Metronidazole (Vaginal)

Metronidazole vaginal works by suppressing or killing the bacteria that causes vaginal infections.

Overview

Metronidazole vaginal is an antibiotic used to treat women with vaginal infections such as bacterial vaginosis. However, it is important to understand that this medication does not work for yeast infection or vaginal fungus.

As a prodrug, Metronidazole vaginal works by invading protozoal and bacterial cells to interfere with its genetic material (DNA). It damages the DNA to prevent the protozoa from forming new DNA. Eventually, this results in metronidazole clearing up the infection by destroying the organisms.

Metronidazole vaginal comes as a gel to be used in the vagina. It is usually administered either as a single dose at bedtime or once daily for five consecutive days at bedtime. It can also be used twice per day for five days. The medication is produced under the following brand names: Vandazole, Flagyl, and Metrogel-Vaginal.

Metronidazole vaginal is only available with the doctor's prescription and can also come in the following dosage forms:

  • Cream
  • Suppository

Conditions Treated

Type Of Medicine

  • Antibacterial agent

Metronidazole vaginal side effects

Alongside the intended effects, metronidazole does come with some unwanted effects. Some of these side effects are mild and tend to go away as the body adjusts to the medication. However, some metronidazole side effects can be severe with a need for medical attention.

Check with your healthcare provider immediately if you experience any of the following side effects while on metronidazole treatment:

  • Pain during sexual intercourse
  • Itching in the vagina
  • Thick, white discharge with mild or no odor
  • Burning sensation while passing urine
  • Abdominal or stomach cramps and pain
  • Itching, stinging, or redness around the vaginal area
  • Burning or irritation of the sex partner's penis
  • Yellowing of the skin and eyes (a symptom of liver disorder)

Less common metronidazole vaginal side effects include:

  • Nausea and vomiting
  • Diarrhea
  • Inflamed and sore mouth
  • Unpleasant taste
  • Severe swelling of the lips, tongue, and face (angioedema)
  • Dizziness
  • Shaky movements and lack of control while walking (ataxia)
  • Darkening of the urine
  • Skin rashes and itching
  • Pain in the joints and muscles
  • Confusion
  • Visual disturbances
  • Hallucinations
  • Liver disorders
  • Reduced number of white of blood cells in the blood (leucopenia)
  • Disorder of the peripheral nerves known as the peripheral neuropathy, which causes numbness and body weakness
  • Seizures
  • Dryness of mouth
  • Dizziness or lightheadedness
  • Change of taste

Some metronidazole side effects do not need medical attention as they often go away as the body adjusts to the medication. In addition, your healthcare provider may be able to advise you on how to reduce the severity of these side effects. That said, check with your healthcare provider if the following side effects persist or become bothersome.

  • Loss of appetite
  • Sensation of a furry tongue
  • Headache
  • Drowsiness
  • Nausea and vomiting
  • Diarrhea
  • Runny nose
  • Urinating more than usual
  • Breast enlargement and discharge

Call your healthcare provider for advice on how to manage these side effects. You may also report the side effects to the FDA at 1-800-FDA-1088.

Metronidazole vaginal dosage

It is important that you use metronidazole vaginal as directed by your healthcare provider. You should never use it more often or longer than the duration prescribed by your healthcare provider.

Metronidazole vaginal, as the name indicates, should be used only in the vagina. Additionally, it should be used at bedtime, unless directed otherwise by your healthcare provider.

Do not get it into your mouth, nose, eyes, or open wounds. If this medication does come into contact with your eyes, wash them straight away with plenty of tap water. Check with your healthcare provider if the burning sensation persists.

Metronidazole vaginal comes with patient directions. It is important that you carefully read and understand the instructions. Ask your healthcare provider any questions you might have.

Thoroughly clean your hands with soap and plenty of water before and after using metronidazole.

Metronidazole vaginal gel comes in a tube. The gel is applied into the vagina using an applicator, which comes with a plastic tube called a barrel that opens at one end and has a plunger another piece of plastic that moves within the barre at the other end.

Filling the applicator

For gel and cream dosage forms

  • Use the point on the top of the cap to break the metal seal at the tube's opening
  • Screw the applicator onto the tube
  • Slowly squeeze the medicine into the applicator until it is full
  • Separate the applicator from the tube and replace the cap

For vaginal tablet dosage form

  • Place the vaginal tablet into the applicator and wet it with water for about 5 seconds.

