Metrogyl solution for infusion

Metrogyl solution for infusion (Solutio MetroGyl Pro InfusionIbus)

international and chemical name:metronidazole; 1- (B-oxyethyl) -2-methyl-5-nitroimidazole;

Basic physico-chemical characteristics: transparent, colorless or light yellow color liquid;

Structure.1 ml of solution includes metronidazole 5 mg;

other components: sodium chloride, lemon acid, sodium phosphate biennial anhydrous, water for injection.

Form release medication.Solution for infusion.

Pharmacotherapeutic group. Antibacterial agents. The derivatives of imidazole. PBX code J01X D01.

Action of the drug. Metronidazole - antiprotozoic and antibacterial drug. Exhibits Trichomonas Vaginalis, Giardia Intestinalis, Entamoeba Histolytica, Balantium Coli, Lamblia, as well as bonded anaerobes - Bacteroides SPP. (B. Fragilis, B. DistaSonis, B. Thetaiotaomicron, B. Vulgatus, B. Ovatus), Fusobacterium SPP. , Clostridium SPP. , Peptostreptococcus SPP. , Peptococcus SPP. Aerobic microorganisms to metronidazole are insensitive.

Pharmacodynamics. The mechanism of action lies in the biochemical resumption of the 5-nitro group of metronidazole by intracellular transport proteins of anaerobic microorganisms and the simplest. The reduced 5-nitro group of metronidazole interacts with DNA of microorganisms, which leads to their death.

Pharmacokinetics. After intravenous infusion (for 20 minutes), 500 mg of metronidazole in patients with anaerobic infections The concentration of the preparation in serum became 35, 2 μg / ml after 1 hour, 33, 9 μg / ml after 4 hours and 25, 7 μg / ml after 8 hours.

The half-life after a single dose is 6 to 7 hours. The binding of metronidazole with plasma proteins is insignificant - does not exceed 10-20%. It easily penetrates the tissue, the volume of its distribution is 70 - 95% body weight.

Metronidazole reaches a bactericidal concentration in most of the tissues and liquids of the human body, including the brain, spinal fluid, cavities of abscesses, saliva, horizontal, germ, amniotic fluid and breast milk.

Metronidazole is excreted from the human body mainly due to metabolism with the oxidation of the side chain, hydroxylation, or compounds of the starting material. The main product of metabolism is 1- (2-oxyethyl) -2-oxymethyl-5-nitroimidazole, which, together with glucuronide, is from 40 to 50% of the substance that is derived from the urine. Acid and alcoholic metabolites of metronidazole have its activity, respectively, by 50% and by 30%.

During 24 hours with urine, from 35 to 65% of all nitro-produce preparations are derived. The kidney clearance is 10, 2 ml / min. In patients with a normal function of the gall tract, the concentration of metronidazole in the bile of the gallbladder after intravenous infusion

500 mg is significantly higher than in serum.

In patients with impaired kidney functions after repeated doses of the drug, metronidazole in serum is accumulated. Therefore, often take the drug is not recommended for patients with acute renal failure.

Indications for use. The infusion solution of metrogil is used in infections caused by sensitive microorganisms. They belong to them:

- Internal abrasive infections - purulent appendicitis, purulent cholecystitis, peritonitis, liver abscess, postoperative wound infection;

- gynecological and postpartum infections - endometritis, endomyometritis, postpartum sepsis, pelvic abscess, pelvic peritonitis;

- infection respiratory tract - necrotic pneumonia, empya, abscess lungs;

- Central infections nervous system - meningitis, brain abscess;

- other infections - septicemia, gas gangrene, osteomyelitis;

and also - prevention and treatment of postoperative infections caused by anaerobic bacteria.

Treatment of acute intestinal anmebiasis and amoebic liver abscesses.

Method of use and dose.

For adults and children over 12 years old: Disposal dose - 500 mg (100 ml) is introduced for 20 minutes at the rate of 5 ml per minute. Interval between repeated administration - 8 ocloc'k. Maximum daily dose should not exceed 4 g

For children up to 12 years old: Depending on the mass of the body's body, the amount of fluid that is introduced is determined at the rate of 7, 5 mg / kg. The order and frequency of the injections remain such as adults: for 20 minutes in 5 ml / minutes every 8 hours. The duration of treatment should be appointed by a doctor depending on the results of the clinical examination.

For adult patients with a significant impairment of the kidney function (QC less than 30 ml / minutes) and / or liver, the daily dose of metronidazole is 1000 mg (for two receptions).

Side effect.Side effects are rarely observed in patients who are made by intravenous infusion of metronidazole.

From side gastrointestinal tract: nausea, vomiting, diarrhea, no appetite, metal taste in the mouth, epigastric pain.

From the central nervous system: in the case of long-term reception - headache, dizziness, increasing excitability, depression, sleep disorder, weakness; In some cases, the tumorization of consciousness, hallucinations, convulsions.

From the urogenital system: a feeling of burning in the urethra channel, an increase in the likelihood of the development of fungal flora of the vagina (candidiasis);

Allergic reactions: rash, itching, urticaria.

From the skeleton side: arthralgiy.

From the side of the hematopoietic system: leukopenia.

Contraindications. Increased sensitivity to metronidazole and other nitroimidazole derivatives;

organic lesions of the central nervous system;

blood diseases;

1 trimester of pregnancy (ІІ and ІІІ trimester of pregnancy - only on life indications);

breastfeeding period.

Excess the allowable dose of the drug (overdose).When receiving the drug in high doses, cramps and peripheral neuropathy were observed. In such cases, symptomatic therapy should be carried out. Metronidazole is excreted from the body by hemodialysis.

Features of use.Do not remove the inner container with wrap up to use. The outer wrapper protects the drug from the liquid. The internal container provides the sterility of the drug. After removing the external wrapper, press the container to clarify, or there is no partial discharge of the drug. If the foundation takes place, the drug does not use, replace the new one.

Immediately before use, heat the bottle with a preparation to room temperature or even better - up to 37 ° C.

In the first way, it is necessary to move from intravenous injections of the metrogil to oral administration of the drug (200 - 400 mg three times a day).

Pregnancy I. breastfeeding. Since the metronidazole can penetrate into breast milk in sufficiently serious concentrations, it is contraindicated to women who are breastfeeding. Also recommended for the possibility of avoiding metronidazole in the first three months of pregnancy, since its effect on the development of the fetus is not sufficiently studied.

Interaction with other drugs.Although, when using the metrogil for infusion, the interaction with other drugs is minor, it is necessary to carefully appoint a metrogyl when treating some litter drugs.

Warfarin and some indirect anticoagulants. Metronidazole enhances the effect of indirect anticoagulants, which leads to an increase in prothrombin formation time.

Disulfiram (Esparl). Simultaneous use can lead to the development of neurological symptoms, so one should not be prescribed by the metrged patients who took disulfiram over the past two weeks.

Cimetidine inhibits metropolism of metronidazole, which can lead to an increase in its serum concentration and an increase in the risk of adverse reactions.

The simultaneous use of drugs that stimulate the enzymes of microsomal oxidation in the liver (phenobarbital, phenytoin) can accelerate the elimination of the metrogil. As a result, the concentration of the plasma metrogil is reduced.

In patients, which long received treatment with lithium drugs in high doses, with simultaneous reception of metrogil, it is possible to increase the concentration of lithium in the blood plasma and the development of symptoms of intoxication.

The antimicrobial action of the metrogil is intensified in combination with antibiotics and sulfonamides.

During the use of the drug should not be alcohol. Metrogil has the ability to cause immediately to alcoholic beverages.

Introduction Simultaneously with the metrogyl mixtures of 10% dextrose, penicillin G, potassium, lactose and ringer solution are contraindicated, since these substances are chemically incompatible.

