Buy Trichopol pills 250 mg, 20 pcs
  • Buy Trichopol pills 250 mg, 20 pcs

Metronidazole

Polpharma
830 Items
2019-09-19
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Clinical Pharmacology

Anti-protozoan drug with antibacterial activity, a derivative of 5-nitroimidazole. The mechanism of action is the biochemical reduction of the 5-nitro group of metronidazole by intracellular transport proteins of anaerobic microorganisms and protozoa. The recovered 5-nitro group of metronidazole interacts with the microbial cell DNA, inhibiting the synthesis of their nucleic acids, which leads to the death of microorganisms.

Metronidazole is active against Trichomonas vaginalis, Entamoeba histolytica, Gardnerella vaginalis, Giardia intestinalis, Lamblia spp .; as well as obligate anaerobes Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus), Fusobacterium spp., Veillonella spp., Prevotella spp. (Prevotella bivia, Prevotella buccae, Prevotella disiens); some gram-positive microorganisms (Eubacterium spp., Clostridium spp., Peptococcus spp., Peptostreptococcus spp.). The BMD for these strains is 0.125-6.25 mcg / ml.

In combination with amoxicillin is active against Helicobacter pylori (amoxicillin inhibits the development of metronidazole resistance).

Metronidazole does not have a bactericidal effect against most bacteria and facultative anaerobes, fungi and viruses. In the presence of mixed flora (aerobes and anaerobes), metronidazole is synergistic with antibiotics that are effective against conventional aerobes.

Metronidazole increases the sensitivity of tumors to radiation, causes sensitization to ethanol (disulfiram-like action), stimulates reparative processes.

Indications

  • trichomoniasis;
  • bacterial vaginosis;
  • all forms of amebiasis (diseases of the intestinal and extra-intestinal localization, including amebic liver abscess, amoebic dysentery, as well as asymptomatic amebiasis);
  • giardiasis;
  • periodontal infections (including acute ulcerative gingivitis, acute odontogenic infections);
  • anaerobic bacterial infections (gynecological and abdominal infections, CNS infections, bacteremia, sepsis, endocarditis, infections of bones and joints, skin and soft tissues, respiratory tract infections) caused by Bacteroides spp., Clostridium spp., Eubacterium spp., Peptococcus spp. Peptostreptococcus spp. and anaerobes sensitive to metronidazole;
  • treatment of Helicobacter pylori infections in gastric or duodenal ulcers in combination with bismuth preparations and an antibiotic, for example, amoxicillin;
  • prophylactic appointment before surgery on the digestive tract and reproductive organs.

Composition

Excipients: potato starch, gelatin, starch syrup, magnesium stearate.

Metronidazole is marketed under different brands and generic names, and comes in different dosage forms:

Brand nameManufacturerCountryDosage form
Trichopol Polpharma Poland pills
Metrogyl Yunik Pharmaceutical India vials
Metrogyl Yunik Pharmaceutical India gel
Flagyl® Sanofi-aventis France pills
Metronidazole Takeda GmbH Japan pills
Metronidazole Anzhero-Sudzhensky HFZ Russia suppositories
Metronidazole Pharmstandard Russia pills
Metronidazole-AKOS Synthesis AKOMP Russia vials
Rosex Laboratories Galderma France cream
Rozamet Jadran-Galensky Laboratories ao Croatia cream
Klion Gedeon Richter Hungary pills
Flagyl® Sanofi-aventis France suppositories

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Metronidazole

Dosage and Administration

The drug is prescribed inside, during or after a meal, pills are taken without chewing.

Trichomoniasis

Adults and children over 10 years old are prescribed 250 mg (1 tab.) 3 times / day or 500 mg (2 tab.) 2 times / day for 7 days. Women need to additionally appoint metronidazole in the form of vaginal suppositories or pills. If necessary, you can repeat the treatment. Between courses, you should take a break of 3-4 weeks with repeated laboratory tests.