Inserting vaginal metronidazole using the applicator

For all dosage forms

  • While lying on your back, relax with your knees bent (or in any position that makes you feel comfortable)
  • While holding the full applicator in one hand, insert it slowly in to your vagina. Stop when it becomes uncomfortable
  • In slow motion, press the plunger until it stops
  • Withdraw the applicator once the medicine has been deposited inside the vagina.
  • Remove the applicator from your vagina. The applicator should only be used once and disposed of. Do not use it multiple times.

To help treat the infection completely, it is important that you continue using metronidazole for the full treatment course, even after your symptoms begin to go away after a few days of treatment. Your symptoms might return if you stop using the medication too soon. Never miss or skip a dose. Also, continue treating yourself even if your menses start while on treatment.

Dosing information

Metronidazole vaginal dosage differs from patient to patient. It is important that you follow your healthcare provider's prescription or the directions on the label. The following information is only for average metronidazole vaginal dosing. If your healthcare provider has recommended a different dosage, do not change it without their approval.

The amount of medication you take depends on the strength of the drug, the number of recommended daily doses, and time recommended in between the doses. The duration of time you take the medication depends on the medical problem you are treating as well as your response to treatment.

Dosing for treating bacterial vaginal infections:

Metronidazole vaginal cream form

  • Teenagers and adults insert one full applicator (about 500 mg) into the vagina. Apply the cream once or twice per day for 10 to 20 days.
  • Children the dosage and use must be determined by the child's healthcare provider

Metronidazole gel form dosage

  • Teenagers and adults insert one full applicator (about 500 mg) into the vagina once per day, preferably at bed time for up to 5 days.
  • Children the dosage and use must be determined by the child's healthcare provider

Metronidazole vaginal tablets

  • Teenagers and adults Inset one tablet (500 mg) high into the vagina once per day, preferably at bed time, for 10 to 20 days
  • Children the dosage and use must be determined by the child's healthcare provider

Missed Dose

If you miss your metronidazole vaginal dose, take it as soon as possible. However, you may skip the missed dose and resume your regular dosing schedule if it is almost time for your next dose. Do not make up for the missed dose by double dosing.

Metronidazole overdose

Contact the emergency room as soon as possible if metronidazole vaginal overdose is suspected. You may also report metronidazole overdose to the local poison control center at 1-800-222-1222. The medicine may be harmful if ingested.

Metronidazole vaginal interactions

Although certain medications should never be used together, in other cases two different medicines may be combined even if this might cause an interaction. Under such circumstances, your healthcare provider will recommend a change of dosage for one or both medications or recommend appropriate precautions. Inform your healthcare provider about the medications you are currently on before starting metronidazole vaginal treatment. These include prescription as well as over-the-counter medications, nutritional supplements, multivitamins as well as herbal medicines.

Additionally, do not take the following medications while on metronidazole vaginal treatment without the approval of your healthcare provider:

  • Terfenadine
  • Thioridazine
  • Ziprasidone
  • Bepridil
  • Cisapride
  • Disulfiram
  • Dronabinol
  • Pimozide
  • Saquinavir
  • Sparfloxacin
  • Amifampridine
  • Amisulpride
  • Amprenavir
  • Dronedarone
  • Mesoridazine

Using metronidazole with any of the following medications is not recommended. However, this combination may be required in some cases. If both medicines are prescribed together, your healthcare provider may recommend a change of dosage or how you take both drugs.

  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Aripiprazole Lauroxil
  • Arsenic Trioxide
  • Asenapine
  • Bedaquiline
  • Buprenorphine
  • Bupropion
  • Buserelin
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Dasatinib
  • Degarelix
  • Deutetrabenazine
  • Disopyramide
  • Dofetilide
  • Doxifluridine
  • Droperidol
  • Ebastine
  • Famotidine
  • Felbamate
  • Fingolimod
  • Fluoxetine
  • Formoterol
  • Foscarnet
  • Fosphenytoin
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Inotuzumab Ozogamicin
  • Levofloxacin
  • Lumefantrine
  • Macimorelin
  • Mebendazole
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perphenazine
  • Pimavanserin
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Sertindole
  • Sertraline
  • Sevoflurane
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Tegafur
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Zuclopenthixol
  • Anagrelide
  • Apomorphine
  • Aripiprazole
  • Sulpiride
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Triptorelin
  • Vandetanib
  • Vardenafil
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Mefloquine
  • Methadone
  • Mifepristone
  • Mizolastine
  • Moxifloxacin
  • Ondansetron
  • Paliperidone
  • Panobinostat
  • Papaverine Hydrochloride
  • Paroxetine
  • Haloperidol
  • Histrelin
  • Hydroquinidine
  • Hydroxychloroquine
  • Nafarelin
  • Nelfinavir
  • Nilotinib
  • Norfloxacin
  • Astemizole
  • Atazanavir
  • Azithromycin
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Ribociclib
  • Risperidone
  • Ritonavir
  • Itraconazole
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Busulfan
  • Capecitabine
  • Chloroquine
  • Chlorpromazine
  • Cholera Vaccine, Live
  • Delamanid
  • Desipramine
  • Deslorelin
  • Tizanidine
  • Tolterodine
  • Toremifene
  • Trazodone
  • Trimipramine
  • Vemurafenib
  • Venlafaxine
  • Dolasetron
  • Domperidone
  • Donepezil
  • Doxepin
  • Itraconazole
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Clozapine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Efavirenz
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Flecainide
  • Fluconazole
  • Fluorouracil

