Pronunciation:

met-roe-NYE-da-zole

Brand Names:

• Flagyl
• Flagyl ER
• Likmez

Dosage Forms:

• Tablet
• Capsule
• Powder for Suspension

Warnings:

Metronidazole has been shown to be carcinogenic in mice and rats. Unnecessary use of the drug should be avoided. Its use should be reserved only for conditions for which it is approved .

Potential For CarcinogenicityMetronidazole has been shown to be carcinogenic in mice and rats. Avoid unnecessary use of metronidazole. Reserve metronidazole for use in the following indications: trichomoniasis, amebiasis and anaerobic bacterial infections .

Classifications:

Therapeutic—

Antibiotic

Chemical—

Nitroimidazole

Uses of This Medicine:

Metronidazole is used to treat bacterial infections in different areas of the body. It is also used to treat infections caused by protozoa (eg, trichomoniasis and amebiasis) and infections caused by bacteria that do not need oxygen to survive. The extended-release tablets are used to treat women with vaginal infections (bacterial vaginosis).

Metronidazole belongs to the class of medicines known as antibiotics. It works by killing bacteria or preventing their growth. However, this medicine will not work for colds, flu, or other virus infections.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of metronidazole capsules, oral liquid, and tablets in the pediatric population, except for the treatment of amebiasis. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of metronidazole extended-release tablets to treat bacterial vaginosis in teenage females, but should not be used before the start of menstruation.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of metronidazole in the elderly. However, elderly patients are more likely to have unwanted effects and age-related liver problems, which may require caution and an adjustment in the dose for patients receiving metronidazole.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Amprenavir
• Bepridil
• Cisapride
• Disulfiram
• Dronabinol
• Dronedarone
• Levoketoconazole
• Mesoridazine
• Pimozide
• Saquinavir
• Sparfloxacin
• Terfenadine
• Thioridazine
• Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Adagrasib
• Alfuzosin
• Amiodarone
• Amitriptyline
• Anagrelide
• Apomorphine
• Aripiprazole
• Aripiprazole Lauroxil
• Arsenic Trioxide
• Asenapine
• Astemizole
• Atazanavir
• Azithromycin
• Bedaquiline
• Buprenorphine
• Bupropion
• Buserelin
• Busulfan
• Capecitabine
• Ceritinib
• Chloroquine
• Chlorpromazine
• Cholera Vaccine, Live
• Ciprofloxacin
• Citalopram
• Clarithromycin
• Clofazimine
• Clomipramine
• Clothiapine
• Clozapine
• Crizotinib
• Cyclobenzaprine
• Dabrafenib
• Dasatinib
• Degarelix
• Delamanid
• Desipramine
• Deslorelin
• Deutetrabenazine
• Dexmedetomidine
• Disopyramide
• Dofetilide
• Dolasetron
• Domperidone
• Donepezil
• Doxepin
• Doxifluridine
• Droperidol
• Ebastine
• Efavirenz
• Encorafenib
• Entrectinib
• Eribulin
• Erythromycin
• Escitalopram
• Famotidine
• Felbamate
• Fexinidazole
• Fingolimod
• Flecainide
• Fluconazole
• Fluorouracil
• Fluoxetine
• Formoterol
• Foscarnet
• Fosphenytoin
• Galantamine
• Gatifloxacin
• Gemifloxacin
• Glasdegib
• Gonadorelin
• Goserelin
• Granisetron
• Halofantrine
• Haloperidol
• Histrelin
• Hydroquinidine
• Hydroxychloroquine
• Hydroxyzine
• Ibutilide
• Iloperidone
• Imipramine
• Inotuzumab Ozogamicin
• Itraconazole
• Ivabradine
• Ivosidenib
• Ketoconazole
• Lapatinib
• Leuprolide
• Levofloxacin
• Lofexidine
• Lumefantrine
• Macimorelin
• Mebendazole
• Mefloquine
• Methadone
• Methotrexate
• Mifepristone
• Mizolastine
• Mobocertinib
• Moxifloxacin
• Mycophenolate Mofetil
• Mycophenolic Acid
• Nafarelin
• Nelfinavir
• Nilotinib
• Norfloxacin
• Octreotide
• Ofloxacin
• Olanzapine
• Ondansetron
• Osimertinib
• Oxaliplatin
• Ozanimod
• Pacritinib
• Paliperidone
• Panobinostat
• Papaverine Hydrochloride
• Paroxetine
• Pasireotide
• Pazopanib
• Pentamidine
• Perphenazine
• Phenobarbital
• Pimavanserin
• Pipamperone
• Pitolisant
• Ponesimod
• Posaconazole
• Primidone
• Probucol
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Relugolix
• Ribociclib
• Risperidone
• Ritonavir
• Selpercatinib
• Sertindole
• Sertraline
• Sevoflurane
• Siponimod
• Sodium Phosphate
• Sodium Phosphate, Dibasic
• Sodium Phosphate, Monobasic
• Solifenacin
• Sorafenib
• Sotalol
• Sulpiride
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tegafur
• Telaprevir
• Telavancin
• Telithromycin
• Tetrabenazine
• Tolterodine
• Toremifene
• Trazodone
• Trimipramine
• Triptorelin
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Vilanterol
• Vinflunine
• Voclosporin
• Voriconazole
• Vorinostat
• Warfarin
• Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Carbamazepine
• Cholestyramine
• Cyclosporine
• Lithium
• Milk Thistle

