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standards of non-Merck sources.
ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section and/or refer to product labeling for additional detail.
Medication Safety Issues
Sound-alike/look-alike issues:
MetroNIDAZOLE may be confused with meropenem, metFORMIN
Pronunciation
(met roe NYE da zole)
U.S. Brand Names
Index Terms
Generic Available
Yes: Capsule, cream, gel, infusion, lotion, tablet
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of susceptible anaerobic bacterial and protozoal infections in the following conditions: Amebiasis, symptomatic and asymptomatic trichomoniasis; skin and skin structure infections; CNS infections; intra-abdominal infections (as part of combination regimen); systemic anaerobic infections; treatment of antibiotic-associated pseudomembranous colitis (AAPC), bacterial vaginosis; as part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence
Topical: Treatment of inflammatory lesions and erythema of rosacea
Use: Dental
Treatment of oral soft tissue infections due to anaerobic bacteria including all anaerobic cocci, anaerobic gram-negative bacilli (Bacteroides), and gram-positive spore-forming bacilli (Clostridium). Useful as single agent or in combination with amoxicillin, Augmentin®, or ciprofloxacin in the treatment of periodontitis associated with the presence of Actinobacillus actinomycetemcomitans (AA).
Use: Unlabeled/Investigational
Crohn's disease
Pregnancy Risk Factor
B (may be contraindicated in 1st trimester)
Pregnancy Considerations
Crosses the placenta (carcinogenic in rats); contraindicated for the treatment of trichomoniasis during the first trimester of pregnancy, unless alternative treatment is inadequate. Until safety and efficacy for other indications have been established, use only during pregnancy when the benefit to the mother outweighs the potential risk to the fetus.
Lactation
Enters breast milk/not recommended (AAP rates “of concern”)
Breast-Feeding Considerations
It is suggested to stop breast-feeding for 12-24 hours following single dose therapy to allow excretion of dose.
Contraindications
Hypersensitivity to metronidazole, nitroimidazole derivatives, or any component of the formulation; pregnancy (1st trimester - found to be carcinogenic in rats)
Warnings/Precautions
Boxed warnings:
• Carcinogenic: See “Concerns related to adverse effects” below.
Concerns related to adverse effects:
• Carcinogenic: [U.S. Boxed Warning]: Possibly carcinogenic based on animal data.
• CNS effects: Seizures and neuropathies have been reported especially with increased doses and chronic treatment; if this occurs, discontinue therapy. Use with caution in patients with a history of seizure disorder; reduce doses with patients with CNS disease.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Blood dyscrasias: Use with caution in patients with blood dyscrasias.
• Heart failure: Use with caution in patients with heart failure or other sodium retaining states.
• Hepatic impairment: Use with caution in patients with liver impairment due to potential accumulation; reduce dosage in patients with severe impairment.
• H. pylori infection: If H. pylori is not eradicated in patients being treated with metronidazole in a regimen, it should be assumed that metronidazole-resistance has occurred and it should not again be used.
• Renal impairment: Consider dosage reduction in longer-term therapy with severe renal failure (Clcr <10 mL/minute).
