A synthetic antimicrobial drug, C6H9N3O3, used in the treatment of vaginal trichomoniasis, anaerobic bacterial infections, and intestinal amebiasis.
[ME(THYL) + -tron- (alteration of NITRO-) + (IM)IDAZOLE.]
metronidazole
Dictionary:
me·tro·ni·da·zole (mĕt'rə-nī'də-zōl')  |
n.
| 5min Related Video: metronidazole |
| Dental Dictionary: metronidazole |
n
A generic synthetic antibacterial compound available for both oral and intravenous use. Metronidazole is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. In dentistry, metronidazole is used in the treatment of HIV, gingivitis, and HIV periodontitis.
| Drug Info: Metronidazole |
Brand names: Flagyl®MetroCream®MetroGel®Metrolotion®Metron™Noritate™Nydamax®Rozex®Vandazole™
Chemical formula:
- Drug Forms:
- Metronidazole extended-release tablets (below)
- Metronidazole injection
- Metronidazole vaginal gel
- Metronidazole Oral tablet, extended-release
- Metronidazole Oral capsule
- Metronidazole Oral tablet
- Metronidazole Topical cream
- Butylparaben, Cetyl Alcohol, Methylparaben, Propylene Glycol, Propylparaben, Sodium Lauryl Sulfate, Stearyl Alcohol, Water Topical emulsion, Metronidazole Topical gel
- Metronidazole Solution for injection
- Metronidazole Topical gel
- Metronidazole Topical lotion
- Metronidazole Vaginal gel
- Español:
- Tabletas de liberación prolongada de metronidazol
- Inyección de metronidazol
- Gel vaginal de metronidazol
- Metronidazol, Tableta oral de liberación prolongada
- Metronidazol, Cápsula oral
- Metronidazol, Tableta oral
- Metronidazol, Crema tópica
- Metronidazol gel tópico, Emulsión tópica no esteroidea
- Metronidazol, Solución para inyección
- Metronidazol, Gel tópico
- Metronidazol, Loción tópica
- Metronidazol, Gel vaginal
Metronidazole extended-release tablets
What are metronidazole extended-release tablets?
METRONIDAZOLE (Flagyl® ER) kills or prevents the growth of certain bacteria and protozoa (single cell organisms). Metronidazole extended-release tablets are used to treat an infection of the vagina called bacterial vaginosis. Metronidazole is also used to treat other types of infections. Generic extended-release tablets of metronidazole are available.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
• if you drink alcoholic beverages
• anemia or other blood disorders
• liver disease
• disease of the nervous system
• seizures (convulsions)
• other chronic illness
• an unusual or allergic reaction to metronidazole, or other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding
How should I take this medicine?
Take metronidazole tablets by mouth. Follow the directions on the prescription label. Swallow tablets whole with a full glass of water. Take this medicine on an empty stomach 1 hour before or 2 hours after meals or food. Do not take your medicine more often than directed. Finish the full course prescribed by your prescriber or health care professional even if you think your condition is better. Do not stop taking except on your prescriber's advice.
Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.
What drug(s) may interact with metronidazole?
• alcohol or alcohol-containing beverages or medicines
• amprenavir
• barbiturate medicines for inducing sleep or treating seizures (convulsions)
• carbamazepine
• cimetidine
• disulfiram
• fluorouracil
• lithium
• methadone
• phenytoin
• ramelteon
• sirolimus
• tacrolimus
• warfarin
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
What should I watch for while taking metronidazole?
Tell your prescriber or health care professional if your symptoms do not improve in 2 or 3 days.
If you are taking this medicine for a long time you must visit your prescriber or health care professional for regular blood checks.
Avoid alcoholic drinks while you are taking metronidazole and for three days afterwards. Alcohol may make you feel dizzy, sick, or flushed. Drinking alcohol while you are taking metronidazole may also give you headaches or stomach pains.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how metronidazole affects you. To reduce the risk of dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient.
Your mouth may get dry. Chewing sugarless gum, sucking hard candy, and drinking plenty of water will help.
If you are being treated for an infection of your sex organs, your sexual partner may also need treatment. You can use a condom to stop reinfection of you or your sexual partner.
If you are going to have surgery, tell your prescriber or health care professional that you are using metronidazole.
What side effects may I notice from taking metronidazole?
Side effects that you should report to your prescriber or health care professional as soon as possible:
Rare or uncommon:
• clumsiness, dizziness, or unsteadiness
• fever or chills, sore throat
• numbness, tingling, pain or weakness in the hands or feet
• seizures (convulsions)
• skin rash, itching
• vomiting or severe stomach pain
More common:
• unusual tiredness or weakness
• irritation or discharge from the vagina
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• dark brown or reddish urine
• diarrhea
• dry mouth
• food tasting unusual or like metal
• headache
• loss of appetite
• nausea
• mild stomach pain or cramps
Where can I keep my medicine?