Features of the conditions, storage and implementation periods.. To contain room temperature (not higher than 25 0s) in places inaccessible to children. Protect from light. Do not freeze.

Shelf life - 3 years.

Sources of information: rsml.med.by, mednet.by, drugs.com, Webmd.com.

Antibacterial agents for systemic use. Other antibacterial agents. The derivatives of imidazole.

ATH code:

Pharmacological properties

Pharmacodynamics

Metronidazole is a stable compound capable of penetrating into microorganisms. In anaerobic conditions, the metronidazole forms with microbial pyruvate ferredoxin-oxidoreductase nitrosoradicals by oxidation of ferredoxin and flaskoxin. Nitrosoradicals form products of attachment with the main pairs of DNA, which leads to the rupture of the DNA chains and to the death of the cells.

The minimum inhibitory concentration (MIC) is established by the European Committee for Testing Antimicrobial Sensitivity, interrupt points separating sensitive organisms (S) from resistant (R), as follows:

gram-positive anaerobes (S: ≤ 4 mg / ml, R\u003e 4 mg / ml);

gram-negative anaerobes (S: ≤ 4 mg / ml, R\u003e 4 mg / ml).

List of sensitive and resistant microorganisms

Usually sensitive strains

Anaerobes

Bacteroides Fragilis

Clostridium Difficile °

Clostridium Perfringens ° Δ

Fusobacterium SPP. °

Peptoniphilus spp. °

Peptostreptococcus SPP. °

Porphyromonas SPP. °

Veillonella SPP. °

Other microorganisms

Entamoeba Histolytica °

Gardnerella vaginalis °

Giardia Lamblia °

Trichomonas vaginalis °

Naturally resistant microorganisms

All bond aerobes

Gram-platebmicroorganisms

Enterococcus SPP.

Staphylococcus SPP.

Streptococcus SPP.

Gram-negative microorganisms

Enterobacteriaceae.

Haemophilus SPP.

° During the publication of these tables available, there was no available data. The primary literature presents possible standard reference references and therapeutic recommendations for the sensitivity of the respective strains.

Δ can be used only to patients with allergies to penicillin.

Mechanisms of resistance K.metronidazole.w.

Mechanisms of resistance to metronidazole are still investigated only partially.

Bacteroides strains are resistant to metronidasesol due to genes encoding nitroimidazoledases, which convert nitroimidazole in aminoimidazoles, as a result of which the formation of antibacterial efficient nitrosoradicals is inhibited.

There is a complete cross resistance between metronidazole and other nitroimidazole derivatives (tinidazole, ornidazole, nimoresol).

The prevalence of the acquired sensitivity of individual strains may vary depending on the region and time. Therefore, it is necessary to use specific locals, especially for effective treatment heavy infections. In case of doubt about the effectiveness of metronidazole associated with the local picture of resistance, the expert council should be used. It is necessary to establish a microbiological diagnosis, including the definition of strains of microorganisms and their sensitivity to metronidazole, especially in the case of severe infection or the ineffectiveness of treatment.

Pharmacokinetics

Since Metrogyl® should be administered intravenously, its bioavailability is 100%.

Distribution

Metronidazole after administration is widely metabolized in the tissues of the body. Metronidazole was found in most tissues and fluids of the body, including bile, bones, cerebral abscess, cerebrospinal fluid, liver, saliva, seminal liquid and discharge from the vagina, where concentrations close to the concentration in the blood plasma are achieved. It also penetrates the placenta and turns out in maternal milk in concentrations equivalent to serum concentrations. Protein binding is less than 20%, the visible distribution volume is 36 liters.

Metabolism

Metronidazole is metabolized in the liver by oxidizing the side chains and the formation of glucuronide. Its metabolites include a product of acid oxidation, hydroxyl derivative and glucuronide. The main metabolite in serum is hydroxyllated metabolite, and the main metabolite in the urine is acidic.

Election

Approximately 80% of the substance is displayed with urine, of which less than 10% - unchanged. A small amount is excreted by the liver. The half-life is 8 (6-10) hours.

Characteristics B. special groups Patients

Renal failure detains allotment only slightly.

With severe liver diseases, we should expect a delay in clearance and lengthening the semi-exploration period from serum (up to 30 hours).

Indications for use

Treatment of anaerobic bacterial infections

Metrged, solution for intravenous administration, Designed to treat the following severe infections caused by anaerobic microflora and the simplest:

Infections organs abdominal cavity , including peritonitis, intraper abscess, liver abscess and caused by Bacteroides SPP., Including groups V. Fragilis (V. Fragilis, B. Distasonis, V. Ovatus, V. Thetaiotaomicron, V. Vulgatus), Clostridium SPP., EUBACTERIUM Peptococcus SPP. and peptostreptococcus SPP.

Skin infectioncaused by Bacteroides SPP., Including groups V. Fragilis, Clostridium SPP., Peptococcus SPP., Peptostreptococcus SPP. and Fusobacterium SPP.

Gynecological infections, including endometritis, endomyometritis, tubarial abscess, vaginal cord infection caused by Bacteroides SPP., Including groups V. Fragilis, Clostridium SPP., Peptococcus SPP., Peptostreptococcus SPP. and Fusobacterium SPP.

Bacterial sepsiscaused by Bacteroides SPP., Including group V. Fragilis and Clostridium SPP.

Bone and joint infections, as additional therapy caused by the types of Bacteroides, including groups V. Fragilis.

Infection of the central nervous system, including meningitis and brain abscess caused by Bacteroides SPP., Including group V. Fragilis.

Infections N.izhni respiratory tract, including inflammation of the lungs, empath and abscess of the lungs caused by Bacteroides species, including groups V. Fragilis.

Endocarditiscaused by Bacteroides SPP., Including groups V. Fragilis.

Protozoy infections: extra-piece Amebiaz, including ambitious liver abscess, intestinal Amebiaz ( ameboy Dieseneria).

Prevention of anaerobic bacterial infections:

Prevention postoperative complications (especially interventions on the colon, paragreotal region, appendectomy, gynecological operations).

Preventive application of metronidazole must be discontinued within 12 hours after the operation.

Surgical intervention must be performed in combination with intravenous purpose of metronidazole.

In the case of mixed aerobic and anaerobic infection, antibiotics suitable for the treatment of aerobic infections should be used in addition to the metronidazole.

Metronidazole is effective with respect to Bacteroides Fragilis, resistant to chloramphenicol, clindamycin and penicillin.

To reduce the development of resistant bacteria and maintain the effectiveness of metronidazole therapy, only for the treatment or prevention of infections caused by the simplest or bacteria, for which their sensitivity to the metronidazole is proved.

When applying metronidazole, national and international recommendations should be taken into account on the proper use of antimicrobial drugs.

Method of application and dose

The dose is adjusted in accordance with the patient's individual reaction for treatment, age and body weight, as well as the type and severity of the disease.

Treatment of installed anaerobic infection

Adults and children over 12 years old:

The usual dose is 500 mg every 8 hours. In the presence of medical testimony, at the beginning of treatment, a loadal dose of 15 mg / kg body weight can be prescribed. The maximum daily dose of 4.0 g should not be exceeded.

Children under the age of 12:

Every 8 hours of 7-10 mg of metronidazole / kg of body weight, which corresponds to a daily dose of 20-30 mg of metronidazole / kg of body weight.

Prevention of anaerobic infection in surgery

For the prevention of anaerobic infection during abdominal interventions (especially on the thick intestine) and gynecological operations are prescribed:

adults and children over 12 years old - 500 mg shortly before the operation and then every 8 hours, followed by an early transition to the reception of the drug inside.

children under 12 years old - 20-30 mg / kg in one dose 1-2 hours before surgery.