An alternative treatment regimen is the administration of 750 mg (3 tab.) In the morning and 1250 mg (5 tab.) In the evening or 2000 mg (8 tab.) / Day once. The duration of treatment is 2 days. Treatment is carried out simultaneously with both sexual partners.

Children aged 3 to 7 years, appoint 125 mg (1/2 tab.) 2 times / day; at the age of 7 to 10 years - 125 mg (1/2 tab.) 3 times / day. The course of treatment is 7 days.

Bacterial vaginosis

Adults appoint 500 mg (2 tab.) 2 times / day for 7 days or 2000 mg (8 tab.) / Day once. Simultaneous treatment of the sexual partner is not required.

Amebiasis

In invasive forms of intestinal amebiasis in susceptible patients (including those with amoebic dysentery), adults and children over 10 years old are prescribed 750 mg (3 tab.) 3 times / day. Children aged 3 to 7 years - 250 mg (1 tab.) 4 times / day; at the age of 7 to 10 years old - at 375 mg (1.5 tab.) 3 times / day. The course of treatment is usually 5 days.

In intestinal amebiasis in less susceptible patients and in chronic amoebic hepatitis, adults and children over 10 years old are prescribed 375 mg (1.5 tab.) 3 times / day. Children aged 3 to 7 years - 125 mg each (1/2 tab.) 4 times / day; at the age of 7 to 10 years - 250 mg (1 tab.) 3 times / day. Duration of treatment is 5-10 days.

In amoebic abscess of the liver and other forms of extraintestinal amebiasis, adults and children over 10 years old are prescribed 375 mg (1.5 tab.) 3 times / day. Children aged 3 to 7 years - 125 mg (1/2 tablet) 4 times / day; at the age of 7 to 10 years, 250 mg each (1 tab.) 3 times / day. The course of treatment is 5 days.

For asymptomatic cysts carriage, adults and children over 10 years old are prescribed 375-750 mg (1.5-3 pills) 3 times / day. Children aged 3 to 7 years - 125 mg (1/2 tab.) 4 times / day; at the age of 7 to 10 years, 250 mg each (1 tab.) 3 times / day. Duration of treatment is 5-10 days.

Giardiasis

Adults and children over 10 years old are prescribed 500 mg (2 tab.) 2 times / day for 5 -7 days; or 2000 mg (8 tab.) 1 time / day for 3 days.

Children aged 3 to 7 years - 250-375 mg each (1-1.5 tab.) 1 time / day for 5 days, or 500-750 mg (2-3 tab.) 1 time / day for 3 days Children aged 7 to 10 years - 250 mg (1 tab.) 2 times / day for 5 days, or 1000 mg (4 tab.) 1 time / day for 3 days.

Periodontal infections

In acute ulcerative gingivitis, adults and children over 10 years old are prescribed 250 mg each (1 tab.) 3 times / day. Children aged 3 to 7 years - 125 mg (1/2 tab.) 2 times / day; at the age of 7 to 10 years, 125 mg each (1 tab.) 3 times / day. Duration of treatment is 3 days.

In acute odontogenic infections, adults and children over 10 years old are prescribed 250 mg each (1 tab.) 3 times / day for 3-7 days.

Infections caused by anaerobic bacteria

Treatment of anaerobic infections usually begin with IV infusion. As soon as it becomes possible, treatment should be continued with metronidazole in the form of pills.

Adults and children over 10 years old appoint 500 mg (2 tab.) 3-4 times / day. The duration of treatment should not exceed 7 days.

Children under 10 years old when treating anaerobic infections are advised to use metronidazole in the form of infusion solutions.

Eradication of Helicobacter pylori

Assign 500 mg (2 tab.) 3 times / day for 7 days (as part of combination therapy, for example, with amoxicillin 2.25 g / day).

