08. There is no second brand behind it and no newer registration ahead of it, at least not in the copy we hold.

The rest of the penicillin shelf is in reasonable shape. Fortified procaine penicillin, the procaine-plus-benzylpenicillin combination that is a Nigerian hospital staple, has 20 registrations, 17 of them Active. Plain benzylpenicillin sodium, sold as crystalline penicillin, has 11, with 9 Active. Oral phenoxymethylpenicillin has five. In other words the register is not short of penicillin injections. It is short of the one that lasts a month.

What "Inactive" does and does not mean

We want to be exact here, because a register status is easy to over-read in both directions.

It does not mean the product is fake. A lapsed registration is a paperwork state. Stock that was imported while the registration was current can still be legally on shelves, and its own expiry date, printed on the vial, is the date that governs whether it can be used. Renewals also sit in queues; a registration can be Inactive in the public register for months while the renewal is being processed. If Sterling Drugs, or anyone else, holds a current registration that our August copy does not show, we would like to hear it and we will say so. Our guide to what "not found" and "expired" actually mean walks through all of this.

It also does not mean the drug is unavailable to the health system. NAFDAC operates permit routes that let hospitals and public programmes bring in unregistered essential medicines for specific institutional use, and those imports never appear in the Greenbook, which lists products registered for general sale. Whether that is happening for benzathine penicillin is not something the public register can tell us.

What it does mean is this: as of our copy, there is no benzathine benzylpenicillin registered for general sale in Nigeria with a current status. A trader offering it by the carton today, and a buyer accepting it, are dealing in a product that cannot at this moment be verified as a currently registered medicine. That is a fact about the register, and the register is where verification starts.

The name trap

One more thing the register shows, and it will catch people. There is a product called Bicillin Injection registered in Nigeria, number 04-3787, Active until December 2028, made in China. It is not benzathine penicillin. It is fortified procaine penicillin: procaine benzylpenicillin 3,000,000 IU with benzylpenicillin sodium 1,000,000 IU. Outside Nigeria, "Bicillin L-A" is the best-known brand of benzathine penicillin, and anyone who learned the drug from an international guideline or a foreign supplier will read the Nigerian Bicillin as the same thing. It is not. A daily procaine injection and a once-a-month depot injection are different regimens for different situations, and that choice belongs to the prescriber, not the label. If you are buying or dispensing, read the active ingredient, not the brand.

What we are seeing on the buying side

Our evidence of demand is thin and we will not dress it up. In the past month, one enquiry reached us from the Federal Capital Territory asking for benzathine penicillin 2.4 MU by the carton, and another from Niger State asked for fortified procaine penicillin at wholesale. Two enquiries are not a trend. But the first of them is exactly the situation this post is about: a buyer looking, in the open market, for a product the register cannot currently vouch for, and a seller somewhere presumably able to supply it. Where that supply comes from, and under what registration, is the question a careful buyer should ask before the price.

If you prescribe, buy or sell it

Clinicians and programme managers: ask your supplier for the NAFDAC number on the pack and check its status, not just its existence. If the answer is A4-9168, you are looking at stock imported under a registration that has since lapsed, and the vial's own expiry date is your guide. If the answer is a number you have never seen, our guide to NAFDAC number formats says what its series should look like.
Wholesalers and market traders: do not list a lapsed or unregistered product as if it were current. If you hold genuine stock imported before June 2026, say so plainly, with the batch and expiry, and let the buyer decide. Our guide to buying medicines in bulk safely covers the paperwork to ask for.
Anyone who knows more than the register: if a renewal has gone through, or a second product has been registered since August, tell us. We refresh our copy monthly, we print the date on every result, and we will update this post the day the register changes.

We will re-count when the September copy lands.

This article reports the contents of our dated copy of the public NAFDAC Greenbook and is not medical advice. Treatment decisions belong to a qualified clinician. The authority on any registration is NAFDAC and the live Greenbook at greenbook.nafdac.gov.ng.