Adverse Reactions
Systemic: Frequency not defined:
Cardiovascular: Flattening of the T-wave, flushing
Central nervous system: Ataxia, confusion, coordination impaired, dizziness, fever, headache, insomnia, irritability, seizure, vertigo
Dermatologic: Erythematous rash, urticaria
Endocrine & metabolic: Disulfiram-like reaction, dysmenorrhea, libido decreased
Gastrointestinal: Nausea (?12%), anorexia, abdominal cramping, constipation, diarrhea, furry tongue, glossitis, proctitis, stomatitis, unusual/metallic taste, vomiting, xerostomia
Genitourinary: Cystitis, darkened urine (rare), dysuria, incontinence, polyuria, vaginitis
Hematologic: Neutropenia (reversible), thrombocytopenia (reversible, rare)
Neuromuscular & skeletal: Peripheral neuropathy, weakness
Respiratory: Nasal congestion, rhinitis, sinusitis, pharyngitis
Miscellaneous: Flu-like syndrome, moniliasis
Topical: Frequency not defined:
Central nervous system: Headache
Dermatologic: Burning, contact dermatitis, dryness, erythema, irritation, pruritus, rash
Gastrointestinal: Unusual/metallic taste, nausea, constipation
Local: Local allergic reaction
Neuromuscular & skeletal: Tingling/numbness of extremities
Ocular: Eye irritation
Vaginal:
>10%: Genitourinary: Vaginal discharge (12%)
1% to 10%:
Central nervous system: Headache (5%), dizziness (2%)
Gastrointestinal: Gastrointestinal discomfort (7%), nausea and/or vomiting (4%), unusual/metallic taste (2%), diarrhea (1%)
Genitourinary: Vaginitis (10%), vulva/vaginal irritation (9%), pelvic discomfort (3%)
Hematologic: WBC increased (2%)
<1%: Abdominal bloating, abdominal gas, darkened urine, depression, fatigue, itching, rash, thirst, xerostomia
Metabolism/Transport Effects
Inhibits CYP2C9 (weak), 3A4 (moderate)
Drug Interactions
Alcohol (Ethyl): MetroNIDAZOLE may enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk C: Monitor therapy
Amprenavir: MetroNIDAZOLE may enhance the adverse/toxic effect of Amprenavir. This is specifically related to the propylene glycol contained in amprenavir oral solution, not capsules. Risk X: Avoid combination
Busulfan: MetroNIDAZOLE may increase the serum concentration of Busulfan. Risk D: Consider therapy modification
Calcineurin Inhibitors: MetroNIDAZOLE may decrease the metabolism of Calcineurin Inhibitors. Risk C: Monitor therapy
CYP3A4 Substrates: CYP3A4 Inhibitors (Moderate) may decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Disulfiram: May enhance the adverse/toxic effect of MetroNIDAZOLE. Risk D: Consider therapy modification
Eplerenone: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Eplerenone. Management: A lower starting dose of eplerenone (25 mg once daily) is recommended in patients with hypertension who are also taking drugs that are moderate inhibitors of CYP3A4. Risk D: Consider therapy modification
Maraviroc: CYP3A4 Inhibitors may increase the serum concentration of Maraviroc. Risk D: Consider therapy modification
Mebendazole: May enhance the adverse/toxic effect of MetroNIDAZOLE. Particularly the risk for Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis may be increased. Risk D: Consider therapy modification
Mycophenolate: MetroNIDAZOLE may decrease the serum concentration of Mycophenolate. Specifically, metronidazole may decrease concentrations of the active metabolite of mycophenolate. Risk C: Monitor therapy
Pimecrolimus: CYP3A4 Inhibitors (Moderate) may decrease the metabolism of Pimecrolimus. Risk C: Monitor therapy
Ranolazine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ranolazine. Risk X: Avoid combination
Salmeterol: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Salmeterol. Risk C: Monitor therapy
Tipranavir: MetroNIDAZOLE may enhance the adverse/toxic effect of Tipranavir. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): MetroNIDAZOLE may decrease the metabolism of Vitamin K Antagonists. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Ethanol: The manufacturer recommends to avoid all ethanol or any ethanol-containing drugs (may cause disulfiram-like reaction characterized by flushing, headache, nausea, vomiting, sweating, or tachycardia).
Food: Peak antibiotic serum concentration lowered and delayed, but total drug absorbed not affected.
Storage
Metronidazole injection should be stored at 15°C to 30°C and protected from light. Product may be refrigerated but crystals may form. Crystals redissolve on warming to room temperature. Prolonged exposure to light will cause a darkening of the product. However, short-term exposure to normal room light does not adversely affect metronidazole stability. Direct sunlight should be avoided. Stability of parenteral admixture at room temperature (25°C): Out of overwrap stability: 30 days.
Reconstitution
Standard diluent: 500 mg/100 mL NS.
Compatibility
Stable in D5W, NS.
