Presentation
Initial neurological symptoms followed by mucocutaneous manifestation of SJS following metronidazole use is probably a new presentation of this case. [ncbi.nlm.nih.gov]
Entire Body System
- Pain
Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. [ncbi.nlm.nih.gov]
Check with your doctor immediately if any of the following side effects occur while taking metronidazole: More common Agitation back pain blindness blurred vision burning, numbness, tingling, or painful sensations in the hands or feet changes in speech [drugs.com]
Sleeping Dizziness Excess Urination Fainting Fever Generalized Weakness Inflammation Of The Rectum Involuntary Leakage Of Urine Irritability Itching Pain With Sexual Intercourse Sensation Of Spinning Or Whirling Stomatitis, A Condition With Painful Swelling [webmd.com]
- Surgical Procedure
We aimed to assess whether a dual oral antibiotic prophylaxis regimen provides adequate serum concentrations throughout the surgical procedure. [ncbi.nlm.nih.gov]
It also can be used to treat Crohn´s disease or even like prophylaxis, before surgical procedures. Metronidazole is well tolerated with mild to moderate side effects such as nausea, abdominal pain, and diarrhea. [europeanreview.org]
Indicated surgical procedures should be performed in conjunction with Metronidazole Injection, USP RTU® therapy. [globalrph.com]
Indicated surgical procedures should be performed in conjunction with Metronidazole tablet therapy. [web.archive.org]
Indicated surgical procedures should be performed in conjunction with Metronidazols-Grindeks therapy. [ndrugs.com]
- Fatigue
Chronic Fatigue Syndrome (CFS) Symptoms and Diagnosis Chronic fatigue syndrome (CFS) can occur at any age for men or women. Learn more about the causes of chronic fatigue syndrome... [medicinenet.com]
Side effects: irritated heartbeat, palpatations, breathlessness, dizziness, anxiety, flue like symptoms, extreme fatigue, tingling, pain in arm Comments: prescribed tablets by Dentist for gum infection. i was told i should take antibiotics but nothing [druglib.com]
With the pill I experienced daily headaches, a feeling of being distorted, fatigue, dizziness, nausea, diarrhea, a stiff neck, and a metal taste in my mouth. I never had BV until the year 2011 after being sex-free for 3 years after my divorce. [webmd.com]
Adverse reactions CNS: dizziness, headache, ataxia, vertigo, incoordination, insomnia, fatigue EENT: rhinitis, sinusitis, pharyngitis GI: nausea, vomiting, diarrhea, abdominal pain, furry tongue, glossitis, dry mouth, anorexia GU: dysuria, dark urine, [medical-dictionary.thefreedictionary.com]
- Intravenous Administration
Intravenous administration produces similar maternal plasma and milk levels to equivalent oral doses, although the data are limited. Short-course IV metronidazole is considered to be compatible with breastfeeding. [sps.nhs.uk]
For both intravenous and oral administration, a linear dose-concentration curve pertained for usual therapeutic doses between 200 and 2000mg. [link.springer.com]
Intravenous administration is commonly associated with thrombophlebitis. [en.wikipedia.org]
In therapeutic use as radiosensitizers for radiation therapy of tumors, the compounds of the present invention may be administered to a patient either orally or intravenously. The preferred route of administration is intravenous administration. [patents.google.com]
Respiratoric
- Cough
Taking alcohol or other medications containing alcohol (for example, cough syrups), may result in vomiting, headaches and increased heart rate. How to take Metronidazole: Take with food to avoid an upset stomach. Finish the prescription. [kflaph.ca]
During this time, it may be sensible to also avoid alcohol-containing cough and cold remedies and mouthwashes. Speak to your GP or pharmacist if you are unsure. [nhs.uk]
Alcohol is found in most over-the-counter cough and cold medicines. Let your doctor know if you have had seizures or if you have numbness or tingling in your hands or feet. [stjude.org]
