By Kathleen G. Burke, PhD, RN
Reviewed by Tamara Malm, PharmD, MPH, BCPS
Last Update: August 20, 2024
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What is it?
Flagyl is a broad-spectrum drug against microbes. It quite effectively copes with bacteria and protozoa, such as vaginal trichomonas, intestinal giardia, dysentery amoeba.
The drug is not effective against actinomycetes, Propionibacterium acnes and mobiluncus. The drug is not dependent on meal times. Flagyl has high digestibility and absorption by the body. It begins to act already within the first hour after ingestion. It has the ability to penetrate into all tissues of the body, fluid and water (breast milk and amniotic fluid).
Indications
The treatment of infectious diseases caused by microorganisms Bifidobacterium, Bacteroides fragilis, Bilophilia, Clostridium perfringens, Clostridium difficile, Eubacterium, Peptostreptococcus, Fusobacterium, Prophyromonas, Prevotella and Veilonella.
It is effective in the treatment of amebiasis, nonspecific vaginitis, urogenital trichomoniasis, surgical infections, giardiasis.
Tablets may be prescribed as a continuation of non-oral metronidazole therapy.
Dosage and mode of application
Flagyl is produced for oral administration. The dose and duration of treatment are determined by the doctor, based on the overall picture of the disease course, the patient’s tolerance to the drug, additional drugs that the patient is taking.
Amebiasis is usually treated for a week by taking 500 mg of the drug 3 times a day. Children dose calculated on the basis of body weight (daily dose of 30-40 mg per pound of weight). The course duration is 3 days.
Giardiasis requires 375-500 mg for 5 days twice a day. Children over 10 years require a dose of 250 mg.
Trichomoniasis (vaginitis or urethritis) is treated in “pediatric” doses with the same frequency of administration for 10 days. At the same time, it is necessary to introduce metronidazole into the vagina with the simultaneous treatment of a partner.
Contraindications
- Patients with allergic reactions to metronidazole, its derivatives, and any component of the drug.
- The drug is contraindicated in case of sensitivity to gluten. Patients with complex diseases of the central nervous system (a high probability of deterioration) are contraindicated to take this drug.
- You cannot use the drug if your weight is up to 16 kg (usually children under 6 years).
- It is forbidden to simultaneously take this antibiotic and disulfiram and/or ethyl alcohol.
- The drug is prescribed to people with blood diseases (including cured). During the course of treatment, the patient’s blood condition should be constantly monitored.
Side effects
Generic Flagyl is usually well tolerated without causing adverse reactions. But some studies of the drug warn about the possible side effects:
- sensory peripheral neuropathy;
- headache;
- dizziness;
- ataxia;
- convulsions;
- hallucinations;
- confusion.
The digestive system can react with nausea, vomiting, abnormal stool, pain, dry mouth and stomatitis.
There is also a decrease in vision, allergic reactions, and a change in the color of urine.
All cases have a reversible consequence and pass on their own.
The occurrence of atoxia, clouding of consciousness and dizziness suggests that the drug is better to withdraw. If any of the side effects occur, the physician should be informed. Finally, the question to continue therapy should be assessed.
Pregnancy and breastfeeding
Data on the effect of Flagyl on the course of pregnancy is yet not clear. Therefore, it is recommended to prescribe the drug carefully with regular and careful monitoring of the state of the mother and fetus. If there is a safer and studied alternative to this medication, it is better to apply it.
This antibiotic tends to penetrate into the amniotic fluid and breast milk, so it is recommended either to refrain from breastfeeding during the treatment period or to stop it.
Interactions
Disulfiram – It was reported about the development of psychotic reactions in patients who took both metronidazole and disulfiram (the interval between administration of these substances must be at least 2 weeks).
Ethanol – Disulfiram-like reactions may occur (skin hyperemia, vomiting, tachycardia).
Indirect anticoagulants (warfarin) – They increase the anticoagulant effect and the hemorrhagic risk associated with slowing their hepatic metabolism, which can lead to an increase in prothrombin time. In the case of simultaneous use, it requires more frequent monitoring of prothrombin time and, if necessary, it is better to conduct correction of doses of anticoagulants.
Lithium preparations – With simultaneous use of metronidazole with lithium preparations, the concentration of the latter in the blood plasma may increase. If taken constantly, plasma concentrations of lithium, creatinine and electrolytes should be monitored.
Cyclosporine – While taking metronidazole with cyclosporine, the serum concentration of cyclosporine may increase. If necessary, the simultaneous use of these two metronidazoles requires monitoring of serum concentrations of cyclosporine and creatinine.
Cimetidine – This substance inhibits the metabolism of metronidazole, which can lead to an increase in its concentration in serum and an increase in the risk of side effects.
Drugs that induce microsomal oxidation enzymes in the liver (phenobarbital, phenytoin) – The simultaneous application of metronidazole with drugs that stimulate the enzymes of microsomal oxidation in the liver (phenobarbital, phenytoin) can accelerate the elimination of metronidazole, resulting in a decrease in its concentration in plasma.
Fluorouracil – Metronidazole reduces the clearance of fluorouracil, leading to an increase in its toxicity.
Busulfan – This antibiotic increases the concentration of busulfan in the blood plasma, which can result in the development of a severe toxic effect of busulfan.
Non-depolarizing muscle relaxants (vecuronium bromide) – It is not recommended to combine with non-depolarizing muscle relaxants (vecuronium bromide).
Sulfonamides enhance the antimicrobial action of metronidazole.
Safety precautions
Since the simultaneous use of metronidazole with alcohol can have an effect similar to that of disulfiram (fever, vomiting, tachycardia), patients should avoid alcoholic beverages or drugs containing alcohol.
It is necessary to carefully weigh the indications for long-term use of the drug and to avoid its long-term use without strict indications. If, in the presence of strict indications, the drug is used for a longer time than is usually recommended, then treatment should be carried out under the control of hematological parameters and adverse reactions, such as peripheral or central neuropathy (paresthesias, ataxia, dizziness, convulsions), with which the treatment should be discontinued.
When treating Trichomonas vaginitis in women and Trichomonas urethritis in men, it is necessary to abstain from sex. It is necessary for both partners to undergo treatment. The treatment should not be discontinued during menstruation. After treatment of trichomoniasis, control tests should be carried out for 3 consecutive cycles before and after menstruation.
It is necessary to take into account that metronidazole can immobilize treponema, which leads to a false-positive Nelson test.
How to Buy Flagyl?
All the antibiotics are sold with a prescription only. Nowadays, online services offer to buy antibiotics online without a prescription but they recommend to attend a physician. The physician will recommend the dosage and regimen. The course may vary depending on the severity and type of the disease you suffer from.
Antibiotics online are the way out for people having no spare time to visit conventional drugstore. You just need to make an order online and wait for your parcel. Nothing special should be done. Flagyl online is the way to get effective treatment for the diseases shown in the “Indications” section.
About the Author
Kathleen G. Burke, PhD, RN, CENP, FAAN, is an influential nurse leader and educator, currently serving as the Assistant Dean for Clinical Nurse Learning and Innovation at Penn Nursing and the Corporate Director of Nursing Professional Development and Innovation at the University of Pennsylvania Health System. She is also the Editor-in-Chief of the Journal for Nurses in Professional Development and a board member of the CCNE. Dr. Burke’s extensive experience and commitment to advancing nursing education and practice have significantly shaped the nursing profession both nationally and internationally.
Disclaimer: The information provided on this site is solely for educational purposes and is not a replacement for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before altering your medical treatment or medications. Relying on this content instead of seeking professional advice is not recommended.