Buy Metronidazole Online Over The Counter

Pharmacodynamics

Metronidazole is a derivative of 5-nitroimidazole. The mechanism of action is the biochemical reduction of the 5-nitro group by intracellular transport proteins of anaerobic microorganisms and protozoa. The reduced 5-nitro group interacts with the deoxyribonucleic acid (DNA) of microorganism cells, inhibiting the synthesis of their nucleic acids, which leads to the death of bacteria.

Active against Trichomonas vaginalis, Entamoeba histolytica, as well as gram-negative anaerobes Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus), Fusobacterium spp. and some gram-positive anaerobes (sensitive strains of Eubacterium spp., Clostridium spp., Peptococcus niger., Peptostreptococcus spp.). The minimum inhibitory concentration for these strains is 0.125-6.25 µg/ml.

In combination with amoxicillin, it is active against Helicobacter pylori (amoxicillin inhibits the development of resistance to metronidazole).

Aerobic microorganisms and facultative anaerobes are not sensitive to metronidazole, but in the presence of mixed flora (aerobes and anaerobes), metronidazole acts synergistically with antibiotics effective against ordinary aerobes.

Pharmacokinetics

When taken orally, metronidazole is rapidly and almost completely absorbed (approximately 80% in 1 hour). Eating does not affect the absorption of metronidazole. Bioavailability is at least 80%. After oral administration of metronidazole at a dose of 500 mg, its plasma concentration is 10 μg / ml after 1 hour, 13.5 μg / ml - after 3 hours. Binding to blood proteins is insignificant and does not exceed 10-20%. Metronidazole online rapidly penetrates tissues (lungs, kidneys, liver, skin, bile, cerebrospinal fluid, saliva, seminal fluid, vaginal secretion), into breast milk and passes through the placental barrier. About 30-60% of metronidazole is metabolized by hydroxylation, oxidation and glucuronidation. The main metabolite (2-oxymetronidazole) also has antiprotozoal and antimicrobial effects.

40-70% of metronidazole is excreted by the kidneys (unchanged - about 35% of the dose taken). The half-life is 8-10 hours.

In patients with impaired renal function, a course of taking metronidazole may increase its concentration in the blood serum.

Indications

Protozoal infections: extraintestinal amoebiasis, including amoebic liver abscess, intestinal amoebiasis (amebic dysentery), trichomoniasis (including trichomonas vaginitis, trichomonas urethritis).

Infections caused by Bacteroides spp. (including Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus): infections of bones and joints, infections of the central nervous system (CNS), incl. meningitis, brain abscess, bacterial endocarditis, pneumonia, empyema and lung abscess, sepsis.

Infections caused by Clostridium spp., Peptococcus niger and Peptostreptococcus spp.: infections of the abdominal cavity (peritonitis, liver abscess), infections of the pelvic organs (endometritis, abscess of the fallopian tubes and ovaries, infections of the vaginal fornix).

Pseudomembranous colitis (associated with the use of antibiotics).

Gastritis or duodenal ulcer associated with Helicobacter pylori.

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

Radiation therapy of patients with tumors - as a radiosensitizing agent, in cases where tumor resistance is due to hypoxia in tumor cells.

Сonsult your doctor before you decide to buy metronidazole over the counter. Never take medication without visiting a doctor!

Contraindications

Hypersensitivity, leukopenia (including history), organic lesions of the central nervous system (CNS) (including epilepsy), liver failure (in the case of high doses), pregnancy (I trimester), lactation.

Carefully: Pregnancy (II-III trimesters), renal/liver failure.

Pregnancy and lactation

During lactation it is recommended to stop breastfeeding.

Dosage and administration

Inside, during or after a meal, (or drinking milk), without chewing.

With trichomoniasis - 250 mg 2 times a day for 10 days or 400 mg 2 times a day for 5-8 days. Women need to additionally prescribe metronidazole in the form of vaginal suppositories or tablets. If necessary, you can repeat the course of treatment or increase the dose to 0.75-1 g / day. Between courses, you should take a break of 3-4 weeks with repeated control laboratory tests. An alternative therapy regimen is the appointment of 2 g once to the patient and his sexual partner.

Children 2-5 years old - 250 mg / day; 5-10 years old - 250-375 mg / day, over 10 years old - 500 mg / day. The daily dose should be divided into 2 doses. The course of treatment is 10 days.

Children under 1 year - 125 mg / day, 2-4 years - 250 mg / day, 5-8 years - 375 mg / day, over 8 years - 500 mg / day (in 2 divided doses). The course of treatment is 5 days.

Adults: with asymptomatic amebiasis (if a cyst is detected), the daily dose is 1-1.5 g (500 mg 2-3 times a day) for 5-7 days.

In chronic amebiasis the daily dose is 1.5 g in 3 doses for 5-10 days, in acute amoebic dysentery - 2.25 g in 3 doses until the symptoms stop.

With liver abscess - the maximum daily dose is 2.5 g in 1 or 2-3 doses, for 3-5 days, in combination with antibiotics (tetracyclines) and other methods of therapy.

Children 1-3 years old - 1/4 adult dose, 3-7 years old - 1/3 adult dose, 7-10 years old - 1/2 adult dose.

