Metronidazole

CLINICAL USE

Antibiotic:Anaerobic and protozoal infections

DOSE IN NORMAL RENAL FUNCTION

Oral: 200–500 mg every 8–12 hoursIV: 500 mg every 8 hoursPR: 1 g every 8–12 hours

PHARMACOKINETICS

Molecular weight :171.2

%Protein binding :

10 to 20 :

%Excreted unchanged in urine : 20

Volume of distribution (L/kg) :0.7–1.5

half-life – normal/ESRD (hrs) :5.6–11.4/7–21

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Dialysed. Dose as in normal renal function

HDF/high flux :Dialysed. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Alcohol: disulfiram-like reaction

Anticoagulants: effects of coumarins enhanced

Anti-epileptics: metabolism of phenytoin inhibited; concentration reduced by primidone and barbiturates

Ciclosporin: raised blood level of ciclosporinCytotoxics: busulfan concentration increased; metabolism of fluorouracil inhibited

ADMINISTRATION

Reconstition

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Route

IV, oral, PR

Rate of Administration

IV: 5 mL/minute, i.e. 500 mg over 20 minutes

Comments

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OTHER INFORMATION

Active metabolites have long half-life in renal impairmentIncreased incidence of GIT reactions and vestibular toxicity in renal failureDrug induced lupus is a rare adverse drug reactionRectally: dose frequency reduced to 12 hours after 3 days500 mg /100 mL infusion provides 14 mmol sodium.

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