Patients with renal failure

There is no need to reduce the dose (see the section "Pharmacological properties").

Patients with hepatic insufficiency

Since with severe hepatic insufficiency, the semi-anniversary of metronidazole from serum is increased, and the clearance decreases, such patients needed low doses (reduced dose to 50% with severe liver failure).

Elderly patients

The usual duration of therapy is 7 to 10 days, however, infections of bones and joints, lower respiratory tract, and endocardium may require longer treatment.

The duration of treatment with the drug or drugs containing other nitroimidazoles, as a rule, should not exceed 10 days. Only in special cases, if necessary, the treatment period can be extended accompanied by the relevant clinical and laboratory monitoring. Repeat therapy should be maximally limited by private cases. It should be clearly followed by these restrictions, since it is impossible to exclude possible mutagenic activity of metronidazole, as well as due to the increase in the frequency of development of certain tumors, was recorded in animal studies.

At the first opportunity, it is necessary to move from intravenous injections of the drug for oral administration.

Method of administration

Apply in the form of intravenous infusion.

The contents of 1 bottle should be administered intravenously, that is, a maximum of 100 ml for at least 20 minutes, but usually for 1 hour.

The drug can also be breeding before administration by adding other drugs or solutions for dilution, such as a 0.9% solution of sodium chloride for injection or a 5% glucose solution for infusions.

Only for disposable application. Unused residues to destroy.

The solution should be applied only if it is transparent, and the container or packaging does not have visible signs of damage.

External packaging protects the drug from moisture. The internal container provides the sterility of the drug. After removing the external wrapper, you must click on the container to check whether there is no partial leakage of the drug. If the leakage takes place, the bottle must be replaced.

Contraindications

Increased sensitivity to metronidazole, another nitroimidazole derivative. Psychotic reactions to disulfirama in patients with alcohol addiction.

Simultaneous admission of alcohol and preparations containing propylene glycol. Pregnancy and lactation.

Precautions

When applying metronidazole cases are registered encephalopathy and peripheral neuropathy, Including the defeat of the optic nerve.

Encephalopathy in combination with cerebelchikova toxicity is characterized by ataxia, dizziness, dysarthria. Reversible CNS lesions can be detected on MRI.

The symptoms of the TSS defeat, as a rule, disappear within a few days or weeks after the cancellation of metronidazole. Peripheral neuropathy, mainly sensory type is characterized by numbness or paresthesia limbs. In patients who received Metronidazole, convulsions were registered.

Aseptic meningitis: Cases of aseptic meningitis were recorded. Symptoms may arise within a few minutes during the infusion of metronidazole and completely stop after canceling the drug.

The emergence of neurological pathology requires an urgent assessment of the benefit / risk ratio to solve the issue of continuing therapy.

In case of hard hypersensitivity reactions (including anaphylactic shock) The drug must be canceled immediately and start overall urgent therapy.

Patients S. heavy lesions of the liver, renal failure, impaired hemopoiesome (including granulocyptopenia) Metronidazole should be applied only if the expected benefits exceeds the potential risk. The use of metronidazole requires constant monitoring of the condition of the functions of the liver, kidney, bone marrow (the possibility of leukopenia), as well as the appearance of appropriate adverse reactions.

Fungal Superinfections

The emergence or recurrence of the candidiasis during the appointment of antifungal drugs.

Severe persistent diarrhea appearing during treatment or over the next weeks may be a consequence pseudomambranous colitis (In many cases called Clostridium Difficile), see the section "Side Effects". This is a bowel disease caused by antibiotics, can threaten life and requires immediate appropriate treatment. It is impossible to take preparations that overwhelm the intestinal peristalsis.

Pregnancy and lactation

1 trimester of pregnancy - contraindicated; II and III trimesters of pregnancy - only on life indications;

nursing mothers - according to indications with simultaneous cessation of breastfeeding.

Impact on the ability to drive a car and working mechanisms

During the period of treatment, caution must be taken when driving vehicles and during the occupations of other potentially hazardous species Activities requiring increased concentration of attention and speed of psychomotor reactions (dizziness, disturbances, hallucinations, convulsions, disruption of coordination of movements, ataxia) are possible.

Medicinal interaction

Disoulphyram.

Psychotic reactions were recorded in patients with alcoholism, which are used metronidazole and disulfers at the same time. Metronidazole should not be prescribed to patients who took disulfiram over the past two weeks.

Alcoholic beverages

With simultaneous use of alcohol or preparations containing propylene glycol, a disulfiramoid syndrome with spasms in the abdomen, nausea, vomiting, headache, "tides", hypotension, etc. (see the section "Contraindications") may develop.

Derivatives Kumarina

The simultaneous use of metronidazole can enhance the anticoagulant effect of Cumarine derivatives and increase the risk of bleeding due to decreasing degradation in the liver. Correction of the dose of anticoagulants may be required.

With the simultaneous use of metronidazole with lithium salts, caution should be observed, since at the time of therapy with metronidazole, elevated serum lithium concentrations were observed. Lithium treatment must be completed or canceled before applying metronidazole.

If patients accept lithium at the same time as the metronidazole, the concentration of lithium, creatinine and electrolytes in the blood plasma should be monitored.

Busulfan

The simultaneous use of metronidazole can significantly increase the plasma concentration of busulfan. The mechanism of their interaction is not described. Through the potential risk of severe toxicity and fatal outcome related to the increasing plasma levels of busulfan, it should be avoided by its simultaneous application with the metronidazole.

Amiodar

With the simultaneous use of metronidazole and amidarone, the Qt and Torsade de Pointes interval addresses. When using amiodarone in combination with metronidazole, it may be appropriate for the monitoring of the Qt interval to the ECG.

Barbiturates

Phenobarbital can enhance the liver metabolism of metronidazole, reducing the period of its half-life from blood plasma.

Carbamazepine

Metronidazole may suppress carbamazepine metabolism and as a result of this, increase its plasma concentrations.

Cimetidine

The simultaneous use of cimetidine in some cases can reduce the removal of metronidazole and, accordingly, lead to an increase in the concentrations of the latter in the serum.

Contraceptives

Some antibiotics in some cases can reduce the effectiveness of oral contraceptives, affecting the bacterial hydrolysis of steroid conjugates in the intestine and, thus, reducing the re-absorption of non-conjugated steroids, as a result of which the plasma concentrations of active steroids are reduced.

Cyclosporin

With simultaneous treatment with cyclosporin and metronidazole, there is a risk of the growth of serum concentrations of cyclosporine. Regular monitoring of the level of cyclosporine and creatinine is required.

Formuracyl

Metronidazole suppresses fluorouracil metabolism with simultaneous use, i.e., plasma concentrations of fluorouracil grow.

Mikophenolate Mofetila

Substances that change the gastrointestinal flora (for example, antibiotics) can reduce the oral bioavailability of IFC preparations. During therapy with anti-infectious means, careful clinical and laboratory monitoring is recommended to detect a decrease in the immunosuppressive effect of the IFC.

Phenytoin

Metronidazole inhibits phenytin metabolism while simultaneously use, i.e., plasma concentrations of phenytoin decrease. On the other hand, the efficiency of metronidazole decreases while simultaneously use with phenytio.

Tacrolimus

The simultaneous use of metronidazole can lead to an increase in the concentration of tacrolimus in the blood. The probable mechanism for suppressing liver metabolisms of the tacrolimus occurs with CYP 3A4. It should often be controlled by the level of tacrolimus in the blood and kidney function and, accordingly, adjust the dosage, especially after the beginning of the cancellation of the treatment with metronidazole patients stabilized on the tacrolimus reception mode.

