Prothrombin times should be monitored. There is no interaction with heparin. Lithium retention accompanied by evidence of possible renal damage has been reported in patients treated simultaneously with lithium and metronidazole. Lithium treatment should be tapered or withdrawn before administering metronidazole. Plasma concentrations of lithium, creatinine and electrolytes should be monitored in patients under treatment with lithium while they receive metronidazole.
Patients receiving phenobarbital or phenytoin metabolise metronidazole at a much greater rate than normally, reducing the half-life to approximately 3 hours. Metronidazole reduces the clearance of 5 fluorouracil and can therefore result in increased toxicity of 5 fluorouracil. Patients receiving ciclosporin are at risk of elevated ciclosporin serum levels. Serum ciclosporin and serum creatinine should be closely monitored when coadministration is necessary.
Plasma levels of busulfan may be increased by metronidazole which may lead to severe busulfan toxicity.
Nevertheless Flagyl, like other medicines, should not be given during pregnancy or during lactation unless the physician considers it essential; in these circumstances the short, high-dosage regimens are not recommended. Serious adverse reactions occur rarely with standard recommended regimens. Clinicians who contemplate continuous therapy for the relief of chronic conditions, for periods longer than those recommended, are advised to consider the possible therapeutic benefit against the risk of peripheral neuropathy.
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 CYP 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 CYP 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.
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 nm and metronidazole nm at pH 7. Encephalopathy has been reported in association with cerebellar toxicity characterized by ataxia , dizziness, and dysarthria.
CNS symptoms are generally reversible within days to weeks upon discontinuation of metronidazole. Peripheral neuropathy, mainly of sensory type has been reported and is characterized by numbness or paresthesia of an extremity. Convulsive seizures have been reported in patients treated with metronidazole. Aseptic meningitis Cases of aseptic meningitis have been reported with metronidazole. Symptoms can occur within hours of dose administration and generally resolve after metronidazole therapy is discontinued.
Renal Impairment Patients with end-stage renal disease may excrete metronidazole and metabolites slowly in the urine, resulting in significant accumulation of metronidazole metabolites. Fungal Superinfections Known or previously unrecognized candidiasis may present more prominent symptoms during therapy with FLAGYL and requires treatment with a candidacidal agent.
Use In Patients With Blood Dyscrasias Metronidazole is a nitroimidazole and should be used with caution in patients with evidence of or history of blood dyscrasia.
A mild leukopenia has been observed during its administration; however, no persistent hematologic abnormalities attributable to metronidazole have been observed in Clinical Studies. Total and differential leukocyte counts are recommended before and after therapy. Drug-Resistant Bacteria And Parasites Prescribing FLAGYL in the absence of a proven or strongly suspected bacterial or parasitic infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drugresistant bacteria and parasites.
Carcinogenesis, Mutagenesis, Impairment Of Fertility Tumors affecting the liver, lungs , mammary, and lymphatic tissues have been detected in several studies of metronidazole in rats and mice, but not hamsters. Pulmonary tumors have been observed in all six reported studies in the mouse, including one study in which the animals weredosed on an intermittent schedule administration during every fourth week only. Malignant lymphomas and pulmonary neoplasms were also increased with lifetime feeding of the drug to mice.
Mammary and hepatic tumors were increased among female rats administered oral metronidazole compared to concurrent controls. Two lifetime tumorigenicity studies in hamsters have been performed and reported to be negative. Metronidazole has shown mutagenic activity in in vitro assay systems including the Ames test.
Studies in mammals in vivo have failed to demonstrate a potential for genetic damage. However, rats treated at the same dose for 6 weeks or longer were infertile and showed severe degeneration of the seminiferous epithelium in the testes as well as marked decreases in testicular spermatid counts and epididymal sperm counts. Do not start on a new medication without consulting your doctor or pharmacist about potential drug interactions.
Your doctor or pharmacist also needs to know about any allergies you have and if you have other illnesses or medical conditions. Flagyl and Alcohol Alcoholic beverages and drugs containing alcohol, should not be consumed by patients being treated with Flagyl tablets and for at least a day after treatment is over as nausea, vomiting, abdominal cramps, headaches, tachycardia and flushing may occur.
There is also the possibility of a disulfiram-like Antabuse effect reaction. Contraindications Flagyl Tablets Metronidazole are contraindicated in the following cases: Patients with evidence of or a history of blood dyscrasias should not be treated with Flagyl tablets since upon occasion a mild leucopenia has been observed during its administration.
Patients with active organic disease of the central nervous system. Patients with a hypersensitivity to metronidazole and other imidazoles. Metronidazole mg and mg pills, manufactured by Abbott India are supplied in a strip of 10 tablets.
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