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
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