What is Metronidazole?
Metronidazole is a type of antibiotic used to treat different infections due to its different faculties fighting against bacteria, helminths and protozoan microorganisms. Mostly used to treat infections when different pathogens are identified such as:
- Gardnerella vaginalis
- Entamoeba histolytica
- Giardia lamblia
- Balantidium coli
- Fusobacteria Clostridia
Each white colored, round tablet contains 400 mg of Metronidazole as active ingredient. Every box contains 21 Metronidazole tablets to treat infections according to the specified treatment given by your doctor. Metronidazole is not an over the counter medicine, therefore you need a prescription from a doctor to obtain this medication.
What other substances does Metronidazole 400 mg contain?
- Maize Starch
- Magnesium Stearate
- Colloidal anhydrous silica
What are Metronidazole tablets mainly used for?
Metronidazole tablets are used to fight different types of diseases caused by anaerobic microorganisms. Metronidazole can be used to treat BV or Bacterial Vaginosis.
What is Bacterial Vaginosis?
Bacterial Vaginosis is a type of inflammation in your vagina caused by the multiplication and overgrowth of the microorganisms that are naturally found in your vagina, called Lactobacilli. It is also known as nonspecific vaginitis.
Commonly known as BV, is considered to be one of the most common vaginal affection in women of reproductive age (14-49 years old). Normally, the vaginal flora consists of different microorganisms, being one of the most important Lactobacilli. Lactobacili have different sub-types and are different according to your ethnicity. These microorganisms maintain your vagina in an acidic environment (pH levels), preventing harmful bacteria to reproduce. When this barrier fails, “bad” bacteria start multiplying and that’s when the bacterial vaginosis occurs.
What are the risk factors of contracting BV?
- Changes in your body: Pregnancy can lead to a higher prevalence and it is found that around 7-22% of pregnant women will suffer from this condition.
- Multiple sexual partners throughout your lifetime
- New sexual partner.
- Birth control devices such as IUD (intrauterine device)
- Vaginal hygiene products that contain perfume: vaginal deodorants, perfumed bubble baths
- Vaginal douches
- Use of strong detergents to wash underwear
- Tight clothing such as underwear or pants.
- Underwear made out of synthetic fibers.
- History of induced abortion
- Recent antibiotic treatment for other infections.
- Recent studies have identified vitamin D deficiency as a risk factor in pregnant women
- BV can be associated with hormonal factors since it develops most often around the time of menstruation, and may resolve spontaneously mid-cycle.
- Natural lack of Lactobacilli.
It is important to know that bacterial vaginosis can’t be transmitted from using public toilet seats, swimming pools, bed sheets or through contact.
Sexual activity has an indirect role in this disease. Women who have never had any type of sexual intercourse including oral, vaginal or anal sex can still be affected by this disease, but the prevalence of BV has a significant increase based on the number of sexual partners throughout your lifetime.
What are the signs and symptoms of BV?
The most common symptoms are usually recognized after sexual intercourse and include:
- Distinctive “fish-like” vaginal odor
- Increase in vaginal discharge
- Change in color of vaginal discharge: White to grayish color.
- Vulvar irritation or itching
- Burning pee sensation or pain decrease in the amount of urine. ( Less commonly.)
What are the complications if you don’t get treated?
BV can be spontaneously cure because of the hormonal changes that occur throughout your menstrual cycle, but it is important to take certain precautions and use medicine so that complications do not develop and mostly in pregnant women.
Some of the complications are:
- Susceptibility to other sexually transmitted infections such as chlamydia, gonorrhea, HIV, herpes simplex virus and others.
- Pelvic Inflammatory disease: also known as PID, is a complication of sexually transmitted disease that affects the uterus and Fallopian tubes that increase the risk of being infertile.
- Cervicitis: inflammation of the cervix, usually goes hand in hand with other infections such as gonorrhea, chlamydia and HSV (herpes simplex virus)
- Endometritis: Inflammation of the endometrium which can cause abnormal bleeding
- Higher predisposition to suffer from urinary tract infections
- Spontaneous abortions
- Salpingitis: inflammation of Fallopian tubes
- Bacteremia: Presence of bacteria in the bloodstream
When should you visit a doctor?
You should make an appointment with your doctor if you
- notice that your vaginal discharge is different in color and or smell
- presence of fever
- you’ve tried over the counter medicines and symptoms are still persistent
- if you present the symptoms and have a new sexual partner
- if you have had vaginal infections in the past but this time it appears different
- if you are pregnant or plan to get pregnant
- if you are breastfeeding
- if you experience abdominal or pelvic pain
Who should consider other alternatives over Metronidazole tablets 400 mg?
Metronidazole has a Black Box Warning, meaning that studies with animals have shown it can produce a carcinogenic effect, therefore might have the same effect in humans. Metronidazole should only be used when prescribed by a doctor.
You should consider other options over Metronidazole 400 mg tablets if you suffer or have:
- Known hypersensitivity to metronidazole or other medicines that contain nitrimidazoles.
- If you are pregnant in your first trimester.
- Suffer from Liver disease: A doctor will either change medication or change the therapeutic dosage.