Prevention of infections caused by anaerobic bacteria (before surgery on the abdomen, in gynecology and obstetrics)

Adults and children over 12 years old are prescribed 250-500 mg (1-2 tab.) 3 times / day for 3-4 days before surgery. 1-2 days after surgery (when oral administration is already permitted), 250 mg (1 tab.) Is prescribed 3 times / day for 7 days.

In case of severe renal failure (CC less than 10 ml / min), the daily dose of Trihopol should be reduced by 2 times.

Adverse reactions

From the digestive system: epigastric pain, nausea, vomiting, diarrhea, constipation, intestinal colic, loss of appetite, anorexia, taste disturbance, unpleasant metallic taste in the mouth, dry mouth, glossitis, stomatitis; very rarely - abnormal liver function tests, cholestatic hepatitis, jaundice, pancreatitis.

From the side of the central nervous system: with prolonged use - headache, dizziness, incoordination, ataxia, peripheral neuropathy, irritability, irritability, depression, sleep disturbance, drowsiness, weakness; in some cases - confusion, hallucinations, convulsions; very rarely - encephalopathy.

From the urinary system: dysuria, cystitis, polyuria, urinary incontinence, urine staining in red-brown color.

From the reproductive system: pain in the vagina.

Allergic reactions: skin rash, itching, urticaria, erythema multiforme exudative, nasal congestion, fever.

From the musculoskeletal system: myalgia, arthralgia.

From the hemopoietic system: leukopenia; rarely - agranulocytosis, neutropenia, thrombocytopenia, pancytopenia.

Other: flattening of the T wave on the ECG; extremely rarely - ototoxicity; pustular rash.

Contraindications

With care, the drug should be prescribed to patients with renal and / or liver failure, in the II and III trimesters of pregnancy.

Drug interactions

Metronidazole enhances the effect of warfarin and other coumarin anticoagulants (this combination requires a reduction in the doses of both drugs).

Similar to disulfiram, metronidazole causes ethanol intolerance. The simultaneous use of Trichopol with disulfiram can lead to the development of various neurological symptoms (the interval between the use of these drugs should be at least 2 weeks).

Cimetidine inhibits the metabolism of metronidazole, which can lead to an increase in its concentration in the blood plasma and an increased risk of adverse reactions.

The simultaneous administration of drugs that stimulate the activity of microsomal liver enzymes (phenobarbital, phenytoin) can accelerate the elimination of metronidazole, which leads to a decrease in its concentration in blood plasma.

In patients receiving long-term treatment with lithium preparations in high doses, when taking metronidazole, it is possible to increase the concentration of lithium in the blood plasma and develop intoxication symptoms.

It is not recommended to combine metronidazole with non-depolarizing muscle relaxants (vecuronium bromide).

With the combined intake of metronidazole and cyclosporine, an increase in plasma concentration of cyclosporine may be observed.

Metronidazole reduces the clearance of fluorouracil, which can cause an increase in the toxicity of the latter.

Sulfonamides enhance the antimicrobial action of metronidazole.

Pregnancy and Lactation

Trichopolum is contraindicated for use in the first trimester of pregnancy. The use of the drug in the II and III trimesters is possible only in cases where the intended benefit to the mother outweighs the potential risk to the fetus.

If necessary, use Trichopolum during lactation breastfeeding should be discontinued.

Special instructions

Caution should be appointed Trichopol® in patients with severe liver failure, because as a result of slower metabolism, plasma concentration of metronidazole and its metabolites increases.

Due to slower excretion, care must be taken when choosing a dose of metronidazole in patients with renal insufficiency.

Caution is required when prescribing Trihopol to patients with oppression of bone marrow hematopoiesis and CNS functions, as well as elderly patients. The appearance of ataxia, dizziness, and any other deterioration in the neurological status of patients requires discontinuation of treatment.

With prolonged therapy with metronidazole (more than 10 days), the picture of peripheral blood and liver function should be monitored.