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood or bone marrow problems, or history of or
• Brain disease (eg, aseptic meningitis, encephalopathy) or
• Leukopenia (low white blood cells), history of or
• Optic neuropathy (eye disease with vision changes), history of or
• Oral thrush (Candida infection) or
• Peripheral neuropathy (nerve problem), history of or
• Seizures, history of or
• Vaginal yeast infection (Candida infection)—Use with caution. May make these conditions worse.

• Cockayne syndrome (genetic disorder)—Should not be used in patients with this condition.

• Kidney disease, end-stage or
• Liver disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a patient information leaflet. Read and follow the instructions carefully. Ask your doctor if you have any questions.

The capsules can be taken with or without food. If the medicine upsets your stomach, it is best to take it with a meal or snack.

The extended–release tablet must be taken without food, 1 hour before or 2 hours after a meal.

Swallow the extended-release tablet whole. Do not break, crush, or chew it.

To use the suspension: Shake the bottle well before using. Measure the oral liquid medicine with a marked oral syringe or medicine cup. Do not use a household measuring cup.

To help clear up your infection completely, keep using this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop using this medicine too soon, your infection may return.

This medicine works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times during the day. If you need help planning the best times to take your medicine, check with your doctor.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage forms (capsules or tablets):
  • For amebiasis:
    • Adults—
      • For acute intestinal amebiasis: 750 milligrams (mg) 3 times a day for 5 to 10 days.
      • For amebic liver abscess: 500 to 750 mg 3 times a day for 5 to 10 days.
    • Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 35 to 50 milligrams per kilogram of body weight (mg/kg) per day, divided into 3 doses, for 10 days.
  • For bacterial infections:
    • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 7.5 milligrams per kilogram of body weight (mg/kg) every 6 hours for 7 to 10 days. Your doctor may increase your dose as needed. However, the dose is usually not more than 4 grams (g) per day.
    • Children—Use and dose must be determined by your doctor.
  • For trichomoniasis infections:
    • Adults—
      • Capsule: 375 milligrams (mg) 2 times a day for 7 days.
      • Tablet:
        • One-day treatment: 2 grams (g) given as a single dose or 1 g given in 2 doses per day.
        • 7-day course treatment: 250 mg 3 times a day for 7 days.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (extended-release tablets):
  • For bacterial vaginosis:
    • Adults—750 milligrams (mg) once a day for 7 days.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (suspension):
  • For amebiasis:
    • Adults—
      • For acute intestinal amebiasis: 750 milligrams (mg) or 7.5 milliliters (mL) 3 times a day for 5 to 10 days.
      • For amebic liver abscess: 500 to 750 mg or 5 to 7.5 mL 3 times a day for 5 to 10 days.
    • Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 35 to 50 milligrams per kilogram of body weight (mg/kg) per day, divided into 3 doses, for 10 days. However, the dose is usually not more than 2250 mg per day.
  • For bacterial infections:
    • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 7.5 milligrams per kilogram of body weight (mg/kg) every 6 hours for 7 to 10 days. However, the dose is usually not more than 4 grams or 40 mL per day.
    • Children—Use and dose must be determined by your doctor.
  • For trichomoniasis:
    • Adults—
      • One-day treatment: 2 grams (g) or 20 milliliters (mL) given as a single dose or 1 g or 10 mL given in 2 divided doses per day.
      • 7-day course treatment: 250 milligrams (mg) or 2.5 milliliters (mL) 3 times a day for 7 days.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is important that your doctor check your progress at regular visits to make sure that the infection is cleared up. Blood tests may be needed to check for unwanted effects.

