What is Flagyl (metronidazole), and what is it used for?
Flagyl and Flagyl Extended Release (metronidazole) is an antibiotic used to treat bacterial and parasitic infections including Giardia infections of the small intestine, amebic liver abscess, amebic dysentery, bacterial vaginosis, trichomonas vaginal infections, carriers of trichomonas (both sexual partners) who do not have symptoms of infection; abscesses in the liver, pelvis, abdomen, and brain; C. difficile (C. diff) diarrhea; Helicobacter pylori (H. pylori) that causes stomach or intestinal ulcers; and acne rosacea.
Common side effects of Flagyl and Flagyl ER include nausea, headaches, loss of appetite, rash (rare), abdominal cramps, vomiting, diarrhea, dry mouth, dark-colored urine, metallic taste in mouth, weight loss, constipation, furry tongue, nasal congestion, flushing, and vaginal dryness.
Serious side effects of Flagyl and Flagyl ER include brain disease, fevers, mouth sores, painful urination, nerve damage resulting in prickling or tingling sensations that may become permanent, cystitis, pelvic pain or pressure, decreased sex drive, inflammation of the lining of the rectum, inflammation of the mouth and lips, inflammation of the tongue, seizures, numbness and tingling of extremities, encephalopathy, aseptic meningitis, and colon cancer in people with Crohn's disease.
Drug interactions with Flagyl and Flagyl ER include alcohol, warfarin, cimetidine, cholestyramine, amprenavir, propylene glycol, carbamazepine, lithium, and cyclosporine. Flagyl and Flagyl ER should not be used in early pregnancy because of potential adverse effects on the fetus. Flagyl and Flagyl ER are excreted in breast milk. Because of potential adverse effects on the newborn, females who are nursing should not use metronidazole.
What are the important side effects of Flagyl (metronidazole)?
Flagyl is a useful antibiotic and is generally well tolerated with appropriate use.
The most common and minor side effects include:
- Loss of appetite
- A metallic taste
- Rarely a rash
- Abdominal cramps
- Dry mouth
- Dark-colored urine
- Metallic taste in mouth
- Weight loss (anorexia)
- Furry tongue
- Nasal congestion
- Vaginal dryness
Side effects that are uncomfortable, but may become serious include:
- Brain disease
- Mouth sores
- Pain with urination
- Prickling or tingling sensations that may become permanent
- Pelvic pain or pressure
- Decrease of libido
Serious side effects of Flagyl are rare and the drug should be stopped if these symptoms appear:
Flagyl (metronidazole) side effects list for healthcare professionals
The following reactions have been reported during treatment with metronidazole:
Central Nervous System
The most serious adverse reactions reported in patients treated with metronidazole have been convulsive seizures, encephalopathy, aseptic meningitis, optic and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity. Since persistent peripheral neuropathy has been reported in some patients receiving prolonged administration of metronidazole, patients should be specifically warned about these reactions and should be told to stop the drug and report immediately to their physicians if any neurologic symptoms occur. In addition, patients have reported headache, syncope, dizziness, vertigo, incoordination, ataxia, confusion, dysarthria, irritability, depression, weakness, and insomnia.
The most common adverse reactions reported have been referable to the gastrointestinal tract, particularly nausea, sometimes accompanied by headache, anorexia, and occasionally vomiting; diarrhea; epigastric distress; and abdominal cramping and constipation.
A sharp, unpleasant metallic taste is not unusual. Furry tongue, glossitis, and stomatitis have occurred; these may be associated with a sudden overgrowth of Candida which may occur during therapy.
Erythematous rash and pruritus.
Flattening of the T-wave may be seen in electrocardiographic tracings.
Dysuria, cystitis, polyuria, incontinence, and a sense of pelvic pressure. Instances of darkened urine have been reported by approximately one patient in 100,000. Although the pigment which is probably responsible for this phenomenon has not been positively identified, it is almost certainly a metabolite of metronidazole and seems to have no clinical significance.