Y-site administration: Compatible: Acyclovir, allopurinol, amiodarone, amifostine, cefepime, cisatracurium, clarithromycin, cyclophosphamide, diltiazem, docetaxel, dopamine, doxorubicin liposome, enalaprilat, esmolol, etoposide phosphate, fluconazole, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, hydromorphone, labetalol, linezolid, lorazepam, magnesium sulfate, melphalan, meperidine, methylprednisolone sodium succinate, midazolam, morphine, perphenazine, piperacillin/tazobactam, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine. Incompatible: Amphotericin B cholesteryl sulfate complex, aztreonam, filgrastim, meropenem, warfarin.
Compatibility when admixed: Compatible: Amikacin, aminophylline, ampicillin, cefazolin, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, clindamycin, disopyramide, floxacillin, fluconazole, gentamicin, heparin, hydrocortisone sodium succinate, multivitamins, netilmicin, penicillin G potassium, tobramycin. Incompatible: Aztreonam, dopamine, meropenem. Variable (consult detailed reference): Cefamandole, cefepime.
Mechanism of Action
After diffusing into the organism, interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death in susceptible organisms
Pharmacodynamics/Kinetics
Absorption: Oral: Well absorbed; Topical: Concentrations achieved systemically after application of 1 g topically are 10 times less than those obtained after a 250 mg oral dose
Distribution: To saliva, bile, seminal fluid, breast milk, bone, liver, and liver abscesses, lung and vaginal secretions; crosses placenta and blood-brain barrier
CSF:blood level ratio: Normal meninges: 16% to 43%; Inflamed meninges: 100%
Protein binding: <20%
Metabolism: Hepatic (30% to 60%)
Half-life elimination: Neonates: 25-75 hours; Others: 6-8 hours, prolonged with hepatic impairment; End-stage renal disease: 21 hours
Time to peak, serum: Oral: Immediate release: 1-2 hours
Excretion: Urine (20% to 40% as unchanged drug); feces (6% to 15%)
Dosage
Infants and Children:
Amebiasis: Oral: 35-50 mg/kg/day in divided doses every 8 hours for 10 days
Trichomoniasis: Oral: 15-30 mg/kg/day in divided doses every 8 hours for 7 days
Anaerobic infections:
Oral: 15-35 mg/kg/day in divided doses every 8 hours
I.V.: 30 mg/kg/day in divided doses every 6 hours
Clostridium difficile (antibiotic-associated colitis): Oral: 20 mg/kg/day divided every 6 hours
Maximum dose: 2 g/day
Adults:
Anaerobic infections (diverticulitis, intra-abdominal, peritonitis, cholangitis, or abscess): Oral, I.V.: 500 mg every 6-8 hours, not to exceed 4 g/day
Acne rosacea: Topical:
0.75%: Apply and rub a thin film twice daily, morning and evening, to entire affected areas after washing. Significant therapeutic results should be noticed within 3 weeks. Clinical studies have demonstrated continuing improvement through 9 weeks of therapy.
1%: Apply thin film to affected area once daily
Amebiasis: Oral: 500-750 mg every 8 hours for 5-10 days
Antibiotic-associated pseudomembranous colitis: Oral: 250-500 mg 3-4 times/day for 10-14 days
Note: Due to the emergence of a new strain of C. difficile, some clinicians recommend converting to oral vancomycin therapy if the patient does not show a clear clinical response after 2 days of metronidazole therapy.
Giardiasis: 500 mg twice daily for 5-7 days
Helicobacter pylori eradication: Oral: 250-500 mg with meals and at bedtime for 14 days; requires combination therapy with at least one other antibiotic and an acid-suppressing agent (proton pump inhibitor or H2 blocker)
Bacterial vaginosis or vaginitis due to Gardnerella, Mobiluncus:
Oral: 500 mg twice daily (regular release) or 750 mg once daily (extended release tablet) for 7 days
Vaginal: 1 applicatorful (?37.5 mg metronidazole) intravaginally once or twice daily for 5 days; apply once in morning and evening if using twice daily, if daily, use at bedtime
Trichomoniasis: Oral: 250 mg every 8 hours for 7 days or 375 mg twice daily for 7 days or 2 g as a single dose
Elderly: Use lower end of dosing recommendations for adults, do not administer as a single dose
Dosing adjustment in renal impairment: Clcr <10 mL/minute, but not on dialysis: Recommendations vary: To reduce possible accumulation in patients receiving multiple doses, consider reduction to 50% of dose or every 12 hours; Note: Dosage reduction is unnecessary in short courses of therapy. Clinical recommendations and practice vary. Some references do not recommend reduction at any level of renal impairment (Lamp, 1999).
