Metronidazole

Metronidazole Brand Names

First-Metronidazole 100 | First-Metronidazole 50 | Flagyl | Flagyl ER | Flagyl RTU | MetroCream | MetroGel | MetroGel Vaginal | MetroGel-Vaginal | MetroLotion | Noritate | NUVESSA | Nydamax | Rosadan | Rozex | Vandazole | Vitazol

What is Metronidazole

Metronidazole is a synthetic antibacterial and antiprotozoal agent that belongs to the nitroimidazole class.

It is effective therapy against protozoa such as Trichomonas vaginalis, amebiasis, and giardiasis. In addition, it is one of the most effective drugs available against anaerobic bacterial infections.

Metronidazole is also used off-label to treat Crohn’s disease, antibiotic-associated diarrhea, and rosacea.

Metronidazole can be used as a component of multiple regimens that have been shown effective to treat Helicobacter pylori (H. pylori) gastrointestinal infection.

Combination therapy is necessary for successful eradication of H. pylori and to avoid the development of resistance, especially metronidazole resistance, which is prevalent in the US and many other countries.

High eradication rates for H. pylori gastrointestinal infection have been documented with triple-drug regimens that include a proton pump inhibitor (PPI), clarithromycin, and metronidazole (or amoxicillin).

Neurotoxicity, generally reversible, has been reported with metronidazole therapy.

Indications

1. acne rosacea
2. amebiasis
3. appendicitis
4. bacteremia
5. bacterial vaginosis
6. bacterial vaginosis prophylaxis
7. Bacteroides caccae
8. Bacteroides fragilis
9. Bacteroides ovatus
10. Bacteroides sp.
11. Bacteroides thetaiotaomicron
12. Bacteroides uniformis
13. Bacteroides ureolyticus
14. Bacteroides vulgatus
15. Balantidium coli
16. biliary tract infections
17. Blastocystis hominis
18. bone and joint infections
19. bowel preparation
20. brain abscess
21. Campylobacter fetus
22. cholangitis
23. cholecystitis
24. Clostridium difficile
25. Clostridium perfringens
26. Clostridium sp.
27. Crohn’s disease
28. dental infection
29. dentoalveolar infection
30. diabetic foot ulcer
31. Dientamoeba fragilis
32. Dracunculus medinensis
33. endocarditis
34. endometritis
35. endomyometritis
36. Entamoeba histolytica
37. Entamoeba polecki
38. enterocolitis
39. Eubacterium sp.
40. Fusobacterium sp.
41. Gardnerella vaginalis
42. Giardia lamblia
43. giardiasis
44. gynecologic infections
45. Helicobacter pylori
46. Helicobacter pylori (H. pylori) eradication
47. hepatic abscess
48. intraabdominal abscess
49. intraabdominal infections
50. lower respiratory tract infections
51. lung abscess
52. meningitis
53. Mobiluncus sp.
54. Mycoplasma hominis
55. non-gonococcal urethritis (NGU)
56. Parabacteroides distasonis
57. pelvic inflammatory disease (PID)
58. Peptococcus niger
59. Peptococcus sp.
60. Peptostreptococcus sp.
61. periodontitis
62. pleural empyema
63. pneumonia
64. Porphyromonas asaccharolytica
65. Porphyromonas gingivalis
66. Porphyromonas sp.
67. Prevotella bivia
68. Prevotella buccae
69. Prevotella disiens
70. Prevotella intermedia
71. Prevotella melaninogenica
72. Prevotella oralis
73. Prevotella sp.
74. pseudomembranous colitis
75. skin and skin structure infections
76. surgical infection prophylaxis
77. tetanus
78. Trichomonas vaginalis
79. trichomoniasis
80. trichomoniasis prophylaxis
81. tubo-ovarian abscess
82. Veillonella sp.

Side Effects

1. abdominal pain
2. acne vulgaris
3. agranulocytosis
4. anaphylactoid reactions
5. angioedema
6. anorexia
7. arthralgia
8. aseptic meningitis
9. asthenia
10. ataxia
11. back pain
12. breast enlargement
13. candidiasis
14. chest pain (unspecified)
15. chills
16. confusion
17. constipation
18. contact dermatitis
19. cystitis
20. depression
21. diaphoresis
22. diarrhea
23. dizziness
24. drowsiness
25. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
26. dysarthria
27. dysgeusia
28. dysmenorrhea
29. dyspareunia
30. dyspepsia
31. dyspnea
32. dysuria
33. elevated hepatic enzymes
34. encephalopathy
35. eosinophilia
36. erythema
37. fatigue
38. fever
39. flatulence
40. flushing
41. gingivitis
42. glossitis
43. headache
44. hepatic failure
45. hepatotoxicity
46. hiccups
47. hyperhidrosis
48. hypertension
49. hypoesthesia
50. increased urinary frequency
51. infection
52. influenza
53. injection site reaction
54. insomnia
55. irritability
56. leukopenia
57. leukorrhea
58. libido decrease
59. malaise
60. menorrhagia
61. metallic taste
62. muscle cramps
63. myalgia
64. nasal congestion
65. nausea
66. neurotoxicity
67. neutropenia
68. new primary malignancy
69. nystagmus
70. ocular irritation
71. palpitations
72. pancreatitis
73. paresthesias
74. peripheral edema
75. peripheral neuropathy
76. pharyngitis
77. phlebitis
78. polyuria
79. proctitis
80. pruritus
81. pruritus ani
82. psychosis
83. QT prolongation
84. rash
85. rhinitis
86. seizures
87. serum sickness
88. sinus tachycardia
89. sinusitis
90. skin irritation
91. ST-T wave changes
92. Stevens-Johnson syndrome
93. stomatitis
94. superinfection
95. syncope
96. thrombocytopenia
97. toxic epidermal necrolysis
98. urinary incontinence
99. urine discoloration
100. urticaria
101. vaginal discharge
102. vaginal irritation
103. vaginitis
104. vertigo
105. vomiting
106. weakness
107. xerosis
108. xerostomia