Some cold medicines, cough syrups, and mouthwashes have alcohol. Check with the doctor or pharmacist before taking over-the-counter medicines. Do not drink alcohol for another 2 days after you have finished taking metronidazole. [nationwidechildrens.org]
Many nonprescription cough and cold products contain alcohol. Metronidazole can cause an unpleasant reaction when taken with alcohol. The reaction includes flushing, headache, nausea, vomiting, sweating, and increased thirst. [my.clevelandclinic.org]
- Dyspnea
[…] peripheral edema, chest pain, chills, overgrowth of Candida, disulfiram-like reaction, weakness, sensation of pelvic pressure[Ref] Respiratory Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, pharyngitis Frequency not reported: Dyspnea [drugs.com]
Gastrointestinal
- Nausea
The most common side effects that have been reported are nausea, vomiting and hypersensitivity reactions. However, neurotoxicity has been reported with the use of metronidazole but rather rare. [ncbi.nlm.nih.gov]
Potential side effects Uncoordinated gait, confusion, dizziness, hives, disulfiram-like reaction (flushing, nausea, vomiting), nausea, vomiting, constipation, diarrhea, metallic taste, darkened urine, blood disorders (low white blood cell count), weakness [nmihi.com]
Symptoms of overdose may include: nausea, vomiting, unsteadiness. Notes Do not share this medication with others. [healthlinkbc.ca]
- Abdominal Pain
Blastocystis sp. is a gastrointestinal (GI) protozoan parasite reported to cause non-specific GI symptoms including diarrhea, flatulence, abdominal pain, and nausea. [ncbi.nlm.nih.gov]
Symptoms of peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause. [medicinenet.com]
Metallic taste in the mouth, nausea, upper abdominal pain or headaches sometimes occur following usual therapeutic doses. Convulsions, ataxia, skin problems (skin rashes, urticaria), and vaginal candidiasis are not as common. [infomed.ch]
Depression Sleep disorder Nervousness Perineal pain Urinary difficulties Headache Musculoskeletal pain Vaginal estradiol: Headache Vulvovaginal mycotic (fungal) infection Vulvovaginal pruritus (itching) Back pain Abdominal pain Diarrhea Vaginal metronidazole [rxlist.com]
Metronidazole is well tolerated with mild to moderate side effects such as nausea, abdominal pain, and diarrhea. Nevertheless, serious neurotoxicity, optic neuropathy, peripheral neuropathy, and encephalopathy have been reported in rare cases. [europeanreview.org]
- Epigastric Pain
A 25-year-old caucasian lady presented to the Accident & Emergency department complaining of acute onset severe epigastric pain radiating through to the back with associated nausea and vomiting. A diagnosis of acute pancreatitis was made. [ncbi.nlm.nih.gov]
The most common are gastrointestinal disturbances (nausea, vomiting, epigastric pain, metallic taste, furring of the tongue), intolerance to alcohol (disulfiram-like effect) and central nervous system effects (headache, dizziness and sleepiness) [3]. [chemicalbook.com]
(e.g., epigastric pain/distress), proctitis, sudden overgrowth of Candida in mouth, abdominal cramping, dyspepsia, pseudomembranous colitis, mucositis[Ref] Genitourinary Very common (10% or more): Vaginitis (up to 15%) Common (1% to 10%): Genital pruritus [drugs.com]
Giardia lamblia (also known as G. duodenalis ) was treated with metronidazole after this luminal parasite was recognized as a cause of malabsorption and epigastric pain in the 1970s ( 102 ). [aac.asm.org]
Liver, Gall & Pancreas
- Jaundice
Lengthen dosing interval if extreme immaturity, severe jaundice, and/or hepatic dysfunction. Neonates receiving phenobarbitone metabolise metronidazole at a much greater rate than normal, reducing half life by approximately 50-75%. [adhb.govt.nz]
We report on a case of acute fulminant liver failure in a young woman, who had, two years previously, developed jaundice after intake of metronidazol. [ncbi.nlm.nih.gov]
