Metronidazole + Miconazole - instructions for use, dose, side effects, contraindications

The nitro-5-imidazole derivative has an antibacterial and antiprotozoal effect. It recovers 5-nitro group due to transport proteins of anaerobic bacteria and protozoan microorganisms. The restored 5-nitro group of metronidazole inhibits the synthesis of nucleic acids from the DNA of microorganism cells, which leads to their death.

Active with respect to Gardnerella vaginalis, Giardia lamblia, Entamoeba histolytica, Trichomonas vaginalis, as well as in relation to obligate anaerobes Bacteroides spp. (at t.h. B. distasonis, B. ovatus, B. fragilis, B. vulgatus, B. thetaiotaomicron), Fusobacterium spp., Prevotella spp. (Prevotella bivia, Prevotella buccae, Prevotella disiens), Veillonella spp., and some gram-positive microorganisms (Clostridium spp., Eubacterium spp., Peptococcus spp., Peptostreptococcus spp.).

With a mixed flora, it acts synergistically with antibiotics against aerobic bacteria.

Miconazole

It is active against yeast fungi, dermatophytes. When intravaginal application inhibits the synthesis of ergosterol in fungi of the genus Candida albicans, changes the composition of lipid components in their membranes, resulting in the death of fungal cells. Eliminates the itching accompanying vaginal infections. Does not affect the pH and does not change the composition of the microflora of the vagina.

Pharmacokinetics:

Metronidazole

With intravaginal application, up to 50% is absorbed into the systemic circulation. The maximum concentration in the blood plasma is reached after 6-12 hours. The connection with plasma proteins is 20%.

The therapeutic effect develops 1-3 hours after application. Metabolism in the liver with the formation of 2-oxymetronidazole, which shows activity in 30% of the effect of the initial drug.

The elimination half-life is 8 hours. Elimination by the kidneys. Removed during hemodialysis.

Miconazole

In case of intravaginal administration, systemic action does not.

Indications:

It is used for local treatment of vaginitis and colpitis.

ICD-10

I.A50-A64.A59.0 Urogenital trichomoniasis

I.B35-B49.B37.3 Candidiasis of the vulva and vagina (N77.1 *)

Contraindications:

Organic damage to the central nervous system (epilepsy), hepatic insufficiency, individual intolerance.

Carefully:

Disturbances of microcirculation, diabetes mellitus.

Pregnancy and lactation:

Recommendations for FDA - Category B. Contraindicated in I trimester of pregnancy and lactation.

Dosing and Administration:

Intravaginally, previously moistened with water, 1 tablet deep into the vagina before going to bed for 10 days in conjunction with taking metronidazole tablets inside.

The highest daily dose: 1 vaginal tablet.

The highest single dose: 1 vaginal tablet.

Side effects:

Central nervous system: headache, dizziness.

Hemopoietic system: leukocytosis or leukopenia.

Digestive system: nausea, a sense of metallic taste in the mouth, a decrease in appetite, constipation, or diarrhea.

Urinary system: staining of urine in red-brown color due to metabolite 2-oximetronidazole.

Local reactions: itching, burning, irritation of the mucous membrane of the vagina.

Allergic reactions.

Overdose:

With the simultaneous use of metronidazole intravaginally and inwardly, an overdose is manifested by vomiting, diarrhea, ataxia, paresthesia, convulsive syndrome.

Treatment is symptomatic. Effective hemodialysis.

Interaction:

Metronidazole

With the simultaneous use of alcohol, disulfiramoid reactions develop: skin hyperemia, vomiting, cramping pains in the lower abdomen.

Strengthens the effect of indirect coagulants.

Not compatible with nondepolarizing muscle relaxants (vecuronium bromide).

With simultaneous application accelerate elimination and reduce the concentration of metronidazole in blood plasma drugs that stimulate enzymes of microsomal oxidation in the liver (feniotion, phenobarbital).

Enhances the toxic effects of lithium preparations.

With simultaneous use with cimetidine, the concentration of metronidazole in the blood serum increases, which leads to an increase in side effects.

Miconazole

Does not have a systemic effect.

Special instructions:

When treating Trichomonas and Candida colpitis, women need treatment for sexual partners and abstinence from sexual activity for the period of taking the drug.

Instructions

Metronidazole + Miconazole (Metronidazolum + Miconazolum)