Influence on laboratory indicators

Metronidazole affects the results of the enzymatic-spectrophotometric determination of aspartataminotransferase, alanine substransferase, lactate dehydrogenase, triglycerides and glucosohexocinases, reducing their values \u200b\u200b(possibly to zero).

Metronidazole has high values Absorption at a wavelength on which nicotinamide is defined (NADH). Therefore, when measuring the NADH, the constant flow method based on the determination of the end point of the reduction of the reduced NADH, the metronidazole can mask the increased concentrations of hepatic enzymes. Unusually low concentrations of hepatic enzymes can be noted, including zero values.

The use of the drug can cause Treponema immobilization and thus lead to a false positive result of the Nelson test.

Side effect

Violations of the nervous system: peripheral sensory neuropathy, headache, convulsions, dizziness reported on the development of encephalopathy and subacute cerebellar syndrome (violation of coordination and synergies of movements, ataxia, dysarthria, gait disruption, nastagm, tremor), which are reversible after the cancellation of metronidazole , aseptic meningitis.

Violations by the psyche: psychotic disorders, including confusion, hallucinations; Depression, insomnia, irritability, increased excitability.

Violations from the gastrointestinal tract: diarrhea, decline in appetite, anorexia, nausea, vomiting, pain in the epigastria, constipation, "metallic" taste in the mouth, dry oral mucosa, glossitis, stomatitis, pancreatitis (reversible cases), color change Language / "Cold Language" (due to the development of fungal microflora).

Violations of the skin and subcutaneous fabrics: rash, urticaria, pustling skin rash, itching, skin hyperemia, Stevens-Johnson syndrome, toxic epidermal necroliz.

Disorders from the blood and lymphatic system: agranulocytosis, leukopenia, neutropenia, thrombocytopenia.

Violations from immune system: angioedema swelling, anaphylactic shock.

Violations of the cardiovascular system: tapping tongs on an electrocardiogram.

Violations of the organ of vision: transient violations of vision, such as diplopia, myopia, vague contours of objects, a decrease in visual acuity, violation of color perception; Neuropathy / Neuritis of the optic nerve.

Violations by the liver and biliary tract: increasing the activity of "liver" enzymes (aspartatenotransferase, alanine substransferase, alkaline phosphatase), the development of cholestatic or mixed hepatitis and hepatocellular lesion of the liver, sometimes accompanied by jaundice; In patients treated with metronidazole in combination with other antibacterial agents, cases of liver failure, which required conducting liver transplantation.

Disorders from the kidneys and urinary tract: dizuriy, cystitis, polyuria, urinary incontinence, candidiasis, urine staining in brownish-reddish color, due to the presence in the urine of water-soluble metabolite metronidazole.

General disorders and disorders at the injection site: fever, nasal congestion, arthralgia, weakness, thrombophlebitis (pain, hyperemia or swelling at the place of administration).

Other: The spread of Candida in the vagina, dispensation, the decrease in the libido, procts and the fleeting pains in the joints, sometimes resembling a "serum disease".

Part metrogyl solutionincludes current component metronidazole. As well as: sodium chloride, sodium hydrophosphate (anhydrous), citric acid, water.

Tablets metrogyl contain a valid component metronidazole. As well as: corn starch, magnesium stearate, silicon colloid dioxide, hydrogenated castor oil, OPADRY II dye, water.

Gel metrogyl Includes metronidazole. and additional components: propyl aprichedroxybenzoate, methyl aprichedroxybenzoate, Dinatari Edetat, carbomer 940, sodium hydroxide, propylene glycol, water.

Form release

Currently, a solution is made to introduce intravenously, as well as tablets, a vaginal and gel gel for use externally.

• Solution for intravenous administration It can be colorless or pale yellow, transparent, packaged into transparent ampoules of 20 ml (solution 100 mg) and in bottles of polyethylene in 100 ml (solution 500 mg). Capacities are invested in packs from cardboard.
• Tablets 200 mg- Pink, double-screw, with film shell, round, packaged to blisters for 10 pcs., In cardboard packs of 2 blisters.
• T.300 mg bars - Orange, double-screw, with film shell, round, packaging in blisters for 10 pcs., In cardboard packs of 2 blisters.
• Vaginal gel metrogyl Uniform, colorless or has a yellow shade, contained in the tubes of 30 g.

pharmachologic effect

Medicine wide spectrum actions contains metronidazole. , 5-nitroimidazole derivative.

The drug has antimicrobial and antiprotozoic effect. The mechanism of exposure is based on the restoration of the 5-nitro group of metronidazole by transport intracellular proteins of anaerobic microorganisms and the simplest. The 5-nitro group of metronidazole enters into interaction with DNA cells of microbes, inhibiting the synthesis of their nucleic acids. As a result, the death of bacteria occurs.

Metrogil demonstrates activity to Gardnerella vaginalis., Trichomonas Vaginalis, Giardiai Ntestinalis, Entamoeba Histolytica., Lamblia SPP.. Also, the drug is active in relation to bonde anaerobam and a number of gram-positive microorganisms.

If the metronidazole is combined with, activity is manifested in relation to Helicobacter pylori..

No sensitivity to metronidases Optional anaerobes and aerobic microorganisms, however, in the presence of mixed flora, the synergistic action of metronidazole is noted with antibiotics which are effective against aerobones.

Provocates disulfiram-like reactions, under its effect, the sensitivity of tumors to irradiation increases, the reparative processes are stimulated.

When applied, the anti-vault effect is observed, the mechanism of which is not fully known. Metrogil ointment probably demonstrates antioxidant activity. Under the action of this, the production of neutrophils of active oxygen, hydrogen peroxide, hydroxyl radicals, that is, potential oxidants that contribute to the damage to the tissues in the place where the inflammatory process develops.

The outer form of medication is active with respect to telegangectasius when .

Pharmacokinetics and pharmacodynamics

After the patient was introduced by the intravenous metrogyl, approximately 30-60% of the substance is metabolized through hydroxylation, oxidation and glucooner. As a result, metabolite 2-oximeronidases is formed, which also produces anti-counterproof and antimicrobial effect. Half-exploration time is 8 h (provided that the liver is normal), up to 18 hours (with alcohol liver damage).

About 60-80% of the administered dose is derived through the kidneys, another 6-15% goes through the intestine. Both the metronidazole and its metabolites, from the blood output by means.

If the antibiotic was administered orally, it is quickly absorbed, and its maximum blood concentration is observed after 2 hours. There is a high ability to penetrate the means in tissue, organism fluids. 10-20% binds to plasma proteins. About 60-80% are displayed through the kidneys, and approximately 20% is output unchanged. Half-exploration time - 8 hours.

With the outer use of the tool, its minimum amount is absorbed, so there is only a trace of the active ingredient in the blood. It should be borne in mind that the hematorephalic and placental barriers should be held.

Indications for use

The instructions define such indications for the use of the intravenous method:

• protozoic infections: (, extra-core and intestinal amebiaz , balantidiasis , gaardiaz , , vaginit and trichomonade);
• infectious diseases provoked Bacteroides SPP.: infections of the abdominal cavity, pelvis organs, skin, soft tissues;
• infections, provoked Bacteroides SPP.: infections of the nervous system, joints, bones, including abscess brain , empiama , abscess lungs , pneumonia ;
• infectious diseases caused by Bacteroides SPP., including Clostridium SPP., B. Fragilis: sepsis ;
• pseudomambranous colitis, as a consequence of treatment with antibiotics;
• or ulcer as a result of action Helicobacter pylori.;
• prevention of complications after surgery.