Hemodialysis: Extensively removed by hemodialysis and peritoneal dialysis (50% to 100%); dosage reduction not recommended; administer full dose posthemodialysis
Peritoneal dialysis: Dose as for Clcr <10 mL/minute
Continuous arteriovenous or venovenous hemofiltration: Administer usual dose
Dosing adjustment/comments in hepatic disease: Unchanged in mild liver disease; reduce dosage in severe liver disease
Dental Usual Dosing
Anaerobic infections/abscess: Adults: Oral, I.V.: 500 mg every 6-8 hours, not to exceed 4 g/day
Treatment of periodontitis (monotherapy or combination) associated with the presence of Actinobacillus actinomycetemcomitans (AA): Adults: Oral: 500 mg every 8 hours for 8 days.
Administration: Oral
May be taken with food to minimize stomach upset. Extended release tablets should be taken on an empty stomach (1 hour before or 2 hours after meals).
Administration: Topical
No disulfiram-like reactions have been reported after topical application, although metronidazole can be detected in the blood. Apply to clean, dry skin. Cosmetics may be used after application (wait at least 5 minutes after using lotion).
Administration: I.V. Detail
pH: 5-7 (ready to use); 0.5-2.0 (reconstituted); 6-7 (further dilution)
Test Interactions
May interfere with AST, ALT, triglycerides, glucose, and LDH testing
Dietary Considerations
Take on an empty stomach. Drug may cause GI upset; if GI upset occurs, take with food. Extended release tablets should be taken on an empty stomach (1 hour before or 2 hours after meals). Sodium content of 500 mg (I.V.): 322 mg (14 mEq). The manufacturer recommends that ethanol be avoided during treatment and for 3 days after therapy is complete.
Patient Education
Take exactly as directed. May take with or without food. Take with food if medication causes upset stomach. Extended release tablets should be taken on an empty stomach. Avoid alcohol during and for 72 hours after last dose. With alcohol you may experience severe flushing, headache, nausea, vomiting, or chest and abdominal pain. May discolor urine (brown/black/dark) (normal). You may experience "metallic" taste disturbance or nausea or vomiting (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Refrain from intercourse or use a contraceptive if being treated for trichomoniasis. Report unresolved or severe fatigue; weakness; fever or chills; mouth or vaginal sores; numbness, tingling, or swelling of extremities; respiratory difficulty; or lack of improvement or worsening of condition. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Breast-feeding is not recommended.
Topical: Wash hands and area before applying. Apply medication thinly. Wash hands after applying. Avoid contact with eyes. Do not cover with occlusive dressing. Report severe skin irritation or if condition does not improve.
Geriatric Considerations
Adjust dose based on renal function.
Anesthesia and Critical Care Concerns/Other Considerations
Metronidazole may have effects similar to that of disulfiram (Antabuse®). If ethanol is taken during and within 24 hours of the last dose of metronidazole, patients may have severe flushing, headache, nausea, vomiting, or chest and abdominal pain.
Cardiovascular Considerations
Metronidazole may have effects similar to that of disulfiram (Antabuse®). If ethanol is taken during and within 24 hours of the last dose of metronidazole, patients may have severe flushing, headache, nausea, vomiting, or chest and abdominal pain.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Unusual/metallic taste, glossitis, stomatitis, xerostomia (normal salivary flow resumes upon discontinuation), and furry tongue.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Dizziness is common; case reports of depression, insomnia, confusion, panic, delusions, hallucinations, exacerbation of schizophrenia
Mental Health: Effects on Psychiatric Treatment
May rarely cause leukopenia; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels
Nursing: Physical Assessment/Monitoring
Assess effectiveness and interactions of other medications patient may be taking. Assess results of laboratory tests, therapeutic effectiveness, and adverse reactions according to dose, route of administration, and purpose of therapy. Assess knowledge/teach patient appropriate use, interventions to reduce side effects, and adverse symptoms to report.
