- Cockayne Syndrome
- Risk of lethal hepatotoxicity with Metronidazole
- Nitroimidazole Antibiotic (includes tindazole, secnidazole)
- Inhibits Protein synthesis in susceptible organisms by disrupting DNA helix, resulting in DNA breakage
- Metronidazole Systemic
- Intravenous Solution
- Tablets: 250, 375 and 500 mg
- Extended Release: 750 mg
- Metronidazole Topical (e.g. Metrogel): 1% and 0.75% gels, creams and lotions
- See Roseacea
- Metronidazole Vaginal (e.g. Metrogel Vaginal): 0.75% gel
- A 1.3% gel is also available (Nuvessa)
- See Bacterial Vaginosis
- See Helicobacter Pylori
- See Bacterial Vaginosis
- See Diverticulitis
- See Pelvic Inflammatory Disease
- See Amoeba Histolytica Dysentery and Amebic Liver Abscess
- See Pseudomembranous colitis (Clostridioides difficile)
- Taking with food decreases gastric irritation
- Anaerobic Bacterial Infection
- Intravenous (administer each IV dose over 1 hour)
- Loading dose: 15 mg/kg up to 1000 mg IV
- Maintenance dose: 7.5 mg/kg up to 500 mg IV every 6 to 8 hours
- Oral
- Take 250 to 750 mg orally three to four times daily
- See Amoeba Histolytica Dysentery and Amebic Liver Abscess
- Taking with food decreases gastric irritation
- Anaerobic Bacterial Infection
- Intravenous (administer each IV dose over 1 hour)
- Load: Metronidazole 15 mg/kg IV (up to 1000 mg) over 1 hour
- Maintenance: Metronidazole 7.5 mg/kg/dose (up to 500 mg/dose) IV every 8 hours
- Decrease dosing interval to every 12 hours in age <1 week old
- Oral
- Give 7.5 to 12.5 mg/kg/dose (up to 500 to 750 mg/dose) three times daily
-
Half-Life: 8 hours
- Some of drug is metabolized via Glucuronidation
- Renal excretion (mostly unchanged in the urine)
- Carcinogenic in mice and rats (FDA Black box warning)
-
Disulfiram Reaction (Antabuse Effect)
- Alcohol induced Flushing, Vomiting and Headache
- Since the 1960s, Alcohol has been strictly cautioned against when taking Metronidazole
- More recent data suggests no inhibition of aldehyde dehydrogenase as is seen with Disulfiram
- Safest to avoid Alcohol with Metronidazole, but interactions appear to be very uncommon
- (2021) Presc Lett 28(10): 58
- Gastrointestinal intolerance
- Nausea
- Anorexia
- Bloating
- Abdominal cramping
- Neurotoxicity (stop immediately if these occur)
- Seizures
- Encephalopathy
- Aseptic Meningitis
- Optic Neuropathy
- Cerebellar dysfunction (e.g. Ataxia, Dizziness)
- Peripheral Neuropathy (e.g. distal Paresthesias)
- Other effects
- Urine Color change
- Darker Urine
-
Alcohol or Disulfiram
- See Disulfiram reaction under adverse effects above
- Avoid Alcohol for 3 days after last dose
- Avoid Disulfiram for 2 weeks after last dose
-
Warfarin
- Increases INR
- Other interactions
- Barbiturates
- Lithium
- Phenytoin
- Pregnancy Class B Medication
- Avoid in first trimester pregnancy
- Unknown safety in Lactation
- However, generally avoided in Lactation
- May resume Breast Feeding at 12 to 24 hours after a single Metronidazole dose
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 110-1
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
-
Burtin (1995) Am J Obstet Gynecol 172:525-9 [PubMed]
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