Using metronidazole vaginal with any of the following medication may trigger an increase in the severity of the drug's side effects even though combining the medications may provide the best treatment for you. If both medications have been prescribed together, your healthcare provider may recommend a change of dosage or how often you use one or both medications.

Interactions With Food/Tobacco/Alcohol

Certain foods should not be taken while on some medications as this might cause an interaction. Using alcohol and tobacco products while on certain medications may also cause an interaction or affect the efficiency of the medication. Discuss with your healthcare provider the use of metronidazole vaginal with food, alcohol, and tobacco products. Specifically, avoid taking alcoholic beverages while on this medication as this might slow down the drug's absorption and efficiency.

Other medical problems affecting the use and efficiency of metronidazole

Certain underlying medical conditions may also affect the use of this medication. Be sure to inform your healthcare provider if you have any of the following medical problems:

  • A history of aseptic meningitis
  • A history of brain disorder (encephalopathy)
  • A history of epilepsy or seizures
  • A history of leukopenia (low white blood cell count)
  • A history of peripheral neuropathy (a nerve disease that causes pain, tingling, and numbness)
  • A history of optical neuropathy
  • Severe liver disease patients with a history of severe liver disease may experience more severe side effects

Metronidazole vaginal warnings

It is important that your healthcare provider checks your progress after completing metronidazole vaginal treatment. This is to make sure that you are completely cured of the infection.

If your symptoms do not improve within a few days after the onset of metronidazole vaginal treatment, or if they worsen, be sure to check with your healthcare provider.

Do not use metronidazole vaginal if you have taken Antabuse (disulfiram) within the last 14 days. Disulfiram is taken by people who have a drinking problem. Taking these two medications close together can trigger unwanted side effects.

Taking alcoholic beverages while on metronidazole vaginal therapy may trigger side effects like stomach pain, nausea and vomiting, flushing or redness of the face, and persistent headache and lightheadedness. In addition, alcohol-containing medications like cough syrups, elixirs, and tonics may cause interaction with similar effects. The chances of these side effects occurring may continue for up to 2 days after stopping the use of metronidazole. Therefore, avoid drinking alcoholic beverages or taking alcohol-containing medicines while on metronidazole vaginal therapy for at least three days before and after the medication.

Stop using metronidazole vaginal and check with your healthcare provider right away if you experience dizziness, problems with coordination or muscle control, slurred speech, shakiness or unsteady walk, or speaking difficulty. These could be symptoms of a serious brain condition called encephalopathy.

Stop using metronidazole and call your healthcare provider or visit the emergency room immediately if you experience drowsiness, confusion, headache, general feeling of sickness, fever, nausea, loss of appetite, stiff neck or back, or persistent vomiting. These are potential symptoms of a serious medical condition called aseptic meningitis.

Stop using metronidazole vaginal and call your healthcare provider or visit the emergency room immediately if you experience burning, numbness, or a tingling sensation in the hands, arms, legs, or feet. These are possible symptoms of a medical condition called peripheral neuropathy.

Metronidazole may cause dizziness, lightheadedness, and impair judgment in some patients. It is important that you know how you react to this medication before driving, operating dangerous machinery, or performing tasks that could be dangerous if you are not alert. If these reactions persist, check with your healthcare provider.

It is not uncommon for vaginal medication to leak out of the vaginal opening during treatment. To prevent the medicine from staining your clothing, consider wearing a sanitary napkin or mini-pad. Avoid using tampons (like the ones used during menses) since these may soak up the medication.