Oncology: Emetic Potential
Low (10% to 30%)
Oncology: Vesicant
No
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule: 375 mg
Flagyl®: 375 mg
Cream, topical: 0.75% (45 g)
MetroCream®: 0.75% (45 g) [contains benzyl alcohol]
Noritate®: 1% (60 g)
Gel, topical: 0.75% (45 g)
MetroGel®: 1% (46 g, 60 g) [60 g tube also packaged in a kit with Cetaphil® skin cleanser]
Gel, vaginal: 0.75% (70 g)
MetroGel-Vaginal®, Vandazole™: 0.75% (70 g)
Infusion [premixed iso-osmotic sodium chloride solution]: 500 mg (100 mL)
Lotion, topical: 0.75% (60 mL)
MetroLotion®: 0.75% (60 mL) [contains benzyl alcohol]
Tablet: 250 mg, 500 mg
Flagyl®: 250 mg, 500 mg
Tablet, extended release:
Flagyl® ER: 750 mg
Pricing: U.S. (www.drugstore.com)
Capsules (Flagyl)
375 mg (30): $123.89
Cream (MetroCream)
0.75% (45): $194.71
Cream (Metronidazole)
0.75% (45): $59.99
Cream (Noritate)
1% (60): $125.34
Emulsion (Rozex)
0.75% (60): $85.00
Gel (Metrogel)
1% (60): $143.63
Gel (Metronidazole)
0.75% (70): $59.99
Gel (Vandazole)
0.75% (70): $46.99
Kit (Metrogel)
1% (1): $142.87
Lotion (MetroLotion)
0.75% (59): $183.99
Lotion (Metronidazole)
0.75% (59): $79.99
Tablet, 24-hour (Flagyl ER)
750 mg (30): $312.87
Tablet, 24-hour (Metronidazole)
750 mg (30): $201.98
Tablets (Flagyl)
250 mg (30): $89.99
500 mg (30): $152.99
Tablets (Metronidazole)
500 mg (30): $12.99
Extemporaneously Prepared
A 20 mg/mL oral suspension can be prepared by crushing ten 250 mg tablets in a mortar, and then adding 10 mL purified water USP to create a uniform paste. Add a small quantity of syrup, then transfer to a graduate and add a sufficient quantity of syrup to make 125 mL. Label “shake well” and “refrigerate.” Refrigerated stability is 10 days.
Irwin DB, Dupuis LL, Prober CG, et al, “The Acceptability, Stability, and Relative Bioavailability of an Extemporaneous Metronidazole Suspension,” Can J Hosp Pharm, 1987, 40:42-6.
Nahata MC, Morosco RS, and Hipple TF, 4th ed, Pediatric Drug Formulations, Cincinnati, OH: Harvey Whitney Books Co, 2000.
References
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“American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk,” Pediatrics, 2001, 108(3):776-89.
Bartlett JG and Perl TM, "The New Clostridium difficile- What Does it Mean?" N Engl J Med, 2005, 353(23):2503-5.
Belliveau PP, Nightingale CH, and Quintilani R, “Stability of Cefotaxime Sodium and Metronidazole in 0.9% Sodium Chloride Injection or in Ready-to-Use Metronidazole Bags,” Am J Health Syst Pharm, 1995, 52(14):1561-3.
Bradley WG, Karlsson IJ, and Russo ICG, “Metronidazole Neuropathy,” Br Med J, 1977, 2:610-1.
Brodgen RN, Heel RC, Speight TM, et al, “Metronidazole in Anaerobic Infections: A Review of Its Activity, Pharmacokinetics and Therapeutic Use,” Drugs, 1978, 16(5):387-417.
Canto JM and Carcia-Cruz D, “Midline Facial Defect as a Teratogenic Effect of Metronidazole,” Birth Defects, 1982, 18:85-8.
Cassey JG, Clark DA, Merrick P, et al, “Pharmacokinetics of Metronidazole in Patients Undergoing Peritoneal Dialysis,” Antimicrob Agents Chemother, 1983, 24:950-1.