- Suffer from Kidney disease
- Suffer from blood dyscrasia: a health condition that occurs when blood components, ( red blood cells, white blood cells or platelets) are impaired and tend to either increase or decrease in abnormal levels.
Should you be tested for other sexually transmitted diseases?
Since bacterial vaginosis tends to increase the percentage of acquiring a sexually transmitted disease it is recommended for women to be tested for other infections such as gonorrhea, chlamydia, herpes simplex virus (HSV) and HIV depending on the life style habits and risk factors present in the patient.
It is important to know that chronic use of metronidazole or clindamycin may alter the flora found in the vagina which may lead to a predisposition to vaginal candidiasis.
Are there medicines that have interactions with Metronidazole?
- Alcohol :Alcohol consumption is not recommended when using Metronidazole 400 mg tablets. It should be avoided during and 48 hours after using Metronidazole 400 mg tablets.
- Disulfiram: Mixing with Metronidazole can provoke psychotic reactions such as hallucinations, confusion and delusion.
- Antiepileptic medication: Phenobarbital and phenytoin affects the efficiency of metronidazole, therefore the treatment might not work correctly if taken with these medications.
- Psychiatric medications: Lithium taken with Metronidazol may cause renal damage. Therefore, the amount of metronidazole should be adjusted accordingly to these patients.
- Anticoagulant therapy: Metronidazole will cause Warfarin to be potentiated, therefore dosage and coagulation times on patients taking this medication should be adjusted and controlled.
- Cancer treatment: Busulfan should not be given in conjunction with Metronidazol because of possible toxicity by Busulfan.
How should you take Metronidazole 400 mg tablets?
Metronidazole 400 mg tablets are taken orally, can be taken with water, during or after meals. They should not be chewed. Tablets of 400 mg should be taken twice a day for 5 to 7 days, depending on your doctor’s prescription. A single dose of 2000mg for one day can also be taken. (5 tablets)
Can Metronidazole 400mg tablets be used in pregnant or breastfeeding women?
Metronidazole 400 mg tablets should not be used in pregnant women in their first trimester. Women who are pregnant or breastfeeding should consider other options before using Metronidazole 400 mg. Since this medicine is used only with prescription, it is advisable you let your doctor know if you are stilll breastfeeding or if you think you might be pregnant.
Should your sexual partner be treated as well if you were diagnosed with BV?
It is not necessary for your sexual partner to be treated if he/she does not present any symptoms, so no prophylactic treatment is necessary for this.
What should you do if you miss a dose?
If you miss a dose of Metronidazole 400 mg talets be sure to take it as soon as you remember. If you are close to taking the next dosage, do not take double the dosage to try to make up for the forgotten one. Continue your treatment as stated. Be sure to take your medications every day at the same hour to avoid forgetting any dosage.
When should you stop taking the medication?
Always take the medication as prescribed by your doctor. Never stop the regimen just because you feel better or your discharge has stopped. This will lead to recurrent bacterial vaginosis or bacterial antibiotic resistance that will lead to complications.
What should you do if you took the medicine and the symptoms didn’t disappear?
Recurrent symptoms after 3 months are common in around 30% of women who suffer from bacterial vaginosis and 50% of women may present it in the upcoming 6 months. A 7 day oral or vaginal cream treatment may be used. Either Metronidazole or Clindamycin should work, with the only exception that if the first time you took metronidazole orally, next time change the treatment to Clindamycin in cream prospective and vice-versa. Be sure to visit your doctor if you present more than three bacterial vaginosis episodes in between 12 months, since the treatment will have to change.
Is there a risk of overdose by taking Metronidazole 400 mg tablets?
Cases of accidental and suicidal attempts intake of up to 12 g of Metronidazole have been reported. The symptoms presented were fatigue, vomiting, inability to walk or correctly (ataxia) and disorientation were reported. If you or someone you know has taken more than what has been prescribed by your doctor and presents these symptoms, be sure to seek medical help.
Like all medicines, Metronidazole Tablets can cause side effects, although not everybody gets them.
Talk to your doctor straight away if you notice the following side effects.
- Yellowing of the skin and eyes. This could be due to a liver problem (jaundice).
- Unexpected infections, mouth ulcers, bruising, bleeding gums, or severe tiredness. This could be caused by a blood problem.
- Severe stomach pain which may reach through to your back (pancreatitis)
Not known (frequency cannot be estimated from the available data)
- Numbness, tingling, pain, or a feeling of weakness, in the arms or legs
- Unpleasant taste in the mouth
- Furred tongue
- Feeling sick (nausea), being sick (vomiting), upset stomach, or diarrhoea
- Loss of appetite
- Feeling depressed
- Pain in your eyes (optic neuritis)
- A group of symptoms together including: fever, nausea, vomiting, headache, stiff neck and extreme sensitivity to bright light. This may be caused by an inflammation of the membranes that cover the brain and spinal cord (meningitis)
- Hearing impairment/ hearing loss
- Ringing in the ears (tinnitus)
- You get a rash or skin discolouration with or without raised areas which often reoccurs at the same location each time the drug is taken
The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from the PDF-version from this website because it may have been updated since your medicine was packaged or the medicine is from another brand.