Metronidazole

Aka: Metronidazole, Flagyl

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II. Mechanism

  1. Nitroimidazole antibiotic (includes tindazole, secnidazole)
  2. Inhibits Protein synthesis in susceptible organisms by disrupting DNA helix and resulting in DNA breakage

III. Indications

  1. Protozoal Infection
    1. Trichomoniasis
    2. Amebiasis
    3. Giardiasis
  2. Anaerobic Bacteria infection
    1. Bacteroides fragilis
    2. Clostridium difficile
    3. Bacterial Vaginosis

IV. Precautions

  1. Carcinogenic in mice and rats (FDA Black box warning)

V. Pharmacokinetics

  1. Half-Life: 8 hours
  2. Renal excretion

VI. Dosing: Children

  1. Dose
    1. Load: Metronidazole 15 mg/kg IV
    2. Maintenance: Metronidazole 7.5 mg/kg/dose
  2. Interval
    1. First week of life: q12 hours
    2. After first week of life: q 8hours

VII. Dosing: Adult

  1. Intravenous
    1. Loading dose: 15 mg/kg up to 1000 mg IV
    2. Maintenance dose: 7.5 mg/kg up to 500 mg IV q6-8 hour
  2. Oral dose: 250 to 750 mg PO tid

VIII. Adverse Effects

  1. Disulfiram Effect (Antabuse Effect)
    1. Since the 1960s, Alcohol has been strictly cautioned against when taking Metronidazole
    2. More recent data suggests no inhibition of aldehyde dehydrogenase as is seen with Disulfiram
    3. Safest to avoid Alcohol with Metronidazole, but interactions appear to be very uncommon
    4. (2021) Presc Lett 28(10): 58
  2. Gastrointestinal intolerance
  3. Neurotoxicity (stop immediately if these occur)
    1. Seizures
    2. Encephalopathy
    3. Cerebellar dysfunction
    4. Peripheral Neuropathy (e.g. distal Paresthesias)

IX. Pregnancy

  1. Class B Medication (Avoid in first trimester pregnancy)

X. Directions

  1. Taking with food decreases gastric irritation

XI. References

  1. Burtin (1995) Am J Obstet Gynecol 172:525-9 [PubMed]

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Cost: Medications

metronidazole (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
METRONIDAZOLE 0.75% CREAM Generic $0.56 per gram
METRONIDAZOLE 0.75% LOTION Generic $1.90 per ml
METRONIDAZOLE 250 MG TABLET Generic $0.10 each
METRONIDAZOLE 500 MG TABLET Generic $0.14 each
METRONIDAZOLE TOP 1% GEL PUMP Generic $0.69 per gram
METRONIDAZOLE TOPICAL 0.75% GL Generic $0.46 per gram
METRONIDAZOLE TOPICAL 1% GEL Generic $1.06 per gram
METRONIDAZOLE VAGINAL 0.75% GL Generic $0.47 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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