Tablets appropriate to assign in such cases:

• to prevent the development of postoperative complications (in particular gynecological);
• in protozoal infections ( giardiasis , trichomoniaz , ameboy Dieseneria , amebiaz and etc.);
• anaerobic infections (those that were provoked Bac.fragilis, as well as clostridia , fuzobacteria , anaerobic Cockkoff , eubacteria );
• period after operations;
• infectious diseases of the respiratory tract;
• gas;
• septicemia ;
• meningitis , abscess brain ;

The metrogyl cream is prescribed with such diseases and states:

• acne vulgar rash;
• , seborrhea oily;
• trophic ulcers that manifest themselves on the lower limbs as a result varicose , ;
• wounds healing badly;

Gel metrogyl vaginal shown for therapy vaginites which are caused by microflora sensitive to metronidazole, as well as for the treatment of urogenital .

Contraindications

Metrogil in / in Contraindicated for use in such states and diseases:

• the lesions of the nervous system organic ( and etc.);
• blood diseases;
• liver failure (It is impossible to take large doses);
• blood diseases;
• lactation and pregnancy (first trimester);
• pronounced sensitivity to metronidazole, to derivative nitroimidazole .

Caution Injection is intravenously carried out by people suffering from renal failure.

Tablets metrogyl Cannot be taken in the following cases:

• for organic lesions nervous system, in particular epilepsy ;
• for blood diseases;
• for liver failure (large doses of tablets);
• under the age of 12;
• during pregnancy (first trimester);
• high sensitivity to active substance, to other derivatives nitroimidazole .

Carefully prescribe people with liver and kidney disease.

Vaginal gel Do not prescribe with such diseases and conditions:

• disorders coordination movements;
• lakeing (also a history);
• damage to the nervous system of an organic nature, including epilepsy ;
• pregnancy (first trimester);
• liver failure ;
• high sensitivity, also sensitivity to nitroimidazole derivatives.

Side effects

When applying the means intravenously and orally, such side effects:

• Zhkt.: Impairment of appetite, nausea , intestinal colic, vomot , , dryness or taste of metal in the mouth;
• nervous system: impaired coordination, violation of consciousness, ataxia , strong excitability, irritability, weakness, headache , causes ;
• allergy: rash, hyperemia , nasal congestion, artralgia ;
• urinary system : , dizuriy , urinary incontinence , polyuria , urine color change to red-brown;
• local manifestations: , the development of painful pain, redness at the place of administration of the drug;
• other manifestations: lakeing , neutropenia .

When applying the gel, a non-essential amount of the active component is absorbed for local use in the blood, so the system side effects are unlikely. It is rare the development of allergic manifestations, tears, dryness and burning skin.

Instructions for the use of metrogila (method and dosage)

Metrogyl solution, instructions for use

The dropper of the metrogil is shown in the event of severe infectious diseases, as well as if the patient has no opportunity to take medicine inside.

Adolescents older than 12 years old and children receive a means of intravenously drip (the duration of administration is about 40 minutes), the initial dose - 0.5-1. Further, 500 mg should be administered further (speed 5 ml / min.). If a person normally transfers the introduction, then after 2-3 infusions you can enter the drug insert. Pricks need to take 7 days.

If necessary, then practiced a longer administration of the medicine. A permissible dose per day - 4 g. If there are indications, it is possible to use supporting doses - three times a day at 400 mg.

A similar application scheme is practiced for children under 12, motherwise dose equal to 7.5 mg / kg.

For treatment purulent-septic diseases it is enough to spend one course of therapy.

For the prevention of adolescents after 12 years and adults, it is introduced before the operation drip intravenously 0.5-1 g of medication, a day after surgery 1.5 g per day., That is, 500 mg every 8 hours. After 1-2 days, the patient can translate the patient to supporting oral medication.

For Violations of liver and kidney function On a day, it is impossible to take more than 1 g of medication, the dose must be divided into 2 receptions.

Tablets metrogil, instructions for use

You can take tablets both during meals and after, they do not need to be chewed.

Dose for adults and adolescents from 15 years - 200-400 mg of two or three rubles. in day.

Both dosage and the duration of the course depends on the infection.

For trichomoniase it is necessary to drink 200 mg for 7 days 3 times. In addition, women take additionally vaginal means with metronidazole. You can increase the dose or repeated course of therapy if necessary.

For amebiaz Adults receive 400 mg 3 r. On the day, children are 30-40 mg per 1 kg / day., Dose is divided into three receptions. Take the metrged need up to 10 days.

For amoebic liver abscess adults receive 400 mg or 800 mg three times a day, the remedy is combined with tetracycles. Children are 30-35 mg per 1 kg / day., Dose is divided into three techniques. Therapy lasts up to 10 days.

For anaerobic bacterial infections Adults receive 200-400 mg 2-3 r. A day, children should receive 7 mg per 1 kg of weight every 8 hours. Therapy lasts up to 10 days.

In order to prevent operations before operations, 1000 mg should be taken once, further than 200 mg three times a day.

If the metrogil is combined with amoxicillin, then the dose of metronidazole should be 1.5 g, it is divided into three receptions.

Vaginal gel metrogil, instructions for use

Ointment is used intravaginal, once in a dose of 2 g or 500 mg twice a day, 10 days. At this time, sex life is not allowed.

Gel metrogil OT. it is applied to the appointment of a doctor.

The external gel is applied to peeled skin twice a day, the treatment lasts from 3 to 9 weeks, it is possible to use a means for a longer time - up to 4 months. You can apply an occlusal bandage if necessary.

Metrogil from acne

Often those who use for the face of the gel metrogil, feeding from acne leaves positive. Although official instruction Does not inform in detail about the use of this face medication, still gel metrogil from acne is used very often, since Metronidazole has a bactericidal and bacteriostatic effect. Accordingly, helps to get rid of dermatological problems. If a patient has single acne, the ointment is enough to apply several times.

In the case of acne, treatment may be longer. However, after the first application, the severity of negative symptoms is reduced. The meter is used both the main means for the treatment of acne and in the complex with other drugs. Apply the gel twice a day to places affected by acne.

Metrogil and Differin

A means that is a synthetic retinoid in the composition contains active Component adapal. This drug has a favorably affects the skin, when applied with meterogyl, users note a more pronounced effect.

Overdose

When taking large doses of tablets, development is possible nausea , vomiting , ataxia , with severe poisoning develops peripheral neuropathy , possible epileptic seizures . No specific antidotes, conduct symptomatic treatment.

When applying the gel, metrged cases of overdose is not fixed.

Interaction

The dropper with the metrogyl should not hold other drugs - it is not recommended to mix the means with other drugs.

Metronidazole activates the effect of indirect anticoagulants, in the end the education time increases protromina .

Causes intolerance ethanol . When applied at the same time, a variety of neurological symptoms may develop. It is important to stick to the interval between the reception of these drugs at least 2 weeks.

When admission, the metabolism of metronidazole occurs, so the concentration of the latter can increase, which leads to the development of side effects.

With simultaneous use , , that is, drugs stimulating the enzymes of microsomal oxidation in the liver, it is possible to accelerate the elimination of metronidazole. As a result, its plasma concentration is reduced.

If the metronidazole is taken simultaneously with lithium preparations, the concentration of the latter in the plasma may increase. In this case, signs of intoxication of the body can manifest.

Do not combine the reception of the metrogil with nonpolarizing miorlaxanthi .

The antimicrobial metronidazole effect amplifies sulfanimida .

For local application The gel does not notice significant interaction with other drugs, but it is necessary to carefully apply it with and other indirect anticoagulants, as it is possible to increase the prothrombin time.

Terms of sale

On prescription.

Storage conditions

Refers to the list B. Storage temperature of the metrogil - no more than 30 ° C. Take care of the light, from the access of children.