Keep out of the reach of children in a container that small children cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date.
Last updated: 7/1/2002
Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.
| Veterinary Dictionary: metronidazole |
An antimicrobial compound effective against protozoa and anaerobic bacteria. Commonly used to treat trichomoniasis, amebiasis, giardiasis and balantidiasis.
| Wikipedia: Metronidazole |
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Metronidazole
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| Systematic (IUPAC) name | |
| 2-(2- methyl- 5-nitro- 1H- imidazol- 1-yl) ethanol | |
| Identifiers | |
| CAS number | 443-48-1 |
| ATC code | A01AB17 , D06, G01, J01, P01, QP51 |
| PubChem | 4173 |
| DrugBank | APRD00631 |
| ChemSpider | 4029 |
| Chemical data | |
| Formula | C6H9N3O3 |
| Mol. mass | 171.15 g/mol |
| Pharmacokinetic data | |
| Bioavailability | 100% (oral) 59–94% (rectal) |
| Metabolism | Hepatic |
| Half life | 6–7 hours |
| Excretion | Renal (60-80%), biliary (6–15%) |
| Therapeutic considerations | |
| Pregnancy cat. |
B2 (Au) |
| Legal status | |
| Routes | Oral, topical, rectal, IV, vaginal |
 (what is this?) (verify) |
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Metronidazole (INN) (pronounced /mɛtrəˈnaɪdəzoʊl/) is a nitroimidazole anti-infective medication used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. It is marketed by Pfizer under the trade name Flagyl in the US, while Sanofi-Aventis markets metronidazole globally under the same tradename, Flagyl, and also by various generic manufacturers, who sell it at a lower price.
Metronidazole is also used as a gel preparation in the treatment of the dermatological conditions such as rosacea (Rozex and MetroGel by Galderma) and fungating tumours (Anabact, Cambridge Healthcare Supplies).
Contents |
Treatment
Metronidazole, taken up by diffusion, is selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up by anaerobes, it is non-enzymatically reduced because of lowered ferredoxin, which is produced by the action of pyruvate:ferredoxin oxido-reductase. This reduction causes the production of toxic products to anaerobic cells, and allows for selective accumulation in anaerobes.
The metronidazole metabolites are taken up into bacterial DNA, and form unstable molecules. This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic bacteria.[1]
Indications
Systemic metronidazole is indicated for the treatment of:
Bacterial
- Bacterial vaginosis, commonly associated with overgrowth of Gardnerella species and coinfective anaerobes (Mobiluncus, Bacteroides), in symptomatic patients
- Pelvic inflammatory disease in conjunction with other antibiotics such as ofloxacin, levofloxacin, or ceftriaxone
- Anaerobic bacterial infections such as Bacteroides fragilis, spp, Fusobacterium spp, Clostridium spp, Peptostreptococcus spp, Prevotella spp, or any other anaerobes in intra-abdominal abscess, peritonitis, empyema, pneumonia, aspiration pneumonia, lung abscess, diabetic foot ulcer, meningitis and brain abscess, bone and joint infections, septicemia, endometritis, tubo-ovarian abscess, or endocarditis
- Pseudomembranous colitis due to Clostridium difficile
- Helicobacter pylori eradication therapy, as part of a multi-drug regimen in peptic ulcer disease
Protozoal
- Vaginitis due to Trichomonas vaginalis infection[2] in both symptomatic patients as well as their asymptomatic sexual contacts - always consult the GP and contact all previous partners
- Protozoal infections due to Entamoeba histolytica (Amoebic dysentery or Hepatic abscesses), and Giardia lamblia (Giardiasis) should be treated alone or in conjunction with iodoquinol or diloxanide furoate
- With amphotericin B and certain other drugs, it is used as an adjunct in the attempted treatment of primary amoebic meningoencephalitis caused by Naegleria fowleri infection of the bowels
Nonspecific
- Prophylaxis for those undergoing potentially contaminated colorectal surgery or appendectomies and may be combined with neomycin
- Acute gingivitis and other dental infections (TGA approved, non-Food and Drug Administration (FDA) approved)
- Crohn's disease with colonic or perianal involvement (non-FDA approved)- believed to be more effective in combination with ciprofloxacin
- Topical metronidazole is indicated for the treatment of rosacea, and in the treatment of malodorous fungating wounds.[3]
Prevention of preterm births
Latest paper studying Metronidazole found "Metronidazole therapy before 32 weeks was associated with an increased risk of preterm birth", possibly as a result of "changes in the vaginal flora... seen with vaginal clindamycin or oral metronidazole therapy." [4]
Metronidazole has also been used in women to prevent preterm birth associated with bacterial vaginosis, amongst other risk factors including the presence of cervicovaginal fetal fibronectin (fFN). A randomised controlled trial demonstrated that metronidazole was ineffective in preventing preterm delivery in high-risk pregnant women and, conversely, the incidence of preterm delivery was actually higher in women treated with metronidazole.[5].