Proliferation of Candida in the vagina, dyspareunia, decrease of libido, proctitis, and fleeting joint pains sometimes resembling “serum sickness.” Rare cases of pancreatitis, which generally abated on withdrawal of the drug, have been reported.
Patients with Crohn's disease are known to have an increased incidence of gastrointestinal and certain extraintestinal cancers. There have been some reports in the medical literature of breast and colon cancer in Crohn's disease patients who have been treated with metronidazole at high doses for extended periods of time. A cause and effect relationship has not been established. Crohn's disease is not an approved indication for Flagyl tablets.
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What drugs interact with Flagyl (metronidazole)?
Psychotic reactions have been reported in alcoholic patients who are using metronidazole and disulfiram concurrently. Metronidazole should not be given to patients who have taken disulfiram within the last two weeks.
Warfarin And other Oral Anticoagulants
Metronidazole has been reported to potentiate the anticoagulant effect of warfarin and other oral coumarin anticoagulants, resulting in a prolongation of prothrombin time. When Flagyl is prescribed for patients on this type of anticoagulant therapy, prothrombin time and INR should be carefully monitored.
In patients stabilized on relatively high doses of lithium, short-term metronidazole therapy has been associated with elevation of serum lithium and, in a few cases, signs of lithium toxicity. Serum lithium and serum creatinine levels should be obtained several days after beginning metronidazole to detect any increase that may precede clinical symptoms of lithium intoxication.
Metronidazole has been reported to increase plasma concentrations of busulfan, which can result in an increased risk for serious busulfan toxicity. Metronidazole should not be administered concomitantly with busulfan unless the benefit outweighs the risk. If no therapeutic alternatives to metronidazole are available, and concomitant administration with busulfan is medically needed, frequent monitoring of busulfan plasma concentration should be performed and the busulfan dose should be adjusted accordingly.
Drugs That Inhibit CYP450 Enzymes
The simultaneous administration of drugs that decrease microsomal liver enzyme activity, such as cimetidine, may prolong the half-life and decrease plasma clearance of metronidazole.
Drugs That Induce CYP450 Enzymes
The simultaneous administration of drugs that induce microsomal liver enzymes, such as phenytoin or phenobarbital, may accelerate the elimination of metronidazole, resulting in reduced plasma levels; impaired clearance of phenytoin has also been reported.
Drug/Laboratory Test Interactions
Metronidazole may interfere with certain types of determinations of serum chemistry values, such as aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), lactate dehydrogenase (LDH), triglycerides, and glucose hexokinase. Values of zero may be observed. All of the assays in which interference has been reported involve enzymatic coupling of the assay to oxidation-reduction of nicotinamide adenine dinucleotide (NAD+ NADH). Interference is due to the similarity in absorbance peaks of NADH (340 nm) and metronidazole (322 nm) at pH 7.
Common side effects of the antibiotic Flagyl (metronidazole) include nausea, headaches, loss of appetite, vomiting, diarrhea, dry mouth, dark-colored urine, metallic taste in mouth, weight loss, constipation, and vaginal dryness. Serious side effects include brain disease, fevers, mouth sores, painful urination, nerve damage resulting in prickling or tingling sensations that may become permanent, encephalopathy, aseptic meningitis, and colon cancer in people with Crohn's disease, among others.
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Related Disease Conditions
Bacterial vaginosis is an abnormal vaginal condition with signs and symptoms of vaginal discharge, vaginal odor, and vaginal pain. Bacterial vaginosis results from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Antibiotics are the only treatment to cure trichomoniasis.
Clostridium Difficile Colitis (Antibiotic-Associated Colitis, C. difficile colitis)
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found: on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis includes: hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Giardiasis (Giardia lamblia) is a parasite responsible for a common form of infectious diarrhea. The parasite lives in two stages: trophozoites and cysts. People at risk for giardiasis are those that live in areas where there is inadequate sanitation or treatment of drinking water. Giardiasis also is a common cause of outbreaks of diarrhea in day-care centers. Symptoms of giardiasis include abdominal pain, stomach cramping, bloating, nausea, and fatigue. Treatment for giardiasis is with antibiotic medication.
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