Metronidazole

Generic Name (active ingredient): Metronidazole
Brand Name: Flagyl

Metronidazole-is broad spectrum action antibacterial and antiprotozoal medication. Metronidazole is the drug of choice in the treatment of many parasitic diseases in humans caused by protozoa; it is active against vaginal Trichomonas and Giardia intestinal. It is used for the treatment of trichomoniasis, giardiasis, amebiasis, gastric and duodenal ulcer (eradication of Helicobacter pylori), anaerobic infections (peritonitis, abscess, meningitis, empyema, endocarditis). Metronidazole causes disulferam-like reactions.

How does the medication work?
Metronidazole belongs to a group of nitro-5-imidazole and is active mainly against anaerobic microorganisms. Action mechanism is associated interaction of deoxidated 5-nitro group with bacterial DNA and inhibiting synthesis of nucleic acid. This is ultimately fatal for the microorganisms.
Metronidazole suppresses the development of amoebae, Trichomonas as well as some obligate anaerobes: Trichomonas vaginalis, Giardia intestinalis, Entamoeba histolytica, Lamblia, Peptostreptococcus, Clostridium sp., Bacteroides sp., Prevotella, Fusobacterium, Veilonella.
Some aerobic gram-negative bacteria (Helicobacter, gardnerellas) are sensitive to Metronidazole. Concomitant application with alcohol leads to disulfiram-like reaction.

When Metronidazole is prescribed?
Oral forms of Metronidazole are used in:

  • Protozoal infections: extraenteric amebiasis (including amebic liver abscess), intestinal amebiasis (amoebiasis), giardiasis balantidiasis, cutaneous leishmaniasis, trichomoniasis, trichomonas vaginitis, urethritis trichomonas
  • Infections caused by Bacteroides spp. (Including Bacteroides fragilis, Bacteroides distasonis,
  • Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus)
  • Infections of bones and joints
  • Infections of CNS (including meningitis, brain abscess, bacterial endocarditis, pneumonia, empyema and lung abscess).
  • Infections caused by Bacteroides spp. (Including Bacteroides fragilis), Clostridium spp., Peptococcus spp., Peptostreptococcus spp.
  • Infection of the abdominal cavity (peritonitis, liver abscess)
  • Pelvic infections (endometritis, endomyometritis, abscess of fallopian tubes and ovaries, infections of the vagina)
  • Infections of skin and soft tissues
  • Septicemia caused by Bacteroides spp. (Including Bacteroides fragilis) and Clostridium spp. Pseudomembranous colitis (associated with the use of antibiotics)
  • Gastritis or duodenal ulcer associated with Helicobacter pylori
  • Alcoholism
  • Prevention of postoperative infections (especially after operations on the colon, gynecological interventions)
  • Radiation therapy of patients with tumors
  • For local applications: acne rosacea, acne vulgaris, bacterial vaginosis, wounds, trophic ulcers

What should I know before taking Metronidazole?
Do not use this medication if you are allergic to Metronidazole or to any other medicines such as:

  • Ornidazole, Tinidazole and other nitroimidazoles

Do not take Metronidazole if any of the below conditions apply to you:

  • Hypersensitivity to any of the medication ingredients
  • Infectious mononucleosis
  • Severe liver diseases
  • Severe kidney diseases
  • Alcoholic intoxication
  • Organic damage of the central or peripheral nervous system
  • Severe blood diseases

Before taking Metronidazole, tell your health care provider about any other medicines you take or if you have any of the following disorders:

  • Liver diseases in anamnesis
  • Kidney diseases in anamnesis

If you are pregnant, plan to become pregnant, or breastfeed, you should take Metronidazole only under a strict control of your doctor. Metronidazole belongs to a pregnancy category B meaning that safety of the medication was not studied in pregnant women. Talk to your doctor about benefits and risk of taking this medication during pregnancy.

How to take Metronidazole:
Metronidazole is available in the form of tablets, vaginal tablets, vaginal gel, solution for infusions, creams, vaginal suppositories. Dosage of Metronidazole is prescribed individually by physician.

Take the entire amount of Metronidazole prescribed by your doctor, even if you feel better before the end of the treatment. If you stop taking medication too early, symptoms may return.
If you missed the scheduled dose, take the medication as soon as you remember, but skip the dose if it is almost the time for the following dose. Do not take two doses at once.

What are the side effects of Metronidazole?
Metronidazole may cause the following side effects:

  • Digestive system: nausea, vomiting, stomach pain, diarrhea, decreased appetite, metallic taste in the mouth
  • Less common side effects: headache, drowsiness, syncopal conditions, confusion, hyper irritability, seizures, depression, insomnia, arthralgia, weakness, sense or burning during urination, changes of urine color (urine become black), allergic reactions (skin rash, itching, urticaria), thrombophlebitis (after i/v infusions)
  • In very rare cases: leukopenia
  • When used in combination with amoxicillin: diarrhea, constipation, stomach pain, glossitis, stomatitis; in rare cases-hepatitis, pseudo-membranous colitis, interstitial nephritis, hematopoiesis disorders.
  • In local application: redness, irritation, itching

If you experience any side effect that last long or becomes bothersome, please inform your doctor as dose adjustment or treatment discontinuation may be required.

Which are Metronidazole overdose symptoms?
If you overdose Metronidazole, seek immediate medical attention. Overdose symptoms include: nausea, vomiting, ataxia, in severe cases-peripheral neuropathy and epileptic seizures.

Which other medicines may affect Metronidazole?
Metronidazole may interact with the following groups of drugs:

  • Muscle relaxants
  • Disulferam
  • Alcohol
  • Blood thinners
  • Lithium preparations
  • Barbiturates
  • Anti-epileptics (phenytoin)
  • H2 histamine receptor blocker (cimetidine)

For a complete list of possible interactions ask your doctor or pharmacist. Before taking Metronidazole, let your doctor know what other medicines, including OTC, you currently take.

How should I store Metronidazole?
Metronidazole should be store at dry and protected from light place at room temperature out of reach of children.

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