Flagyl ER: Advanced Metronidazole Therapy for Bacterial and Parasitic Infections
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Flagyl ER (extended-release) is a prescription antimicrobial medication containing metronidazole, designed to provide sustained therapeutic effects with a simplified dosing regimen. This formulation is specifically engineered for the treatment of serious anaerobic bacterial infections and certain parasitic infestations. Its extended-release technology ensures consistent plasma concentrations, enhancing efficacy while potentially improving patient adherence. It is a cornerstone therapy in both hospital and outpatient settings for susceptible organisms.
Features
- Contains 750 mg metronidazole per extended-release tablet
- Proprietary extended-release formulation for once-daily dosing
- Bioequivalent to immediate-release metronidazole 250 mg administered three times daily
- Designed for optimal absorption in the fasted state
- Film-coated tablet for ease of swallowing
- Available in bottles of 30 and 100 tablets
Benefits
- Provides sustained antimicrobial coverage over a 24-hour period, maintaining effective drug concentrations
- Reduces dosing frequency from three times daily to once daily, simplifying treatment regimens and improving compliance
- Effectively treats a broad spectrum of anaerobic bacteria and protozoal parasites
- Helps reduce the risk of complications from serious intra-abdominal, gynecologic, and skin structure infections
- Supported by decades of clinical evidence establishing metronidazole’s efficacy and safety profile
- May reduce gastrointestinal side effects compared to immediate-release formulations in some patients due to modified release characteristics
Common use
Flagyl ER is indicated for the treatment of symptomatic trichomoniasis caused by Trichomonas vaginalis in both female and male patients. It is also approved for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women. Furthermore, it is used in the management of anaerobic bacterial infections, including intra-abdominal infections (such as peritonitis, intra-abdominal abscess, and liver abscess), skin and skin structure infections, gynecologic infections (including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection), bacterial septicemia, bone and joint infections, CNS infections (including meningitis and brain abscess), lower respiratory tract infections, and endocarditis. Its use is contingent upon demonstrated susceptibility of the causative organisms.
Dosage and direction
The recommended dosage for Flagyl ER is one 750 mg tablet taken orally once daily, preferably on an empty stomach (at least 1 hour before or 2 hours after meals). For trichomoniasis: a single 750 mg tablet once daily for 7 days in both female and male patients. For bacterial vaginosis: one 750 mg tablet once daily for 7 days. For anaerobic infections: one 750 mg tablet once daily for 7 to 14 days, or longer if clinically warranted. The tablet should be swallowed whole; it must not be crushed, chewed, or split. Dosage adjustments may be necessary in patients with severe hepatic impairment (Child-Pugh C), though specific guidelines should be determined by a healthcare provider. The duration of therapy depends on the clinical response and the nature and severity of the infection.
Precautions
Patients should be advised that Flagyl ER may cause dizziness, confusion, or other CNS effects; therefore, caution should be exercised when driving or operating machinery. Avoid alcohol consumption during therapy and for at least 3 days after the last dose due to the potential for a disulfiram-like reaction (flushing, vomiting, tachycardia). Use with caution in patients with blood dyscrasias, a history of seizures, or other CNS disorders. Peripheral neuropathy, characterized by paresthesia, has been reported with metronidazole use and may become permanent if the drug is not discontinued promptly. Regular clinical monitoring for neurological symptoms is advised during prolonged therapy. Use in pregnancy should be reserved for cases where the potential benefit justifies the potential risk to the fetus (Pregnancy Category B for trichomoniasis and anaerobic infections; Category D for bacterial vaginosis in the second and third trimesters). Caution is advised in nursing mothers, as metronidazole is excreted in human milk.
Contraindications
Flagyl ER is contraindicated in patients with a known hypersensitivity to metronidazole, other nitroimidazole derivatives, or any component of the formulation. It is also contraindicated during the first trimester of pregnancy for the treatment of bacterial vaginosis. Use in patients with active organic neurologic diseases (e.g., epilepsy, multiple sclerosis) requires careful risk-benefit assessment. Concomitant use with disulfiram is contraindicated due to the increased risk of psychotic reactions. Administration with alcohol or propylene glycol-containing products is contraindicated.
Possible side effect
Common adverse reactions include nausea (≈10%), headache (≈9%), metallic taste (≈8%), anorexia, vomiting, diarrhea, abdominal discomfort, and constipation. Less frequently, dizziness, drowsiness, reversible neutropenia, and darkened urine may occur. Serious but rare side effects include seizures, peripheral neuropathy, encephalopathy, aseptic meningitis, optic neuropathy, and Stevens-Johnson syndrome. Hypersensitivity reactions, including urticaria, flushing, and anaphylaxis, have been reported. Persistent vaginal candidiasis may develop. Pancreatitis has been rarely associated with metronidazole use.
Drug interaction
Concomitant use with warfarin may potentiate anticoagulant effect, requiring close monitoring of prothrombin time. Metronidazole may increase plasma concentrations of lithium, phenytoin, and cyclosporine, necessitating monitoring and potential dose adjustment. Cimetidine may inhibit the metabolism of metronidazole, increasing its plasma levels. Phenobarbital may induce metabolism, decreasing metronidazole levels. Concurrent use with disulfiram is contraindicated. Alcohol and propylene glycol-containing products should be avoided. Caution is advised with other drugs that cause CNS effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended.
Overdose
Symptoms of overdose may include nausea, vomiting, ataxia, seizures, and peripheral neuropathy. There is no specific antidote. Management is supportive and symptomatic. Gastric lavage may be considered if ingestion was recent. Hemodialysis may accelerate elimination of metronidazole and metabolites.
Storage
Store at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in the original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Flagyl ER is a prescription medication and should be used only under the supervision of a qualified healthcare provider. Always follow the prescribing information provided by your physician and the product labeling. Do not adjust your dose or discontinue therapy without consulting your healthcare provider.
Reviews
“Flagyl ER simplified my treatment for bacterial vaginosis. The once-daily dosing was convenient, and I experienced minimal gastrointestinal upset compared to the immediate-release version.” – Patient, 34 “As an infectious disease specialist, I find the extended-release formulation improves adherence in my outpatient population, particularly for longer courses of therapy. Efficacy appears consistent with the established profile of metronidazole.” – Physician “Effective for trichomoniasis with a manageable side effect profile. The once-daily regimen is a significant advantage for compliance.” – Clinician