Monitoring Parameters

• CBC with differential
• LFTs

Contraindications

• alcoholism
• apheresis
• AV block
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• Cockayne syndrome
• corticosteroid therapy
• Crohn’s disease
• dialysis
• edema
• ethanol ingestion
• ethanol intoxication
• females
• fever
• fungal infection
• geriatric
• heart failure
• hematological disease
• hepatic disease
• hepatic encephalopathy
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothermia
• hypothyroidism
• laboratory test interference
• long QT syndrome
• myocardial infarction
• new primary malignancy
• ocular exposure
• pheochromocytoma
• pregnancy
• QT prolongation
• renal failure
• renal impairment
• rheumatoid arthritis
• sexually transmitted disease
• sickle cell disease
• sleep deprivation
• sodium restriction
• stroke
• systemic lupus erythematosus (SLE)

Interactions

• Alfuzosin
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Celecoxib
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Anagrelide
• Apomorphine
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Asenapine
• Atomoxetine
• Azithromycin
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Bortezomib
• Bosentan
• Buprenorphine
• Buprenorphine; Naloxone
• Busulfan
• Caffeine; Ergotamine
• Carbamazepine
• Carbidopa
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Celecoxib
• Ceritinib
• Chloroquine
• Chlorpromazine
• Cholestyramine
• Cimetidine
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clofazimine
• Clomipramine
• Clozapine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crizotinib
• Cyclophosphamide
• Cyclosporine
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasatinib
• Degarelix
• Desflurane
• Desipramine
• Deutetrabenazine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Dienogest; Estradiol valerate
• Disopyramide
• Disulfiram
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Doxepin
• Doxercalciferol
• Dronabinol
• Dronedarone
• Droperidol
• Drospirenone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix; Estradiol; Norethindrone acetate
• Eliglustat
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Encorafenib
• Enflurane
• Entrectinib
• Ergonovine
• Ergotamine
• Eribulin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ezogabine
• Fingolimod
• Flecainide
• Floxuridine
• Fluconazole
• Fluorouracil, 5-FU
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluvoxamine
• Foscarnet
• Fosphenytoin
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gilteritinib
• Glasdegib
• Goserelin
• Granisetron
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Histrelin
• Hydroxychloroquine
• Hydroxyzine
• Ibutilide
• Iloperidone
• Imipramine
• Inotuzumab Ozogamicin
• Isoflurane
• Itraconazole
• Ivosidenib
• Ixabepilone
• Ketoconazole
• Lapatinib
• Lefamulin
• Lenvatinib
• Leuprolide
• Leuprolide; Norethindrone
• Levofloxacin
• Levonorgestrel
• Lithium
• Lofexidine
• Long-acting beta-agonists
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Macimorelin
• Maprotiline
• Mebendazole
• Mefloquine
• Meperidine; Promethazine
• Mestranol; Norethindrone
• Methadone
• Methylergonovine
• Methysergide
• Midostaurin
• Mifepristone
• Mirtazapine
• Moxifloxacin
• Mycophenolate
• Nilotinib
• Norethindrone
• Norgestrel
• Nortriptyline
• Octreotide
• Ofloxacin
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Oral Contraceptives
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Ozanimod
• Paclitaxel
• Paliperidone
• Panobinostat
• Pasireotide
• Pazopanib
• Pentamidine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenylephrine; Promethazine
• Phenytoin
• Pimavanserin
• Pimozide
• Pitolisant
• Posaconazole
• Primaquine
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quetiapine
• Quinidine
• Ramelteon
• Ranolazine
• Ribociclib
• Ribociclib; Letrozole
• Rilpivirine
• Risperidone
• Ritonavir
• Romidepsin
• Saquinavir
• Segesterone Acetate; Ethinyl Estradiol
• Selpercatinib
• Sertraline
• Sevoflurane
• Short-acting beta-agonists
• Siponimod
• Sirolimus
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Solifenacin
• Sorafenib
• Sotalol
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sunitinib
• Tacrolimus
• Tamoxifen
• Telavancin
• Telithromycin
• Tetrabenazine
• Thalidomide
• Thioridazine
• Tipranavir
• Tolterodine
• Toremifene
• Trazodone
• Triclabendazole
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine
• Triptorelin
• Vandetanib
• Vardenafil
• Vecuronium
• Vemurafenib
• Venlafaxine
• Voriconazole
• Vorinostat
• Warfarin
• Zalcitabine, ddC
• Ziprasidone