Lamont has argued that Metronidazole is not the right antibiotic to administer in these circumstances and was often administered too late to be of use. Clindamycin administered early in the second trimester to women who test positive for bacterial vaginosis seems to be more effective.[6]
Adverse effects
Common adverse drug reactions (≥1% of patients) associated with systemic metronidazole therapy include: nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine, and/or paraesthesia.[3]
High doses and/or long-term systemic treatment with metronidazole is associated with the development of black hairy tongue, leukopenia, neutropenia, increased risk of peripheral neuropathy and/or CNS toxicity.[3]
Metronidazole is listed by the International Agency for Research on Cancer (IARC) as a potential human carcinogen. Although some of the testing methods have been questioned, it has been shown to cause cancer in experimental animals.[7]. Yet, metronidazole was shown to be safe in humans.[8][9] It appears to have a fairly low potential for cancer risk and under most circumstances the benefits of treatment outweigh the risk. Metronidazole is banned in the EU for veterinary use in the feed of animals. [10]
Common adverse drug reactions associated with topical metronidazole therapy include local redness, dryness, and/or skin irritation; and eye watering (if applied near eyes).[3]
Interaction with alcohol
Consuming ethanol (alcohol) while using metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath,[11] however there are studies calling that notion into question. [12] Consumption of alcohol should be avoided by patients during systemic metronidazole therapy and for at least 48 hours after completion of treatment.[3] However, the mechanism of this reaction in the clinical setting has recently been questioned by some authors,[13][14] and a possible central toxic serotonin reaction for the alcohol intolerance suggested.[15]
Stevens-Johnson Syndrome with Mebendazole
Metronidazole alone rarely causes Stevens-Johnson syndrome but is reported to occur at high rates when combined with Mebendazole.[16]
References
- ^ Cary Engleberg, N.; Schaechter, Moselio; Dermody, Terry; Dermody, Terence; DiRita, Victor (2007). Schaechter's mechanisms of microbial disease. Philadelphia: Lippincott Williams Wilkins. pp. 28. ISBN 0-7817-5342-2..
- ^ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE (October 2004). "Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis". Clin. Microbiol. Rev. 17 (4): 783–93, table of contents. doi:. PMID 15489348. PMC 523556. http://cmr.asm.org/cgi/pmidlookup?view=long&pmid=15489348.
- ^ a b c d e Rossi, Simone(ed). (2006). Rossi S. ed. Australian Medicines Handbook 2006. Australian Medicines Handbook Pty Ltd, Adelaide. ISBN 0-9757919-2-3. OCLC 224831213.
- ^ Carey JC, Klebanoff MA. (April 2005). "Is a change in the vaginal flora associated with an increased risk of preterm birth?". Am J Obstet Gynecol. 192 (4): 1341–6. doi:.
- ^ Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, Jones G, et al. (2006). "A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study". BJOG 113 (1): 65–74. doi:. PMID 16398774.
- ^ Lamont RF (2005). "Can antibiotics prevent preterm birth—the pro and con debate". BJOG 112(suppl): 67–73. doi:. PMID 15715599.
- ^ National Toxicology Program. Metronidazole. In: Report on carcinogens. 11th ed. Research Triangle Park (NC): U.S. Department of Health and Human Services. [updated 2005 Aug 26; cited 2006 Jun 20]
- ^ http://www.pfizer.com/pfizer/download/uspi_flagyl_375.pdf
- ^ http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s112metr.pdf
- ^ http://www.emea.europa.eu/pdfs/vet/mrls/017396en.pdf
- ^ Stephen J Cina, Roger A Russell, Sandra E Conradi (1996). "Sudden death due to metronidazole/ethanol interaction". American Journal of Forensic Medical Pathology 17 (4): 343–346. doi:.
- ^ http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=4320226&dopt=Citation
- ^ Williams CS, Woodcock KR (2000). "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?". Ann Pharmacother 34 (2): 255–7. doi:. PMID 10676835."the authors of all the reports presumed the metronidazole-ethanol reaction to be an established pharmacologic fact. None provided evidence that could justify their conclusions"
- ^ Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP (2002). "Lack of disulfiram-like reaction with metronidazole and ethanol". Ann Pharmacother 36 (6): 971–4. doi:. PMID 12022894.
- ^ Karamanakos PN, Pappas P, Boumba VA, et al. (2007). "Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines". Int. J. Toxicol. 26 (5): 423–32. doi:. PMID 17963129.
- ^ Chen KT, Twu SJ, Chang HJ, Lin RS. (2003). "Outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with mebendazole and metronidazole use among Filipino laborers in Taiwan." Am J Public Health 93(3): 489-492, PMID 12604501, Full text at PMC: 1447769.
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