With ulcerative stomatitis, adults are prescribed 500 mg 2 times a day for 3-5 days; in this case, the drug is not indicated for children.

With pseudomembranous colitis, 500 mg 3-4 times a day.

For the eradication of Helicobacter pylori - 500 mg 3 times a day for 7 days (as part of combination therapy, for example, a combination with amoxicillin 2.25 g / day).

In the treatment of anaerobic infections, the maximum daily dose is 1.5-2 g.

For the prevention of infectious complications - 750-1500 mg / day in 3 doses 3-4 days before surgery, or once 1 g on the first day after surgery. 1-2 days after the operation (when ingestion is already allowed) - 750 mg / day for 7 days.

With severe renal dysfunction (creatinine clearance less than 10 ml / min), the daily dose should be halved.

Сonsult your doctor before you decide to buy metronidazole over the counter

Side effects

Gastrointestinal disorders: epigastric pain, nausea, vomiting, diarrhea, glossitis, stomatitis, metallic taste in the mouth, loss of appetite, anorexia, dryness of the oral mucosa, constipation, pancreatitis (reversible cases), discoloration tongue / "coated tongue" (due to the growth of fungal microflora). Immune system disorders: angioedema, anaphylactic shock.

Nervous system disorders: peripheral sensory neuropathy, headache, convulsions, dizziness; it was reported about the development of encephalopathy and subacute cerebellar syndrome (impaired coordination and synergism of movements, ataxia, dysarthria, gait disturbances, nystagmus, tremor), which are reversible after the abolition of metronidazole; aseptic meningitis.

Mental disorders: psychotic disorders, including confusion, hallucinations; depression, insomnia, irritability, irritability.

On the part of the organ of vision: transient visual impairment, such as diplopia, myopia, blurring of the contours of objects, decreased visual acuity, impaired color perception; neuropathy optic neuritis.

Blood and lymphatic system disorders: agranulocytosis, leukopenia, neutropenia, thrombocytopenia.

Liver and biliary tract disorders: increased activity of "liver" enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase). The development of cholestatic or mixed hepatitis and hepatocellular liver damage, sometimes accompanied by jaundice: in patients treated with metronidazole in combination with other antibacterial agents, there were cases of liver failure, which required liver transplantation.

Skin and subcutaneous tissue disorders: rash, itching, skin flushing, urticaria, pustular skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis.

On the part of the kidneys and urinary tract: brownish-reddish staining of urine due to the presence in the urine of a water-soluble metabolite of metronidazole; dysuria, polyuria, cystitis, urinary incontinence, candidiasis.

General disorders: fever, nasal congestion, arthralgia, weakness.

Laboratory and instrumental data: flattening of the T wave on the electrocardiogram.

Interaction

Enhances the effect of indirect anticoagulants, which leads to an increase in the time of formation of prothrombin.

Similar to disulfiram, it causes ethanol intolerance.

Simultaneous use with disulfiram can lead to the development of various neurological symptoms (the interval between administration is at least 2 weeks).

Cimetidine inhibits the metabolism of metronidazole, which can lead to an increase in its concentration in the blood serum and an increase in the risk of side effects.

The simultaneous administration of drugs that stimulate microsomal oxidation enzymes in the liver (phenobarbital, phenytoin) can accelerate the elimination of metronidazole, resulting in a decrease in its plasma concentration.

When taken simultaneously with lithium preparations, the concentration of the latter in plasma and the development of symptoms of intoxication may increase.

It is not recommended to combine with non-depolarizing muscle relaxants (vecuronium bromide).

Sulfonamides enhance the antimicrobial effect of metronidazole.

Special instructions

During the period of treatment with metronidazole online, ethanol is contraindicated (possible development of a disulfiram-like reaction: spastic abdominal pain, vomiting, headache, sudden rush of blood to the face).

In combination with amoxicillin, it is not recommended to use patients under 18 years of age.

With prolonged therapy, it is necessary to monitor peripheral blood counts.

With leukopenia, the possibility of continuing treatment depends on the risk of developing an infectious process.

The appearance of ataxia, dizziness and any other deterioration in the neurological status of patients requires discontinuation of treatment.

May immobilize treponema and lead to a false positive Nelson test. Colors urine dark.

In the treatment of Trichomonas vaginitis in women and Trichomonas urethritis in men. It is necessary to refrain from sexual activity. Mandatory simultaneous treatment of sexual partners. Treatment does not stop during menstruation. After therapy of trichominosis, control samples should be carried out during three regular cycles before and after menstruation.

Metronidazole can cause severe hypersensitivity reactions that threaten the patient's life, including angioedema, anaphylactic shock, Stevens-Johnson syndrome, toxic epidermal necrolysis. If these reactions develop, metronidazole therapy should be discontinued immediately and appropriate therapy initiated.

Patients taking metronidazole may develop psychotic reactions (confusion, hallucinations, depression) with possible harm to their health after taking the first dose, especially in patients with a history of mental illness. In the event of the occurrence of the reactions described above, the drug should be discontinued and appropriate measures taken.

The simultaneous use of metronidazole and disulfiram or busulfan is not recommended.

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