[…] liver function tests until baseline values are reached; advise patients with Cockayne syndrome to stop taking metronidazole immediately if they experience any symptoms of potential liver injury, such as abdominal pain, nausea, change in stool color or jaundice [reference.medscape.com]
Human systemic effects by ingestion: paresthesia, nerve or sheath structural changes, eye changes, tremors, fever, jaundice and other liver changes, hearingacuity changes, somnolence, and ataxia. Experimental reproductive effects. [chemicalbook.com]
Jaw & Teeth
- Metallic Taste
A metallic taste in the mouth is commonly noted. metronidazole Noritate ® Dermatology An antibiotic used for managing dermatitides and erythema of rosacea. [medical-dictionary.thefreedictionary.com]
Can the use of Metronidazole cause metallic taste? Yes, Metronidazole may cause a temporary metallic taste. This metallic taste can be reduced by staying hydrated, brushing teeth after the meals and chewing sugar-free gum or mints. Q. [1mg.com]
The metal taste in my mouth is a little irritating, my appetite is decreased, and I feel a little groggier than usual, but it's really not so bad. Just thought I would write a review to ease some people's mind... [webmd.com]
Metallic taste in the mouth, nausea, upper abdominal pain or headaches sometimes occur following usual therapeutic doses. Convulsions, ataxia, skin problems (skin rashes, urticaria), and vaginal candidiasis are not as common. [infomed.ch]
[Ref] Nervous system Very common (10% or more): Headache (up to 18%) Common (1% to 10%): Dysgeusia/taste perversion (e.g., metallic taste, sharp unpleasant metallic taste, taste of alcoholic beverages modified), dizziness Rare (0.01% to 0.1%): Encephalopathy [drugs.com]
Musculoskeletal
- Arthralgia
[…] pressure[Ref] Respiratory Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, pharyngitis Frequency not reported: Dyspnea, nasal congestion, hiccup[Ref] Musculoskeletal Common (1% to 10%): Myalgia Very rare (less than 0.01%): Arthralgia [drugs.com]
Skin
- Formication
Chromatographic separation of analytes was achieved on an Acquity UPLC BEH C18 column (1.7 μm, 2.1 × 100 mm) using gradient elution with a blend of 0.1% formic acid in water and 0.1% formic acid in methanol at a flow rate of 0.25 mL/min. [ncbi.nlm.nih.gov]
Decompression to recycle formic acid, water solution is cooled to 10 ℃, filter. The filtrate with sodium hydroxide solution to adjust pH = 10. Set aside to cool, filtering, washing to nearly alterations into neutral, recrystallization in water. [chemicalbook.com]
ACETIC ACID, IODO- Jodeddiksyre, Jodmetan CH 3 I METHANE, IODO- Metyljodid, 3-Jodpropen C 3 H 5 I 1-PROPENE, 3-IODO- Allyljodid, Kadmiumcyanid C 2 CdN 2 CADMIUM CYANIDE (Cd(CN)2), Kadmiumfluorid CdF 2 CADMIUM FLUORIDE (CdF2), Kadmiumformat C 2 CdO 4 FORMIC [kjemi.no]
- Eczema
Demodex mites are more frequently found in rosacea (51%) compared to 28 percent in eczema and 31 percent in discoid lupus erythematosus [ 13 ]. [dermatology.cdlib.org]
Some physicians use a thick ointment to replace the waterproof barrier of the inflamed skin in the treatment of eczema, and a cream might not accomplish the same clinical intention Classes[edit] There are many general classes, with no clear dividing line [en.wikipedia.org]
Neurologic
- Headache
During the metronidazole treatment, loss of sight, vertigo, ataxia, and headache occurred as the adverse effects. By this report, we want to express the rare adverse effects of drugs in the differential diagnoses of nervous system diseases. [ncbi.nlm.nih.gov]
A disulfiram-like reaction (including flushing, headache, nausea, and vomiting) may occur if alcohol is ingested within 7 days of use. [msdmanuals.com]
- Peripheral Neuropathy
Overall, metronidazole is generally well tolerated, but serious neurotoxicity, including peripheral neuropathy, has been reported. The overall incidence of peripheral neuropathy associated with metronidazole is unknown. [ncbi.nlm.nih.gov]
The duration and total dosage of metronidazole received is the primary determinant for patients developing peripheral neuropathy. [pharmaceutical-journal.com]
- Tingling
