Clinical medicine profile
Metronidazole / Diloxanide / Simethicone
Nitroimidazole antimicrobial / antiprotozoal
- Route
- ORAL / IV / TOPICAL / VAGINAL
- Schedule
- POM
- ATC
- Not assigned
- PPB status
- registered
Safety essentials
The information most likely to change a prescribing or dispensing decision.
Contraindications
- Hypersensitivity to nitroimidazoles.
- First trimester use traditionally avoided unless essential (practice evolving — follow current obstetric guidance).
- Disulfiram within 2 weeks.
Precautions
- Avoid alcohol during and for 24–72 h after (disulfiram-like reaction).
- Neurologic toxicity with prolonged/high dose (neuropathy, seizures).
- Metallic taste common.
- Dark urine possible.
Dosing matrix
Population and organ-function guidance, shown together for faster comparison.
Dosing is indication-, age-, weight- and organ-function-specific for this INN. Do not use class averages for high-risk patients. Confirm the exact regimen in the current SmPC and Kenya Standard Treatment Guidelines. Typical professional workflow: (1) confirm indication, (2) check renal/hepatic function, (3) screen interactions/allergies, (4) select dose/route/duration, (5) define monitoring.
Paediatric dosing is weight- and age-based; use a paediatric formulary / SmPC. Do not extrapolate adult tablets without calculation.
Metabolites accumulate in renal failure; review dosing in ESRD.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Hepatic metabolism — reduce dose in severe liver disease.
Use, effects & interactions
Indications
- see under metronidazole, diloxanide and simethicone respectively.
- Clinical selection for Metronidazole / Diloxanide / Simethicone should follow culture results where relevant, Kenya STG/EML recommendations, and the current product SmPC.
- Class context: Nitroimidazole antimicrobial / antiprotozoal.
- Confirm site-specific dose, duration and monitoring before prescribing.
Adverse effects
- [Metronidazole] GI discomfort, anorexia, metallic taste, dry mouth, headache, skin rash, vertigo, depression, insomnia, drowsiness, urethral dis- comfort, darkened urine, transient fall in BP, temporary leucopenia, bone marrow depression, transient epileptic seizure, furred tongue. [Simethicone] Adverse reactions vary by agent.
- Counsel on common predictable effects and serious warning symptoms (allergy, severe rash, jaundice, unusual bleeding, severe GI symptoms, neurological changes).
- Report suspected ADRs via national pharmacovigilance channels.
Drug interactions
Open multi-drug checker ↗- Cornerstone for anaerobic coverage and protozoa (giardia, amoeba, trichomonas).
- Combine with other agents for mixed aerobic–anaerobic infections as indicated.
- Warn every patient about alcohol.
Mechanism & disposition
see under metronidazole, diloxanide and simethicone respectively.
Read complete mechanism
see under metronidazole, diloxanide and simethicone respectively. Nitroimidazoles are reduced by ferredoxin-like systems in anaerobic bacteria and protozoa to reactive nitro radicals that damage DNA and other macromolecules, causing cell death. Selective for anaerobic/microaerophilic organisms.
1–2 hours
8–24 hours
ORAL / IV / TOPICAL / VAGINAL
including abscesses and CSF. Hepatic
Pregnancy, lactation & diet
[Metronidazole] [Metronidazole] Widely used in later pregnancy for BV/trichomoniasis in many protocols; avoid unnecessary first-trimester exposure — follow current guidance. [Simethicone] Use only if potential benefit justifies potential risk; prefer agents with better reproductive data when alternatives exist.
[Metronidazole] [Metronidazole] Single-dose regimens often compatible with pumping/timing advice; prolonged high dose — review. [Simethicone] Assess infant risk vs benefit of maternal therapy; prefer agents with lactation data.
Brands & loaded prices
| Brand | Manufacturer | Pack | Observed price |
|---|---|---|---|
| No reviewed brand listings are linked yet. | |||
Sources & review state
Decision support only. Confirm patient-specific decisions against the current product SmPC, Kenya STG/EML, and professional judgement.