In case of leukopenia, the possibility of continuing treatment depends on the risk of developing an infectious process.

Metronidazole should be avoided in patients with porphyria.

Trichopol® may cause immobilization of treponema, which leads to a false-positive test of Nelson.

When treating Trichomonas vaginitis in women and Trichomonas urethritis in men, it is necessary to refrain from sex. Necessarily simultaneous treatment of sexual partners. After treatment of trichomoniasis, control tests should be carried out for three consecutive cycles before and after menstruation.

After giardiasis treatment, if symptoms persist, after 3-4 weeks it is necessary to perform 3 stool tests at intervals of several days (some successfully treated patients may have lactose intolerance caused by invasion for several weeks or months, recalling the symptoms of giardiasis).

Patients should refrain from drinking alcohol during therapy with metronidazole, as well as for at least 48 hours after completion of treatment, due to the possibility of disulfiram-like reactions: abdominal pain of a spastic nature, nausea, vomiting, headache, a sudden rush of blood to the face.

During treatment with metronidazole, urine may acquire a dark or red-brown color due to the presence of water-soluble dyes.

Use in Pediatrics

In combination with amoxicillin is not recommended to apply Trichopol® in children and adolescents under the age of 18 years.

Influence on ability to drive motor transport and control mechanisms

When taking the drug, you should avoid potentially hazardous activities that require high concentration of attention, speed of psychomotor reactions, especially driving vehicles and maintenance mechanisms.

Overdosage

Symptoms: increased side effects, mainly nausea, vomiting, and dizziness; in more severe cases, ataxia, paresthesia and convulsions are possible. The lethal dose for humans is unknown.

Treatment: symptomatic and supportive therapy. The specific antidote is absent.

  • Active ingredient: Metronidazole

Studies and clinical trials of Metronidazole (Click to expand)

  1. Prenatal exposure to metronidazole and risk of childhood cancer : A retrospective cohort study of children younger than 5 years
  2. Crystal dissolution-controlled release systems. II. Metronidazole release from semicrystalline poly(vinyl alcohol) systems
  3. Metronidazole appears not to be a human teratogen: Review of literature
  4. Metronidazole vaginal gel 0.75% (MetroGel-Vaginal®): A brief review
  5. Narrow-bore reversed-phase liquid chromatography of metronidazole benzoate and its hydrolysis products
  6. Quantitative assay of metronidazole by capillary zone electrophoresis with amperometric detection at a gold microelectrode
  7. Metronidazole and interstitial implantation in the treatment of extensive recurrent head and neck cancers
  8. Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole
  9. Synthesis, Crystal Structure, and Enhancement of the Efficacy of Metronidazole Against Entamoeba histolytica by Complexation with Palladium(II), Platinum(II), or Copper(II)
  10. Metronidazole: A potential therapeutic agent in paroxysmal nocturnal hemoglobinuria
  11. Possible metronidazole teratogenicity and clefting
  12. Bacteroides meningitis successfully treated with metronidazole
  13. Synthesis and antimicrobial activity of metronidazole containing polymer and copolymers
  14. Steady-state pharmacokinetics of metronidazole in Crohn's disease
  15. Teratogenic evaluation of metronidazole and ornidazole using Drosophila melanogaster as an experimental model
  16. Metronidazole prophylaxis for elective large bowel surgery in children: A prospective trial
  17. The use of metronidazole in the preparation of the bowel for surgery
  18. Intrarectal metronidazole in the prevention of anaerobic infections after emergency appendicectomy: A controlled clinical trial
  19. A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy
  20. Short term metronidazole therapy contrasted with povidone-iodine spray in the prevention of wound infection after appendicectomy
  21. Single and multiple dose cotrimoxazole and metronidazole in colorectal surgery
  22. Prophylactic metronidazole in appendicectomy: A controlled trial
  23. Prophylactic use of metronidazole in preventing wound sepsis after elective cholecystectomy

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