Shelf life

The solution and tablets can be stored for 3 years, the gel metrogil is 2 years.

special instructions

Long therapy requires constant control of the pattern of blood.

If the patient develops lakeing The continuation of therapy depends on whether there is a risk of an infectious process.

Need to stop therapy if the patient develops dizziness , ataxia and other symptoms indicating the deterioration of neurological status.

Under the influence of the drug, immobilization of treponam can occur, which leads to a false-positive test of Nelson.

In the process of treatment, urine is painted in a dark color.

During the treatment period trichomonade Vaginitis and ureterita It is necessary to refrain from sex contacts. It is important that both sexual partners pass therapy at the same time. During the period, the treatment does not stop.

It is impossible to make the gel in the eyes. If this happened, you need to wash your eyes with warm water.

The dropper of the metrged in gynecology applies only to the appointment of the attending physician.

In cosmetology, the gel metrogyl for the person is used to treat acne and other lesions of the skin. It is possible to use it for a person only on the recommendation of a specialist.

Analogs

Currently, numerous analogues of gel, tablets and metrogyl solutions are produced. These are drugs Deflamon , Clion , Metrovagin , Metrolacer , Metron , Orvagil , Trichobrol , , Sipmogil , etc. Also implemented candles with active substance metronidazole. .

Children

The use of the solution, if necessary, is carried out according to the instruction. Tablets are not prescribed to children under 12 years old.

With alcohol

Anti-alcohol intake in the period of treatment with all forms of the drug metrogyl, since the manifestation of disulfiram-like reactions is possible.

Metrogyl during pregnancy and lactation

The use of this means during pregnancy is contraindicated, it is possible to use it in late terms exclusively according to life indications. The lactation in the treatment of metrged should be stopped.

If the doctor recommended the patient a dropper metrged, then questions arise. It is important to understand how it affects the human body. Appointed metrogil inflammatory processes, giardiasis or in gynecological pathologies. Consider how the metrged dropper is used and how to put it correctly, readings and side effects.

Description of the drug

The main action at the metrogila is antibacterial. Finding into the patient's body, the metrogil kills pathogenic bacteria.

Metrogil is produced in three pharmacological forms:

• Solution for intravenous injection. Available in plastic container, volume of 100 ml or in the form of ampoules of 20 ml. One package accommodates 10 ampoules or 1 bubble.
• Pills in blister pack. Dosage 200 and 400 mg. Sold in packs of 10, 50, 100 pcs.
• Suspension for intake. Glass bubble in a box of 60 and 100 ml.

Efficiency and selection of a form for reception depends on the type of disease. A dropper for intravenous administration, tablets and suspension only by a doctor is prescribed. You can independently use a solution for injection when rinse the nasopharynx, as a disinfectionary preparation.

The solution for drippers has a light yellow. The solution should be transparent, without precipitation and sterile.

A solution is released for injection from pharmaceutical points only on prescription purposes.

Purpose of the drug

The inject meter solution has the following readings:

• Treatment and how preventive tool From air-drip infections in the preoperative period. Frequent readings before operations on the urinary system and the gastrointestinal organs.
• Indications for mixed infections of various etiology.
• Purulent-serous infection (intestinal amebiasis, sepsis, brain abscess or small pelvic organs, peritonitis, skin suppuration or soft tissues, bone and articular lesions).
• Industrial testimony acute form Diseases: Giardiasis, vaginitis trichomonade, urethritis, amebiasis. On the initial stage A suspension is applied.

After a dropper, the concentration of metrogil in the blood is leveling 35.2 μg / ml. Falls gradually and excreted in an unchanged state by 80%. Complete blood purification occurs on the third day after the last dropper.

Dosage for infusion

Intravenously drug is prescribed only in the acute form of the disease. In the initial stages, the forms for receiving inside - tablets, suspension. Their application scheme will depend on the form and type of disease.

Adult dosage

Dropper Metrogil adult scheme You can also apply to children from 12 years. Instructions for use:

• The first reception of 0.5-1 g with a dropper duration of 30-40 minutes.
• Further, the course is prescribed once at 8 o'clock with a dosage of 500 mg. The rate of introducing a solution of 5 ml / min.

If a child or adult is a good tolerance of infusion, then after 3-4 droppers go to inkjet administration. Duration of the course of drops of 7-8 days. If infection progresses further, the course is extended. At 24 hours the maximum number of metrogol for an adult is permissible for 4 g.

After a dropper, the metrogl is prescribed in the form of tablets or suspension of 200 mg / 2 times a day, as supportive therapy.

Children's dosage

Children solution for administration is assigned in the most extreme cases. The scheme for use is similar to adult. The dosage is selected to each child individually, but should not exceed 1-8 mg / kg of weight in 1 time.

In many ways, the application and appointment scheme depends on the type of disease. If the dropper metrged is prescribed under purulent infesses, then one course of administration is enough to recover. In the preoperative period, an adult and a child over 12 years old is prescribed 1 infusion of 0.5-1 g 24 hours before surgical intervention. On the day of operation, 1.5 g of metrogil is hung according to 500 mg / Introduction Scheme every 8 hours.

After surgery on the second day, supporting treatment with tablets or suspension is prescribed. If the patient has renal failure, then the dosage of the dropper is reduced to 1 mg / 2 administration per day.

In the treatment of cancer, the metrogil is used as a radio network. The dropper is placed 2-3 hours before the start of irradiation procedure in the dosage of 160 mg per 1 kg of the patient's weight. Next, the procedure is repeated 2 weeks, before each irradiation procedure. The maximum dosage on one introduction should not be greater than 10 g, it is impossible to exceed 60 g of the drug on the course. At the rest of the stage radiation therapy The drug is not used.

At the oncology of the uterus, the metrged droppers are not put. It is enough before expulsion to make an applique of 3 g of metrogila and dimethyl sulfoxide 10%.

What side effects to expect and when you should not use the drug?

In the treatment of metrogyl, droppers should expect side effects. Conditionally side effects can be divided into frequent and rare.

From frequently found:

• The mucousness of the nasophack dries.
• Single nausea.
• Loss of appetite.
• Dull pain in the zhkt area.
• The taste of the metal in the mouth.

Side effects are less likely:

• From the gearbox: the latency of the chair, nausea, single vomiting.
• From the CNS side: loss of coordination, dizziness, hyperoportability, loss of sleep, migraine, the overall weakening of the body.
• Allergic manifestations from the body: rash on the skin, swelling of the nasopharynx, hyperemia of the skin.
• From the urinary system: incontinence, urine acquires red or dark brown, cystitis, candidiasis, increased protein in the urine.
• From the vessels, the increase in thrombophlebitis.

In rare cases, the dropper of the metrogil can provoke hallucinations, loss or confusion. One of the 100 patients the drug causes pancreatitis, so people with disabilities of the GCT need to be treated with caution.

Contraindications from medication

Contraindicated drug to people with the following diseases:

• In the history of the patient, the intolerance to the metronomy and its derivatives was observed.
• Pathology and disorders of the central nervous system.
• High dosage is contraindicated to people with hepatic failure.
• Any blood diseases.
• The first three months of pregnancy and breastfeeding period.

Metrogil cannot be taken simultaneously with other medical preparations. It is not recommended to simultaneously take dietary supplements and nutritional supplements. It is especially dangerous to use droppers together with drugs, which contains ethanol. The patient is categorically prohibited by alcoholic beverages throughout the course of treatment and 2 weeks after its end.

Metrogil is an anti-political drug with antibacterial activity.