Rarely, tingling or numbness in the hands or feet may be experienced. If you notice tingling or numbness, stop taking the medication and follow up with your doctor or nurse. [kflaph.ca]
Forty-four days after initiating metronidazole (total intake of 66 g), she complained of tingling sensations in the upper limbs. [ncbi.nlm.nih.gov]
Let your doctor know if you have had seizures or if you have numbness or tingling in your hands or feet. Let your doctor or dentist know you are taking metronidazole before you have surgery requiring general anesthesia. [stjude.org]
Common side effects of metronidazole include vomiting, upset stomach, diarrhea, loss of appetite, dry mouth or mouth irritation, and numbness or tingling of the hands and feet. Metronidazole can also cause dizziness. [rxwiki.com]
Other side effects may include numbness, tingling, pain or weakness in hands or feet. [healthcentral.com]
- Convulsions
The present case is of a patient who used the drug for 4 months and developed peripheral neuropathy, convulsions, and cerebellar ataxia. He was treated with diazepam and levetiracetam. [ncbi.nlm.nih.gov]
Convulsions, ataxia, skin problems (skin rashes, urticaria), and vaginal candidiasis are not as common. Isolated cases of pancreatitis, cystitis, mucous colitis and hemolysis have been observed. [infomed.ch]
Healthcare Professionals Applies to metronidazole: compounding powder, intravenous powder for injection, intravenous solution, oral capsule, oral suspension, oral tablet, oral tablet extended release General The most serious side effects reported were convulsive [drugs.com]
790 mg of sodium per 100 mL; use care when administering injection to patients receiving a controlled sodium diet or corticosteroids or to patients predisposed to edema Severe neurological disturbances, including encephalopathy, cerebellar symptoms, convulsive [reference.medscape.com]
However, because metronidazole metabolites may accumulate in patients with end-stage renal disease, these patients should be monitored for metronidazole-associated adverse effects such as CNS effects, including headaches, convulsions, and peripheral neuropathy [msdmanuals.com]
- Paresthesia
We report a 67-year-old man with progressive painful paresthesias involving all the four limbs of 3 weeks' duration before admission. He had been treated with metronidazole and cephalosporin for 10 weeks for a hepatic abscess. [ncbi.nlm.nih.gov]
[…] somnolence, peripheral neuropathy, ataxia Very rare (less than 0.01%): Subacute cerebellar syndrome (e.g., ataxia, dysarthria, gait impaired, nystagmus, tremor), drowsiness, convulsions, incoordination Frequency not reported: Dysarthria, hypoesthesia, paresthesia [drugs.com]
[…] encephalopathy; CNS symptoms are generally reversible within days to weeks upon discontinuation of therapy; lesions seen on MRI have also been described as reversible Peripheral neuropathy, mainly of sensory type reported and characterized by numbness or paresthesia [reference.medscape.com]
[…] metabolites may accumulate in patients with end-stage renal disease, these patients should be monitored for metronidazole-associated adverse effects such as CNS effects, including headaches, convulsions, and peripheral neuropathy (mainly numbness or paresthesias [msdmanuals.com]
Workup
Serum
- Neutropenia
To the Editor:— Lefebvre and Hesseltine ( 194 :15, 1965) reported a 1% incidence of transient leukopenia and neutropenia in 386 patients treated up to 14 days with metronidazole for Trichomonas vaginalis infections. [jamanetwork.com]
Neutropenia can also develop. Metallic taste in the mouth, nausea, upper abdominal pain or headaches sometimes occur following usual therapeutic doses. [infomed.ch]
Other side effects reported include urticaria, darkening of the urine with a reddish-brown discoloration and transient neutropenia [4]. [chemicalbook.com]
Neutropenia (moderate, reversible). Hypersensitivity reactions rare (urticaria, skin eruptions, anaphylaxis). Lengthen dosing interval if extreme immaturity, severe jaundice, and/or hepatic dysfunction. [adhb.govt.nz]