To help clear up the bacterial infection and ensure that it does not return, you will need to practice good health habits such as:

  • Avoiding panties made of synthetic materials such as rayon and nylon. Instead, wear cotton underpants or panties and pantyhose with cotton crotches.
  • Wear only freshly washed panties on a daily basis. Do not use one panty multiple times without washing.

Avoid sexual intercourse while on metronidazole vaginal treatment. Having sex during the treatment period may reduce the strength of the antibiotic, preventing the medicine from working properly. In addition, ingredients like oil in the vaginal tablets or cream may damage latex (rubber) contraceptive devices like condoms, cervical caps, and diaphragms. This might cause leakage, rapid wear, or malfunction.

Avoid using douches and other vaginal products while on metronidazole treatment without the knowledge and approval of your healthcare provider.

Most vaginal infections such as Chlamydia and trichomoniasis are spread through sexual intercourse. You can pass the infection to your sexual partner, who can also re-infect you. Your partner may also need to check in for treatment for some infections. Until you are certain that both of you are completely treated with metronidazole, you should consider using protection (condom) during sexual intercourse. If you have any concerns about this, be sure to check with your healthcare provider.

Before taking any laboratory test, inform your healthcare provider that you are on metronidazole treatment. This is because metronidazole vaginal can affect some test results.

Do not take any medication while on metronidazole vaginal before discussing with your healthcare provider. These include prescription as well as non-prescription medications, herbal medications, as well as vitamin supplements.

Do not use metronidazole vaginal if you are allergic to it or any of its ingredients. In addition, be sure to inform your doctor about any allergies you might have, including drug, food, as well as animal allergies.

Before using metronidazole vaginal, inform your healthcare provider if you have a history of seizure disorder, liver disease, blood circulation problems such as Raynaud's syndrome, or if you have been treated with disulfiram within the past two weeks.

Metronidazole vaginal storage

Metronidazole vaginal should be stored at room temperature (20 to 25 degrees C). Keep the medication away from pets and children in the original or USP equivalent tight container to avoid accidental administration.

Keep the medication away from direct sunlight, heat and moisture. Additionally, keep the medicine from freezing. The applicator should only be used once and disposed of. Do not use it multiple times.

Do not flush the medication down the sink or toilet unless advised to do so. Consult your pharmacist on how to properly dispose of expired medications or medications that you no longer use.

Summary

Metronidazole vaginal is an antibiotic medication used to treat vaginitis, amebiasis, trichomonas infection, anaerobic bacteria, giardiasis, and treponemal infections. The medication can also be used as a radiation sensitizer for hypoxic cells.

As an antibiotic, metronidazole vaginal works by killing the infection causing the bacteria thus preventing their growth. However, metronidazole should not be administered to treat vaginal yeast or fungal infections.

As the name indicates, this medication is for vaginal use only. Before applying this medication, it is important that you learn how to correctly use it by reading the instructions on the product package. Use metronidazole as directed by your healthcare provider, usually once or twice per day. If you opt to use the medication once per day, be sure to apply it at bed time.

Avoid getting metronidazole vaginal into your mouth, eyes, ears, or nose. This medication can be harmful if ingested. If it comes into contact with your eyes, be sure to rinse your eyes thoroughly with tap water.

Do not take alcoholic beverages while on this medication for at least 24 hours after stopping the treatment. Drinking alcohol while on metronidazole may cause flushing, abdominal cramps, nausea and vomiting, and persistent headache. It is important that you continue using metronidazole vaginal even if the symptoms have gone away. Stopping the medication too early may cause the bacteria to re-grow resulting in a relapse of the infection. Avoid vaginal sex or use of tampons and douches while on metronidazole vaginal treatment. Inform your healthcare provider if symptoms persist or worsen after several days of treatment.

Inform your pharmacist or healthcare provider if you are allergic to metronidazole or any of its ingredients. Ask your pharmacist for a list of the side effects. In addition, be sure to tell your healthcare provider if you have recently taken disulfiram. Your doctor may advise you not to use this medication if you have taken disulfiram within the past 14 days.

Before starting metronidazole vaginal treatment, tell your healthcare provider about the medications you are currently taking. These include prescription as well as non-prescription medications, nutritional supplements, vitamins, as well herbal medicines. Specifically, mention if you are taking any type of anticoagulant (blood thinner) such as lithium or warfarin. In addition, tell your doctor if you have ever suffered from a blood disease or any central nervous system infection (disease of the brain or spinal cord).