Committee on Adolescence, American Academy of Pediatrics, “Sexual Assault and the Adolescent,” Pediatrics, 1994, 94(5):761-5.
Coronado BE, Opal SM, and Yoburn DC, “Antibiotic-Induced D-Lactic Acidosis,” Ann Intern Med, 1995, 122(11):839-42.
Eisenberg L, Suchow R, Coles RS, et al, “The Effects of Metronidazole Administration on Clinical and Microbiologic Parameters of Periodontal Disease,” Clin Prev Dent, 1991, 13(1):28-34.
Falagas ME and Gorbach SL, “Clindamycin and Metronidazole,” Med Clin North Am, 1995, 79(4):845-67.
Fekety R and Shah AB, “Diagnosis and Treatment of Clostridium difficile Colitis,” JAMA, 1993, 269(1):71-5.
Freeman CD, Klutman NE, and Lamp KC, “Metronidazole. A Therapeutic Review and Update,” Drugs, 1997, 54(5):679-708.
Hager WD and Rapp RP, “Metronidazole,” Obstet Gynecol Clin North Am, 1992, 19(3):497-510.
Hampson JP, “The Use of Metronidazole in the Treatment of Malodorous Wounds,” J Wound Care, 1996, 5(9):421-5.
Israel DM and Hassall E, “Treatment and Long-Term Follow-up of Helicobacter pylori-Associated Duodenal Ulcer Disease in Children,” J Pediatr, 1993, 123(1):53-8.
Jenkins WM, MacFarlane TW, Gilmour WH, et al, “Systemic Metronidazole in the Treatment of Periodontitis,” J Clin Periodontol, 1989, 16(7):433-50.
Kelly CP, Pothoulakis C, and LaMont JT, “Clostridium difficile Colitis,” N Engl J Med, 1994, 330(4):257-62.
Lam S and Bank S, “Hepatotoxicity Caused by Metronidazole Overdose,” Ann Intern Med, 1995, 122(10):803.
Lamp KC, Freeman CD, Klutman NE, et al, “Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials,” Clin Pharmacokinet, 1999, 36(5):353-73.
Lau AH, Chang CW, and Sabatini S, “Hemodialysis Clearance of Metronidazole and its Metabolites,” Antimicrob Agents Chemother, 1986, 29(2):235-8.
Loesche WJ, Giordano JR, Hujoel P, et al, “Metronidazole in Periodontitis: Reduced Need for Surgery,” J Clin Periodontol, 1992, 19(2):103-12.
Loesche WJ, Schmidt E, Smith BA, et al, “Effects of Metronidazole on Periodontal Treatment Needs,” J Periodontol, 1991, 62(4):247-57.
Lorber B, "Update in Infectious Diseases," Ann Intern Med, 2006, 145:356-7.
Ludwig E, Csiba A, Magyar T, et al, “Age-Associated Pharmacokinetic Changes of Metronidazole,” Int J Clin Pharmacol Ther Toxicol, 1983, 21(2):87-91.
Oldenburg B and Speck WT, “Metronidazole,” Pediatr Clin North Am, 1983, 30(1):71-5.
Patterson BD, “Possible Interaction Between Metronidazole and Carbamazepine,” Ann Pharmacother, 1994, 28(11):1303-4.
Ralph ED, “Clinical Pharmacokinetics of Metronidazole,” Clin Pharmacokinet, 1983, 8:43-62.
Smilack JD, Wilson WR, and Cockerill FR 3d, “Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole,” Mayo Clin Proc, 1991, 66(12):1270-80.
Smogyi A, Kong C, Sabto J, et al, “Disposition and Removal of Metronidazole in Patients Undergoing Haemodialysis,” Eur J Clin Pharmacol, 1983, 25:683-7.
Soder PO, Frithiof L, Wikner S, et al, “The Effect of Systemic Metronidazole After Nonsurgical Treatment in Moderate and Advanced Periodontitis in Young Adults,” J Periodontol, 1990, 61(5):281-8.
“Treatment of Clostridium difficile Diarrhea,” Med Lett Drugs Ther, 1989, 31(803):94-5.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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