[…] needed in patients receiving hemodialysis Use with caution in history of heart failure, hepatic failure, H. pylori infection, renal impairment Use with care in patients with evidence of or history of blood dyscrasia; agranulocytosis, leukopenia and neutropenia [reference.medscape.com]
Treatment
1 4 Completed Treatment Gingival Inflammation 1 4 Completed Treatment Helicobacter Infection 1 4 Completed Treatment Helicobacter Infections 2 4 Completed Treatment Helicobacter Pylori Treatment Failure 1 4 Completed Treatment Human Immunodeficiency [drugbank.ca]
Medical treatment of peptic ulcer disease. JAMA. 1996; 275:622-9. [IDIS 361115] [PubMed 8594244] 377. Soll AH. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1136-7. 378. [web.archive.org]
Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984; 6(Suppl 1):S235-41. 129. Fekety R, Silva J, Buggy B et al. Treatment of antibiotic-associated colitis with vancomycin. [drugs.com]
Patients with disease unresponsive to first-line treatments pose a major challenge, as therapeutic options are limited. [ncbi.nlm.nih.gov]
Prognosis
We advocate that metronidazole can be associated with severe neurotoxicity, but its prompt cessation leads to better outcome and prognosis. [ncbi.nlm.nih.gov]
[…] medulla, and pons ADC: ADC values of lesions of the dentate nucleus, midbrain, medulla, and pons are similar or higher than those of normal white matter, whilst corpus callosum lesions can show lower values than in normal white matter 3 Treatment and prognosis [radiopaedia.org]
When skin detachment is extensive, however, the prognosis is poor. [doi.org]
Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented. [medicinenet.com]
Etiology
Recall dermatitis from primary cutaneous exposure and subsequent oral exposure are rare, and the etiology remains unknown. We report a case of recall dermatitis with a drug eruption secondary to metronidazole. [ncbi.nlm.nih.gov]
Martin Tomy and Hui LI, Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis, Chinese Medical Journal, 10.1097/00029330-200804020-00019, 121, 8, (756-761), (2008) ., Current awareness: Pharmacoepidemiology [dx.doi.org]
Epidemiology
The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS: There were 873 patients enrolled. [ncbi.nlm.nih.gov]
Biology and Epidemiology 3.2.1.1.2. Chemotherapy 3.2.1.2. American Trypanosomiasis 3.2.1.2.1. Biology and Epidemiology 3.2.1.2.2. Chemotherapy 3.2.1.3. Leishmaniasis 3.2.1.3.1. Biology and Epidemiology 3.2.1.3.2. Chemotherapy 3.2.2. [doi.org]
Martin Tomy and Hui LI, Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis, Chinese Medical Journal, 10.1097/00029330-200804020-00019, 121, 8, (756-761), (2008) ., Current awareness: Pharmacoepidemiology [dx.doi.org]
Pathophysiology
Pathophysiological mechanisms of metronidazole neurotoxicity remain unclear. MRI Nearly all cases show lesions in the cerebellum (93-100%) 1,3, particularly of the cerebellar dentate nuclei. [radiopaedia.org]
Tran and Joseph Poku, Hemodynamic Considerations in the Pathophysiology of Peripheral Neuropathy, Blood Pressure - From Bench to Bed, 10.5772/intechopen.75872, (2018). J. Morera-Montes and M. [dx.doi.org]
Hepatic encephalopathy: Pathophysiology and emerging therapies. Med Clin N Am 2008;93:819-836. Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut 1982;23:1-7. Schiano Thomas D. [medigraphic.com]
Discussion The exact pathophysiology of hemorrhoidal disease remains poorly studied and understood. [scielo.isciii.es]
Prevention
Recurrent Bacterial Vaginosis 1 3 Completed Prevention Appendicitis Acute / Perforated Gastroduodenal Ulcer / Small intestinal obstruction 1 3 Completed Prevention Bacterial Vaginosis (BV) 2 3 Completed Prevention Human Immunodeficiency Virus (HIV) Infections [drugbank.ca]
Article Navigation From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine [doi.org]
KEYWORDS: H. pylori; bactericidal dynamics; human lysozyme; metronidazole; mutant prevention concentration [ncbi.nlm.nih.gov]
It is broadly used to prevent and treat oral anaerobic infections. [chemicalbook.com]