Monuril (Fosfomycin Trometamol)

Monuril (fosfomycin trometamol) is indicated for infections of the urinary tract caused by susceptible bacteria.

• Uncomplicated urinary tract infection: provides a single‑dose bactericidal treatment of susceptible uropathogens.

• Fosfomycin trometamol penetrates bacterial cells and irreversibly inhibits the MurA enzyme, which catalyzes the first step of peptidoglycan synthesis. By blocking this early stage of cell‑wall formation, the drug prevents bacterial growth and leads to cell death, offering a broad spectrum of activity against many Gram‑positive and Gram‑negative uropathogens.

Adverse reactions may range from mild to severe and should be monitored during therapy.

Common Side Effects

• Nausea: mild to moderate upset stomach.
• Diarrhea: loose stools, usually self‑limiting.
• Headache: transient cranial discomfort.
• Abdominal pain: cramping or discomfort in the abdomen.
• Vomiting: occasional emesis.
• Dyspepsia: indigestion or heartburn.

Serious or Rare Side Effects

• Allergic reactions: rash, pruritus, or anaphylaxis.
• Clostridioides difficile infection: severe colitis.
• Hepatic injury: elevated liver enzymes or jaundice.
• Hematologic effects: thrombocytopenia or leukopenia.
• Renal impairment: worsening kidney function.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before prescribing Monuril, consider the following safety measures.

• Renal function: assess kidney function; adjust use in severe impairment.
• Pregnancy: safety not established; avoid unless benefit outweighs risk.
• Breastfeeding: unknown excretion; weigh potential infant exposure.
• Drug interactions: avoid concomitant antacids or supplements containing divalent cations.
• Pediatric use: not recommended as safety and efficacy are not established.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture.

Monuril may interact with other medicines, influencing its absorption or effect.

Major Interactions (Avoid)

• Antacids with magnesium or aluminum: markedly reduce fosfomycin absorption.
• Calcium‑containing antacids or supplements: decrease bioavailability.
• Iron supplements: impair oral uptake of the drug.
• Sucralfate: forms complexes that limit absorption.

Moderate Interactions (Monitor Closely)

• Warfarin: monitor INR for potential anticoagulant effect changes.
• Metformin: observe renal function to reduce lactic acidosis risk.
• Diuretics: watch electrolytes and renal status.
• NSAIDs: assess renal function when used together.