Release form and composition

Metrogil is released in the following dosage forms:

• Tablets: Two-cone, round, covered with pink (200 mg) or orange (400 mg) film shell (in contour cellular packs of 10 pcs., 2 or 10 packages in a cardboard pack);
• Colorless or pale yellow, transparent (in 100 ml polyethylene bottles, 1 vial in a cardboard pack; in ampoules of 20 ml, 5 ampoules in a cardboard pack; in ampoules of 20 ml, 5 ampoules in the thermal container, 1 thermal container in cardboard pack);
• Gel for outdoor use: from yellow to colorless color, homogeneous (in aluminum tubes 30 g, 1 tube in a cardboard pack);
• The gel is vaginal: from light yellow to colorless color, homogeneous (in tubes of 30 g with an applicator bucked, 1 set in a cardboard pack);
• Suspension for oral application (in bottles of 60 or 100 ml, 1 vial in a cardboard pack).

The 1 tablet includes:

• Active substance: metronidazole - 200 or 400 mg;
• Auxiliary components: purified water, colloidal silicon dioxide, magnesium stearate, corn starch; Tablets of 200 mg - castor hydrogenated oil and dye Opadry II pink 85G54815, 400 mg tablets - Pisidone and dye Opadry II orange 85G53070.

The composition of 1 ml of the solution includes:

• Active substance: metronidazole - 5 mg;
• Auxiliary components: citric acid (monohydrate), injection water, sodium hydrochlorophosphate (anhydrous), sodium chloride.

The composition of 100 mg of gel for outdoor use includes:

• Auxiliary components: propylene glycol, methyl aprichedroxibenzoate, purified water, propyl aprichedroxybenzoate, sodium hydroxide, carbomer 940, Dinatarium Edetat.

In 100 mg of vaginal gel:

• Active substance: Metronidazole - 1 mg;
• Auxiliary components: sodium hydroxide, propyl hydroxybenzoate, purified water, propylene glycol, Dinatarium Edetat, carbomer-940.

In 5 ml of suspension for oral administration, an active substance is contained: metronidazole - 200 mg.

Indications for use

Metrogil in the form of tablets is used to treat the following diseases / states:

• Abscess brain, meningitis;
• Anaerobic infections, whose pathogens are Bacteroides Fragilis and other bacteroids, fuzobacteria, eubacteria, clostridia, anaerobic coils;
• Gas gangrene;
• Septicemia;
• Protopic infections: amoebic dysentery, trichomonade vaginitis and urethritis, balancediasis, giardiasis, trichomoniasis, amebiaz;
• Osteomyelitis;
• After surgical interventions on the abdominal organs and urinary trait: pelvic abscesses, postpartum sepsis, liver abscess, appendicitis, intraperitoneal infections, postoperative wound infections, cholecystitis, peritonitis; for the prevention of postoperative anaerobic infections;
• Tetanus;
• Respiratory infections (necrotic pneumonia, lung abscess).

Metrogyl in the form of a solution for intravenous administration is used to treat the following diseases / states:

• Alcoholism;
• Protozoic infections: extra-core Amebiaz, including amoebic liver abscess, hyardiosis, intestinal Amebiaz, Trichomonade Uperrite, Trichomoniasis, Balantidiasis, Lymbaliasis, Skin Leashmaniasis, Trichomonade Vaginitis;
• Infections, whose pathogens are Bacteroides SPP. (including Bacteroides Vulgatus, Bacteroides Thetaiotaomicron, Bacteroides Ovatus, Bacteroides Distasonis, Bacteroides Fragilis): infections of bones and joints, central nervous system, including pneumonia, meningitis, brain abscess, bacterial endocarditis, empathime and lung abscess;
• Pseudomambranous colitis caused by the use of antibacterial drugs;
• Infections whose pathogens are types of Bacteroides SPP., Including group V. Fragilis, Clostridium SPP.: Septis;
• Gastritis or Yazva duodenal gutcaused by Helicobacter pylori;
• Infections, whose pathogens are types of Bacteroides SPP., Including group V. Fragilis, Clostridium SPP., Peptococcus SPP. and peptostreptococcus SPP.: Infections of the skin and soft tissues, abdominal cavity (liver abscess, peritonitis), pelvis organs (vaginal orphan infection after surgical interventions, phallopyan pipes and ovarian abscess, endometrite);
• Prevention of postoperative complications (especially in gynecological operations, interventions on the colon, near-thectal region, appendectomy).

Metrogyl in the form of a gel for external use is used to treat the following diseases / states:

• Trophic ulcers of lower extremities (on the background of diabetes mellitus, varicose expansion veins);
• Pink acne (including postster);
• Bad wounds;
• Vulgar acne rash;
• Cracks rear Passage, hemorrhoids;
• Breakdown;
• Seborrheic dermatitis, fatty seborrhea.

The metrogl in the form of a vaginal gel is used for therapy of urogenital trichomoniasis, bacterial vaginosis of various etiologies, confirmed by clinical and microbiological data.

Metrogyl in the form of a suspension is used to treat anaerobic bacterial infections, amoebic liver abscesses, amebiasis, giardiasis.

Contraindications

Pills:

• Blood diseases (including history instructions);
• Age up to 12 years;
• First trimester of pregnancy;

Solution for intravenous administration:

• Blood diseases;
• Organic lesions of the central nervous system (including epilepsy);
• Liver failure (when prescribing large doses);
• Hypersensitivity to the components of the drug.

Suspension:

• Blood diseases;
• First trimester of pregnancy and lactation period;
• Hypersensitivity to the components of the drug.

Vaginal gel:

• Disorders coordination movements;
• Liver failure;
• Leukopenia (including anamnesis);
• Organic lesions of the central nervous system;
• First trimester of pregnancy;

• Hypersensitivity to the components of the drug.

The gel for the external use of the metrogil is contraindicated to use with hypersensitivity to the components of the drug.

With caution, the preparation in the form of tablets is used in the presence of diseases of the kidney and liver (renal and liver failure); in the form of a solution - with renal failure.

Method of application and dosage

Tablets take inside during or after eating, not chewing or drinking with milk.

Children over 15 years old and adults are prescribed by 200-400 mg of the drug 2-3 times a day. The dosage of the metrogil and the length of therapy is determined depending on the nature of the infection.

Dosing mode:

• Trichomoniasis: 1 tablet (200 mg) 3 times a day for 7 days; Women need to additionally apply metronidazole in the form of a vaginal gel or candles. A repeated course of therapy is allowed if necessary, or an increase in dose to 750-1000 mg per day. Between courses need a break in 21-28 days with repeated control laboratory studies. An alternative treatment scheme is a single application of 2000 mg of the drug to the patient and its sexual partner;
• Amebiaz: children - 30-40 mg per 1 kg of body weight, divided into 3 receptions; Adults - 1 tablet (400 mg) 3 times a day. Therapy duration is 7-10 days;
• Amoebic liver abscess: children - 30-35 mg per 1 kg of body weight, divided into 3 receptions; Adults - 1-2 tablets (400 mg) 3 times a day in combination with antibacterial tetracycline drugs or other methods. Therapy duration - 5-10 days;
• Anaerobic bacterial infections: Children - 7 mg per 1 kg of body weight every 8 hours; Adults - 1-2 tablets (200 mg) 2-3 times a day. Therapy duration is 7-10 days;
• Prevention of anaerobic infection in front of operational interventions carried out on the pelvic organs and the colhesive intestine: 5 tablets (200 mg) once, then - 1 tablet 3 times a day.

When appropriating the metrogil in combination with amoxicillin (2250 mg per day), the daily dose of metronidazole is 1500 mg. Multiplicity of reception - 3 times a day.

With pronounced functional disorders Liver and kidneys The daily dose of metronidazole is 1000 mg, amoxicillin - 1500 mg. Multiplicity of reception - 2 times a day.

