Medicine Information

Renova

Name: Renova
Brand: Renova

Suppository500 mgAmoebicides, Trichomonacides, Anti-bacterial (Anaerobic)ATC: G01AF01

Generic Name

Metronidazole

Manufacturer

Square Pharmaceuticals Ltd.

Country

Bangladesh

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
renova 500 mg suppository	৳ 8.03	N/A

Description

Overview of the medicine

Renova 500 mg Suppository contains Metronidazole, an antibiotic and antiprotozoal agent. It is used to treat infections caused by susceptible anaerobic bacteria and protozoa, particularly in conditions like bacterial vaginosis, trichomoniasis, and other pelvic inflammatory diseases. The suppository form allows for local action, especially in vaginal infections.

Uses & Indications

Bacterial vaginosis

Trichomoniasis

Amoebic dysentery

Giardiasis

Anaerobic bacterial infections (e.g., in pelvic inflammatory disease, post-operative infections)

Dosage

Adults

For Bacterial Vaginosis or Trichomoniasis: One 500 mg vaginal suppository inserted deep into the vagina once daily, preferably at bedtime, for 7 to 10 consecutive days. For other anaerobic infections (if rectal): 500 mg to 1 g rectally 2-3 times daily, depending on the severity of infection, typically for 7-10 days.

Elderly

No specific dosage adjustment is generally required for elderly patients, but caution is advised in patients with impaired hepatic or renal function. Monitor for adverse effects.

Renal_impairment

In severe renal impairment (CrCl < 10 mL/min), the dosage interval should be prolonged or the dose reduced. No adjustment is typically needed for mild to moderate impairment.

How to Take

For vaginal suppository: Carefully unwrap the suppository and insert it deep into the vagina, usually at bedtime. It is recommended to lie down for a few minutes after insertion. For rectal suppository: Unpack and insert into the rectum, rounded end first.

Mechanism of Action

Metronidazole is a nitroimidazole derivative. It enters susceptible microorganisms where its nitro group is reduced by electron-transport proteins. This reduction forms highly reactive nitro-free radicals that damage DNA and other cellular components, leading to cell death. It specifically targets anaerobic bacteria and protozoa that can perform this reduction.

Pharmacokinetics

Onset

Symptomatic relief can begin within hours to days depending on the infection site and severity. Full therapeutic effect may take several days.

Excretion

Mainly excreted in the urine (60-80% of the dose, both unchanged drug and metabolites). A smaller proportion (6-15%) is excreted in the feces.

Half life

Approximately 8-10 hours in adults, slightly prolonged in patients with impaired hepatic function.

Absorption

Systemic absorption varies significantly with suppository route. For vaginal suppositories, approximately 5-20% of the dose is absorbed systemically. Rectal administration may result in higher systemic absorption, up to 60-80%. Peak plasma concentrations are reached in 8-24 hours after vaginal administration.

Metabolism

Extensively metabolized in the liver, primarily by oxidation of the side chain, followed by glucuronide conjugation. The main metabolite, 2-hydroxymethylmetronidazole, has some antimicrobial activity.

Side Effects

Contraindications

Hypersensitivity to metronidazole or other nitroimidazole derivatives
First trimester of pregnancy (relative contraindication, generally avoided unless absolutely necessary)
Severe hepatic impairment (use with extreme caution)

Drug Interactions

Alcohol

Disulfiram-like reaction (flushing, palpitations, nausea, vomiting, abdominal cramps, headache) if consumed during or within 3 days of therapy.

Lithium

May increase plasma concentrations of lithium, leading to lithium toxicity.

Cimetidine

May prolong the half-life of metronidazole by inhibiting its metabolism, leading to increased plasma levels and potential toxicity.

Warfarin and other oral anticoagulants

Potentiates the anticoagulant effect, leading to increased risk of bleeding. Close monitoring of INR/PT is recommended.

Storage

Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.

Overdose

Symptoms of overdose include nausea, vomiting, ataxia, disorientation, and seizures. There is no specific antidote. Management involves symptomatic and supportive treatment. Gastric lavage may be considered if recent oral ingestion, though less relevant for suppository. Hemodialysis can effectively remove metronidazole from the body.

Pregnancy & Lactation

Pregnancy: Metronidazole should be avoided during the first trimester of pregnancy unless absolutely essential. Use in the second and third trimesters should be with caution and only if the potential benefits outweigh the risks. Lactation: Metronidazole is excreted into breast milk. Breastfeeding mothers should either discontinue the drug or consider temporarily stopping breastfeeding for 12-24 hours after a single dose.

Side Effects

Contraindications

Hypersensitivity to metronidazole or other nitroimidazole derivatives
First trimester of pregnancy (relative contraindication, generally avoided unless absolutely necessary)
Severe hepatic impairment (use with extreme caution)

Drug Interactions

Alcohol

Disulfiram-like reaction (flushing, palpitations, nausea, vomiting, abdominal cramps, headache) if consumed during or within 3 days of therapy.

Lithium

May increase plasma concentrations of lithium, leading to lithium toxicity.

Cimetidine

May prolong the half-life of metronidazole by inhibiting its metabolism, leading to increased plasma levels and potential toxicity.

Warfarin and other oral anticoagulants

Potentiates the anticoagulant effect, leading to increased risk of bleeding. Close monitoring of INR/PT is recommended.

Storage

Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.

Overdose

Pregnancy & Lactation

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

Box of 5 vaginal suppositoriesBox of 10 vaginal suppositories

Shelf Life

Typically 24 to 36 months from manufacturing date.

Availability

Pharmacies, Hospitals

Approval Status

Approved by FDA and DGDA

Patent Status

Generic available, original patent expired

WHO Essential Medicine

Yes

Clinical Trials

Numerous clinical trials have established the efficacy and safety of metronidazole for various anaerobic and protozoal infections, including bacterial vaginosis and trichomoniasis. Ongoing research focuses on resistance patterns and new formulations.

Lab Monitoring

Liver function tests (in patients with hepatic impairment or prolonged therapy)
Complete blood count (especially with prolonged or high-dose therapy, due to risk of leukopenia)

Doctor Notes

Advise patients about the strict alcohol avoidance rule to prevent disulfiram-like reactions.
Be aware of potential drug interactions, especially with anticoagulants and lithium.
Monitor for neurological symptoms if therapy is prolonged.

Patient Guidelines

Complete the full course of treatment, even if symptoms improve, to prevent recurrence and resistance.
Avoid alcohol and alcohol-containing products during treatment and for at least 3 days after completing the course.
Report any severe or persistent side effects to your doctor immediately.
For vaginal suppositories: Avoid sexual intercourse during treatment or use barrier methods.
Store in a cool, dry place away from direct sunlight.

Missed Dose Advice

If a dose is missed, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.

Driving Precautions

This medicine may cause dizziness, confusion, or visual disturbances in some individuals. If you experience these symptoms, avoid driving or operating machinery.

Lifestyle Advice

Practice good personal hygiene to prevent reinfection.
Avoid douching and perfumed feminine hygiene products that can irritate the vaginal area.
Wear cotton underwear.