Metrobac
Generic Name
Metronidazole
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| metrobac 500 mg injection | ৳ 53.00 | N/A |
Description
Overview of the medicine
Metronidazole is an antibiotic and antiprotozoal medication used to treat various infections caused by susceptible anaerobic bacteria and protozoa, such as amoebiasis, giardiasis, trichomoniasis, and bacterial vaginosis. The injection form is typically used for severe infections or in patients unable to take oral medication.
Uses & Indications
Dosage
Adults
Typical dose is 500 mg given intravenously every 8 hours. Dosage and duration depend on the type and severity of infection. For surgical prophylaxis, 500 mg 1-2 hours pre-op, then 500 mg 8 hourly for 24-48 hours.
Elderly
Similar to adult dosage; however, caution should be exercised and dosage adjusted based on renal/hepatic function and overall health status.
Renal_impairment
In severe renal impairment (creatinine clearance <10 mL/min), the dosage interval may be extended, or the dose reduced. Hemodialysis removes metronidazole, so additional doses may be needed after dialysis.
How to Take
Administer by slow intravenous infusion over 30 to 60 minutes. Do not administer as an intravenous bolus. Dilution may be required depending on the product.
Mechanism of Action
Metronidazole acts as a prodrug, which is activated by anaerobic organisms. Inside susceptible cells, the nitro group of metronidazole is chemically reduced, forming highly reactive nitro radical anions. These radicals disrupt the DNA helix structure, inhibit nucleic acid synthesis, and ultimately lead to microbial cell death.
Pharmacokinetics
Onset
Rapid, typically within minutes of intravenous administration.
Excretion
Mainly excreted in urine (60-80% as metabolites and unchanged drug), with a smaller portion eliminated in feces (6-15%).
Half life
Approximately 8 hours (range 6-12 hours).
Absorption
Rapid and complete absorption after intravenous administration, reaching peak plasma concentrations quickly.
Metabolism
Extensively metabolized in the liver, primarily by oxidation followed by glucuronidation. Main metabolites are hydroxy and acid derivatives.
Side Effects
Contraindications
- Hypersensitivity to metronidazole or other nitroimidazole derivatives
- First trimester of pregnancy (relative contraindication, use only if essential)
- Concomitant use with disulfiram (within 2 weeks) or alcohol (due to disulfiram-like reaction)
Drug Interactions
Alcohol
Causes a disulfiram-like reaction (e.g., abdominal cramps, nausea, vomiting, headaches, flushing) when consumed during or within 48 hours of metronidazole treatment.
Lithium
Increases serum lithium levels, potentially leading to lithium toxicity. Monitor lithium levels closely.
Warfarin
Enhances the anticoagulant effect of warfarin and other oral coumarin anticoagulants, increasing the risk of bleeding. INR monitoring is essential.
Disulfiram
Concomitant use may result in psychotic reactions; metronidazole should not be given to patients who have taken disulfiram within the last 2 weeks.
Phenytoin/Phenobarbital
Decreases metronidazole plasma concentrations, reducing its efficacy.
Storage
Store below 30°C. Protect from light. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, ataxia, and mild disorientation. There is no specific antidote. Management is supportive and symptomatic.
Pregnancy & Lactation
Pregnancy Category B. Avoid use during the first trimester. Use with caution in the second and third trimesters only if clearly needed and benefits outweigh the potential risks. Metronidazole is excreted into breast milk; breastfeeding should be discontinued during therapy and for 12-24 hours after the last dose.
Side Effects
Contraindications
- Hypersensitivity to metronidazole or other nitroimidazole derivatives
- First trimester of pregnancy (relative contraindication, use only if essential)
- Concomitant use with disulfiram (within 2 weeks) or alcohol (due to disulfiram-like reaction)
Drug Interactions
Alcohol
Causes a disulfiram-like reaction (e.g., abdominal cramps, nausea, vomiting, headaches, flushing) when consumed during or within 48 hours of metronidazole treatment.
Lithium
Increases serum lithium levels, potentially leading to lithium toxicity. Monitor lithium levels closely.
Warfarin
Enhances the anticoagulant effect of warfarin and other oral coumarin anticoagulants, increasing the risk of bleeding. INR monitoring is essential.
Disulfiram
Concomitant use may result in psychotic reactions; metronidazole should not be given to patients who have taken disulfiram within the last 2 weeks.
Phenytoin/Phenobarbital
Decreases metronidazole plasma concentrations, reducing its efficacy.
Storage
Store below 30°C. Protect from light. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, ataxia, and mild disorientation. There is no specific antidote. Management is supportive and symptomatic.
Pregnancy & Lactation
Pregnancy Category B. Avoid use during the first trimester. Use with caution in the second and third trimesters only if clearly needed and benefits outweigh the potential risks. Metronidazole is excreted into breast milk; breastfeeding should be discontinued during therapy and for 12-24 hours after the last dose.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date when stored correctly.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by regulatory authorities (e.g., DGDA in Bangladesh)
Patent Status
Generic, patent expired
WHO Essential Medicine
YesClinical Trials
Metronidazole's efficacy and safety are well-established through numerous clinical trials and extensive clinical use since its introduction. Newer trials focus on specific indications, combinations, or formulations.
Lab Monitoring
- Monitor complete blood count (CBC), especially with prolonged or high-dose therapy, due to potential for leukopenia or neutropenia.
- Liver function tests (LFTs) should be monitored in patients with hepatic impairment.
Doctor Notes
- Monitor patients for signs of peripheral neuropathy, especially during prolonged therapy, and discontinue if neurological symptoms occur.
- Dose reduction is necessary in patients with severe hepatic impairment due to reduced clearance.
- Educate patients about the disulfiram-like reaction with alcohol and emphasize avoidance.
Patient Guidelines
- Complete the full course of treatment as prescribed by your doctor, even if symptoms improve.
- Avoid alcohol consumption during treatment and for at least 48 hours after the last dose.
- Report any new or worsening side effects, especially numbness, tingling, or weakness in hands or feet.
- Inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Missed Dose Advice
If a dose is missed, it should be administered as soon as possible. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose.
Driving Precautions
Metronidazole may cause dizziness, confusion, or visual disturbances. Patients should be advised to exercise caution when driving or operating machinery until they know how the medication affects them.
Lifestyle Advice
- Maintain good personal hygiene to prevent recurrence of certain infections.
- Stay hydrated during treatment.
- Follow a balanced diet.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.