Mextil
Generic Name
Metronidazole
Manufacturer
Hypothetical Manufacturer (e.g., ACI Limited)
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| mextil 250 mg tablet | ৳ 25.09 | ৳ 250.93 |
Description
Overview of the medicine
Metronidazole is an antibiotic and antiprotozoal medication used to treat a wide variety of bacterial and parasitic infections. It belongs to the nitroimidazole class of antibiotics and is effective against anaerobic bacteria and certain protozoa.
Uses & Indications
Dosage
Adults
Varies by indication. For amoebiasis: 500-750 mg three times daily for 5-10 days. For trichomoniasis: 250 mg three times daily for 7 days or 2 g single dose. For anaerobic infections: 500 mg every 8 hours.
Elderly
Dosage adjustments may be considered based on renal/hepatic function and overall health status, though generally, no specific adjustment is needed if organ function is normal.
Renal_impairment
No dosage adjustment usually needed for mild to moderate impairment. For severe renal impairment or end-stage renal disease (ESRD), a reduced dose or increased interval (e.g., 50% of usual dose every 12 hours) may be required.
How to Take
Take Mextil tablets orally with food or milk to minimize gastrointestinal upset. Swallow the tablet whole with water; do not crush, chew, or break it.
Mechanism of Action
Metronidazole is a prodrug that, once absorbed, is converted into its active form. This active metabolite interacts with DNA, causing strand breakage and inhibition of nucleic acid synthesis, leading to bacterial cell death.
Pharmacokinetics
Onset
Varies by infection type and severity, typically clinical effects observed within hours to days.
Excretion
Primarily excreted in urine (60-80%) as unchanged drug and metabolites; a small amount (6-15%) is excreted in feces.
Half life
Approximately 6-12 hours in healthy adults.
Absorption
Rapidly and almost completely absorbed from the gastrointestinal tract. Peak plasma concentrations are reached within 1-2 hours after oral administration.
Metabolism
Extensively metabolized in the liver by oxidation and glucuronidation. Major metabolites are hydroxylated and acid forms.
Side Effects
Contraindications
- Hypersensitivity to metronidazole or other nitroimidazole derivatives.
- First trimester of pregnancy (relative contraindication, generally avoided due to potential risks, though evidence is conflicting).
- Concurrent use of alcohol or disulfiram.
Drug Interactions
Lithium
May increase serum lithium levels, leading to toxicity. Monitor lithium levels.
Warfarin
May potentiate the anticoagulant effect, increasing the risk of bleeding. Close monitoring of INR is required.
Cimetidine
May decrease metronidazole clearance, leading to increased plasma concentrations and potential toxicity.
Disulfiram
Concurrent use may result in psychotic reactions. Avoid concomitant administration.
Alcohol (Ethanol)
Concurrent use can cause a disulfiram-like reaction (e.g., abdominal cramps, nausea, vomiting, headaches, flushing). Avoid alcohol during treatment and for at least 3 days after.
Phenobarbital/Phenytoin
May increase metronidazole metabolism, reducing its plasma concentrations and effectiveness.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, ataxia, disorientation, and mild neurotoxicity. There is no specific antidote. Management involves symptomatic and supportive treatment. Gastric lavage or activated charcoal may be considered if ingestion was recent.
Pregnancy & Lactation
Pregnancy Category B. Generally avoided in the first trimester. Use in the second and third trimesters only if clearly needed and benefits outweigh potential risks. Metronidazole is excreted into breast milk. For a single high dose, breastfeeding should be interrupted for 12-24 hours. For regular dosing, consult a physician to weigh the risks and benefits.
Side Effects
Contraindications
- Hypersensitivity to metronidazole or other nitroimidazole derivatives.
- First trimester of pregnancy (relative contraindication, generally avoided due to potential risks, though evidence is conflicting).
- Concurrent use of alcohol or disulfiram.
Drug Interactions
Lithium
May increase serum lithium levels, leading to toxicity. Monitor lithium levels.
Warfarin
May potentiate the anticoagulant effect, increasing the risk of bleeding. Close monitoring of INR is required.
Cimetidine
May decrease metronidazole clearance, leading to increased plasma concentrations and potential toxicity.
Disulfiram
Concurrent use may result in psychotic reactions. Avoid concomitant administration.
Alcohol (Ethanol)
Concurrent use can cause a disulfiram-like reaction (e.g., abdominal cramps, nausea, vomiting, headaches, flushing). Avoid alcohol during treatment and for at least 3 days after.
Phenobarbital/Phenytoin
May increase metronidazole metabolism, reducing its plasma concentrations and effectiveness.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, ataxia, disorientation, and mild neurotoxicity. There is no specific antidote. Management involves symptomatic and supportive treatment. Gastric lavage or activated charcoal may be considered if ingestion was recent.
Pregnancy & Lactation
Pregnancy Category B. Generally avoided in the first trimester. Use in the second and third trimesters only if clearly needed and benefits outweigh potential risks. Metronidazole is excreted into breast milk. For a single high dose, breastfeeding should be interrupted for 12-24 hours. For regular dosing, consult a physician to weigh the risks and benefits.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture, specific details on packaging.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by regulatory authorities (e.g., DGDA, FDA)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Metronidazole has been extensively studied since its introduction in the 1960s. Numerous clinical trials have confirmed its efficacy and safety profile across various bacterial and parasitic infections. Ongoing research continues to explore its applications and optimize treatment regimens.
Lab Monitoring
- Liver function tests (especially with prolonged therapy or in patients with hepatic impairment).
- Complete blood count (CBC) (especially with prolonged therapy, to monitor for leukopenia).
Doctor Notes
- Strictly counsel patients about the absolute contraindication with alcohol due to the disulfiram-like reaction.
- Monitor for signs of CNS toxicity (e.g., seizures, peripheral neuropathy) during prolonged or high-dose therapy.
- Consider alternative agents or careful risk-benefit assessment in pregnant women, especially during the first trimester.
- Educate patients on the importance of completing the full course of therapy to prevent treatment failure and resistance.
Patient Guidelines
- Complete the entire prescribed course of medication, even if symptoms improve, to prevent recurrence and development of resistance.
- Avoid alcohol and alcohol-containing products during and for at least 3 days after treatment.
- Take with food or milk to reduce stomach upset.
- Inform your doctor if you experience severe diarrhea, rash, numbness, tingling, or unusual weakness.
Missed Dose Advice
If a dose is missed, take it as soon as remembered. If it is almost time for the next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to make up for a missed one.
Driving Precautions
Mextil may cause dizziness, drowsiness, 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 reinfection, especially for sexually transmitted infections.
- Stay well-hydrated, particularly if experiencing gastrointestinal side effects like diarrhea or vomiting.
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