If your symptoms do not improve within a few days after you start this medicine or if they become worse, check with your doctor.

Do not take metronidazole if you have taken disulfiram (Antabuse®) within the last 2 weeks. Using these medicines together may cause serious unwanted effects.

Drinking alcoholic beverages while using this medicine may cause stomach pain, nausea, vomiting, headache, or flushing or redness of the face. Other alcohol-containing preparations (eg, elixirs, cough syrups, tonics) may also cause problems. These problems may last for at least one day after you stop using metronidazole. This medicine may also cause alcoholic beverages to taste different. You should not drink alcoholic beverages or take other alcohol-containing preparations while you are using this medicine and for at least 3 days after stopping it.

If you have trichomoniasis: Using this medicine while you are pregnant (especially during the first 3 months of pregnancy) can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

If you are using this medicine for trichomoniasis (an infection of the sex organs), your doctor may want to treat your sexual partner at the same time you are being treated, even if he or she has no symptoms. Also, it may be desirable to use a condom during sexual intercourse. These measures will help to keep you from getting the infection back again from your partner. If you have any questions about this, talk with your doctor.

Check with your doctor right away if you have burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Check with your doctor right away if you have dizziness, problems with muscle control or coordination, shakiness or an unsteady walk, slurred speech, or trouble speaking. These may be symptoms of a serious brain condition called encephalopathy.

Call your doctor right away if you have confusion, drowsiness, fever, a general feeling of illness, a headache, loss of appetite, nausea, a stiff neck or back, or vomiting. These could be symptoms of a serious condition called aseptic meningitis.

This medicine may increase your risk of having serious liver problems, which may be life-threatening. This is more likely if you have Cockayne syndrome (rare form of dwarfism). Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin.

Metronidazole may cause dry mouth, an unpleasant or sharp metallic taste, and a change in taste sensation. For temporary relief of dry mouth, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. If your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Agitation

back pain

blindness

blurred vision

burning, numbness, tingling, or painful sensations in the hands or feet

changes in speech patterns

confusion

decreased vision

depression

dizziness

drowsiness

eye pain

fever

headache

irritability

lack of coordination

nausea

seeing or hearing things that are not there

seizures

shakiness and unsteady walk

slurred speech

stiff neck or back

trouble speaking

unsteadiness, trembling, or other problems with muscle control or coordination

unusual tiredness or weakness

vomiting

weakness in the arms, hands, legs, or feet

Less common

Black, tarry stools

blood in the urine

body aches or pain

burning while urinating

chills

clumsiness or unsteadiness

difficulty with breathing

ear congestion

fainting

feeling of pelvic pressure

frequent or painful urination

irregular heartbeat

loss of voice

nasal congestion

pinpoint red spots on the skin

runny nose

skin rash, hives, redness, itching

sneezing

stomach and back pain (severe)

unusual bleeding or bruising

vaginal irritation, discharge, or dryness not present before taking the medicine

Rare

Bleeding gums

bloating

chest pain

constipation

cough

dark urine

fast heartbeat

indigestion

loss of appetite

painful or difficult urination

pains in the stomach, side, or abdomen, possibly radiating to the back

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

yellow eyes or skin

Incidence not known

Blistering, peeling, or loosening of the skin

bloody or cloudy urine

burning while urinating

continuing diarrhea

continuing stomach pain

diarrhea

feeling of warmth

increased volume of pale, dilute urine

joint or muscle pain

loss of bladder control

red skin lesions, often with a purple center

red, irritated eyes

redness of the face, neck, arms, and occasionally, upper chest

redness of the skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness or lightheadedness

feeling of constant movement of self or surroundings

heartburn

sensation of spinning

stomach cramps

trouble sleeping

weight loss

Rare

Change in taste sensation

congestion

dry mouth

pain or tenderness around the eyes and cheekbones

tender, swollen glands in the neck

trouble with swallowing

unpleasant or sharp metallic taste

voice changes

Incidence not known

Decreased interest in sexual intercourse

inability to have or keep an erection

loss in sexual ability, desire, drive, or performance

painful sexual intercourse

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.