The metrged solution is administered intravenously. Its use is shown in the severe course of infections, as well as in the absence of the possibility of receiving a drug inside.

The dosage of the drug for children over 12 years and adults is 500-1000 mg intravenously drip at a speed of 30-40 minutes, then 500 mg every 8 hours at a speed of 5 ml in 1 minute. With good tolerability after the first 2-3 infusion, the solution should be introduced insertion. The duration of therapy is 7 days, with a possible increase in a longer period, if necessary. Maximum daily dose - 4000 mg. According to the indications, the transition to the drug is recommended inward in a supporting dose - 400 mg 3 times a day.

Children at the age of 12 years old metrogyl are prescribed by a similar scheme in a single dose of 7.5 mg per 1 kg of body weight.

In cases of purulent-septic diseases, 1 course of therapy is usually held.

With the aim of preventing children over 12 years old and adults, 500-1000 mg intravenously drip on the eve of the operation, on the day of operation and the next day - 1500 mg per day (500 mg every 8 hours). After 1-2 days, the transition to supporting therapy inside is recommended.

The maximum daily dose in chronic renal failure and creatinine clearance less than 30 ml per minute and / or liver failure is no more than 1000 mg, the multiplicity of reception is 2 times a day.

The gel for external use of the metrogil is applied by a thin layer on pre-purified affected skin 2 times a day (in the morning and evening) for 21-63 days.

Therapy duration is 3-4 months, in most cases therapeutic effect It is noted after 21 days of use.

The gel vaginal metrogil is used intravaginal 5000 mg (1 full applicator) 2 times a day (in the morning and evening). The duration of therapy is 5 days.

The suspension of metrogil is taken inside.

Dosing mode:

• Trichomoniasis: 200 mg 3 times a day for 1 week;

• Amebiaz: Children - 30-40 mg per 1 kg of body weight per day, divided into 3 receptions; Adults - 400 mg 3 times a day. Therapy duration is 7-10 days;
• Amoebic liver abscess: children - 30-35 mg per 1 kg of body weight per day, divided into 3 receptions; Adults - 400-800 mg 3 times a day. Therapy duration - 5-10 days;
• Anaerobic bacterial infections: children - 7 mg per 1 kg of body weight every 8 hours; Adults - 200-400 mg 2-3 times a day. Therapy duration is 7-10 days;
• Giardiasis: Children 2-5 years old - 200 mg per day, 5-10 years old - 300 mg per day, 10-15 years old - 400 mg per day for 5 days. The course of therapy can be repeated after 10-15 days;
• Prevention of anaerobic infection in front of the planned operation: 1000 mg once again, then - 200 mg 3 times a day; In cases of emergency surgical intervention - 1000 mg once.

Side effects

In the period of therapy, the meterogil can occur by side effects from some organism systems.

Pills:

• Digestive system: dry mouth, an unpleasant metal taste in the mouth, nausea, diarrhea, vomiting, constipation, absence of appetite, pancreatitis, pseudommbranous colitis, stomatitis, intestinal colic, glossitis, raising the level of hepatic enzymes, hepatitis, cholestatic jaundice;
• Nervous system: headache, ataxia, dizziness, weakness, sleep impairment, hallucination, violation of coordination of movements, violation of consciousness, peripheral neuropathy, increased excitability, attacks of epilepsy, depression;
• Greeting system: urinary incontinence, polyuria, dysuria, red-brown urine staining, vaginal candidiasis, burning sensation in the urethra;
• Allergic reactions: itching, skin rash, leather hyperemia, nasal congestion, fever, arthralgia, anaphylactic shock;
• Hooping system: thrombocytopenia, leukopenia;
• Others: Flooding of the teeth T on the electrocardiogram, neutropenia.

Solution for intravenous administration:

• Digestive system: dry mouth, metal taste in the mouth, constipation, stomatitis, glossitis, intestinal colic, nausea, diarrhea, vomiting, decreased appetite, pancreatitis;
• Nervous system: peripheral neuropathy, hallucinations, cramps, headache, insomnia, weakness, increased excitability, depression, irritability, confusion, ataxia, disorders of coordination of movements, dizziness;
• Allergic reactions: arthralgia, fever, nasal congestion, skin hyperemia, skin rash, urticaria;
• Urinary system: urine coloring in red-brown color, candidiasis, urinary incontinence, polyuria, cystitis, dysuria;
• Local reactions: thrombophlebitis;
• Others: Flooding of the teeth T on the electrocardiogram, leukopenia, neutropenia.

When applying a gel for outdoor use in rare cases, it may occur: tearing (when applying the drug close to eyes), light dryness, peeling and burning skin, hyperemia, allergic reactions (Skin rash, urticaria).

Vaginal gel:

• System effects: leukopenia or leukocytosis, urine dyeing in dark color, constipation or diarrhea, spastic pain in the abdominal cavity, decreased appetite, nausea, vomiting, change in taste sensations, including a metal taste, dry mouth, headache, dizziness;
• Allergic reactions: urticaria;
• Local reactions: vulvit, burning sensation or stripped urination; The sexual partner has a feeling of burning or irritation of the penis. After the abolition of the gel is the development of the candidiasis of the vagina.

special instructions

During the period of therapy, alcohol cannot be used (the development of a disulfira-like reaction is possible.

Patients up to 18 years old apply the drug in combination with amoxicillin is not recommended.

In cases of leukopenia, the possibility of continuing therapy directly depends on the risk of developing an infectious process.

For long use Tablets, suspensions or solution should be monitored by peripheral blood indicators.

Cancellation of the drug is required when ataxia, dizziness and any other deterioration of neurological status.

It should be borne in mind that the metrged can immobilize treponama and lead to Nelson's false-positive test.

During trichomonaceous urethritis and trichomonaceous vaginitis (respectively, men and women) should be refracted from sexual life. The simultaneous treatment of both sexual partners is mandatory. Therapy should not be stopped during menstruation. At the end of the treatment of trichomoniasis, it is necessary to carry out control samples within 3 of the next cycles before and after menstruation.

If the symptoms of the disease are preserved after the treatment of giardiasis - after 21-28 days it is necessary to carry out 3 kala analysis at intervals in several days.

During the period of application of the metrged solution, urine painting is possible in a dark color.

When applying the gel for outdoor use and vaginal gel should be avoided. If the gel fell into the eyes, they need to be immediately rinsed with plenty of water.

Medicinal interaction

With the simultaneous use of metrogil with some drugs, unwanted effects may occur:

• Indirect anticoagulants: strengthening their actions, which leads to an increase in the time of the prolrombine formation;
• Sulfanimamides: strengthening the antimicrobial action of metronidazole;
• Cimetidine: inhibition of metronidazole metropolisms, which can lead to an increase in its serum concentration and risk of development of side effects;
• Preparations stimulating the enzymes of microsomal oxidation in the liver (phenytoin, phenobarbital): acceleration of metronidazole elimination, which is why its plasma concentration is reduced.
• Lithium preparations (high doses): an increase in the concentration of lithium in the blood plasma and the development of signs of intoxication.
• The method of metrged can lead to ethanol intolerance.

Under the local application of metrogyl, interaction with other drugs is insignificant, but care must be taken at simultaneously appointment with warfarin and other indirect anticoagulants.

Metrogyl for intravenous administration To mix with others medicinal preparations Not recommended.

Terms and conditions of storage

Store in an inaccessible for children and protected from light place; Tablets, solution and gel for external use - at temperatures up to 30 ° C, the gel is vaginal and suspension - up to 25 ° C.

Shelf life:

• Gel for external use, suspension, solution for intravenous administration - 3 years;
• Vaginal gel - 2 years.

Did you find a mistake in the text? Highlight it and press Ctrl + Enter.