INN monograph
Metronidazole vaginal gel
Nitroimidazole antimicrobial / antiprotozoal · POM
Source-linked · Updated 03 Aug 2026 · Source: Local active-ingredient clinical extract; RxNorm (NLM RxNav); PubChem; Professional class pharmacology (Nitroimidazole antimicrobial / antiprotozoal)
Kenya market
Wholesale / list prices where loaded
Risk first
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.
Point of care
Dosing
Adult
Applicatorful of the vaginal gel (5gm with 37.5 mg of metronidazole) intravaginally OD (Nocte) or BD x 5/7.
Paediatric
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Renal
Metabolites accumulate in renal failure; review dosing in ESRD.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Hepatic
Hepatic metabolism — reduce dose in severe liver disease.
Safety
Drug interactions
- 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.
Safety
Adverse effects
- Metallic taste, nausea, anorexia, headache.
- Serious: peripheral neuropathy, encephalopathy, seizures (rare), severe hypersensitivity, Stevens–Johnson (rare).
Use
Indications
- Therapeutic use is agent- and indication-specific within the class (Nitroimidazole antimicrobial / antiprotozoal).
- Use according to culture results, national guidelines (Kenya STG/EML where applicable) and the current product SmPC.
- Bacterial Vaginosis
Pharmacology
Mode of action
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.
Full mechanism text
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.
ADME
Pharmacokinetics & PD
| Onset | 1–2 hours |
|---|---|
| Duration | 8–24 hours |
| Route | ORAL / IV / TOPICAL / VAGINAL |
| Distribution | including abscesses and CSF. Hepatic |
Kenya
Brands & prices
| Brand | Company | Pack | KES |
|---|---|---|---|
| No brands linked yet. | |||
Special populations
Pregnancy & lactation
Pregnancy
Widely used in later pregnancy for BV/trichomoniasis in many protocols; avoid unnecessary first-trimester exposure — follow current guidance.
Lactation
Single-dose regimens often compatible with pumping/timing advice; prolonged high dose — review.
Diet
Food & alcohol
- Food
- Food
Trust
Sources & disclaimer
Source: Local active-ingredient clinical extract; RxNorm (NLM RxNav); PubChem; Professional class pharmacology (Nitroimidazole antimicrobial / antiprotozoal)
Clinical review date not recorded.
Decision support only — not a substitute for clinical judgment, product SmPC, or Kenya STG/EML.