Metronidazol Noridem (Metronidazole)

Metronidazole is used to treat infections caused by anaerobic bacteria and certain protozoa.

• Bacterial vaginosis: restores normal vaginal flora by eliminating over‑growth of anaerobic bacteria.
• Trichomoniasis: eradicates Trichomonas vaginalis, relieving symptoms and preventing recurrence.
• Amoebiasis: kills Entamoeba histolytica trophozoites in intestinal and extra‑intestinal disease.
• Anaerobic intra‑abdominal infections: controls mixed anaerobic flora in peritonitis and abscesses.
• Clostridioides difficile infection: reduces toxin‑producing bacteria and aids clinical resolution.

• Metronidazole is taken up by anaerobic microorganisms and reduced by intracellular redox proteins to generate nitro‑radical intermediates. These reactive species damage DNA, inhibit nucleic acid synthesis, and disrupt essential metabolic pathways, leading to bacterial or protozoal cell death while having minimal effect on aerobic cells.

Metronidazole may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: transient upset stomach often occurring early in therapy.
• Metallic taste: a characteristic metallic sensation in the mouth.
• Headache: mild to moderate headache reported by some patients.
• Diarrhea: loose stools that usually resolve after treatment completion.

Serious or Rare Side Effects

• Seizures: rare neurologic events requiring immediate medical attention.
• Severe allergic reaction: anaphylaxis with rash, swelling, and breathing difficulty.
• Peripheral neuropathy: numbness or tingling in extremities, potentially irreversible if not recognized early.

Before using Metronidazol Noridem, consider the following safety measures.

• Renal impairment: adjust dose or monitor plasma concentrations in patients with reduced kidney function.
• Hepatic dysfunction: use with caution in patients with liver disease, as metabolism may be impaired.
• Alcohol consumption: avoid during and for at least 48 hours after therapy to prevent a disulfiram‑like reaction.
• Pregnancy: prescribe only when benefits outweigh potential risks to the fetus.
• Concurrent warfarin therapy: monitor INR closely due to possible potentiation of anticoagulant effect.
• Store at below 25°C: keep in the original container, protect from light and moisture.

Metronidazol Noridem can interact with several medicines; some require avoidance while others need monitoring.

Major Interactions (Avoid)

• Alcohol: may cause severe flushing, tachycardia, and hypotension.
• Lithium: concurrent use can increase lithium toxicity.
• Warfarin: potentiates anticoagulant effect, raising bleeding risk.

Moderate Interactions (Monitor Closely)

• Phenobarbital: may reduce metronidazole plasma levels, decreasing efficacy.
• Cimetidine: can increase metronidazole concentrations, enhancing side‑effect potential.
• Phenytoin: may lower metronidazole effectiveness by increasing its metabolism.