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Patients with evidence of or a history of blood dyscrasias should not receive the drug since upon occasion a moderate leucopenia has been observed during its administration. However, no persistent haematological abnormalities have been observed in animals or clinical studies (see Section 4.4 Special warnings and precautions for use).
Active organic disease of the central nervous system.
Hypersensitivity to metronidazole and other nitroimidazoles.
Patients who have taken disulfiram within the last two weeks should not be administered metronidazole. Use of oral metronidazole is associated with psychotic reactions in alcoholic patients who were using disulfiram concurrently (see Section 4.5 Interactions with other medicines and other forms of interactions).
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Mechanism & pharmacology
“Specific bactericidal activity against important obligate anaerobes.”
“The simultaneous administration of drugs that induce microsomal liver enzymes, such as phenytoin or phenobarbital, may accelerate the elimination of metronidazole, resulting in reduced plasma levels; impaired clearance of phenytoin has also been reported.”
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Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP)
Cases of severe irreversible hepatotoxicity/acute liver failure, including cases with fatal outcomes with very rapid onset after initiation of systemic use of metronidazole
Cases of agranulocytosis, neutropenia or thrombocytopenia have been reported
convulsive seizures
Curated subset. The full adverse-effect list is in the TGA Product Information; click any citation above to open it.
Consumption of alcohol or products containing propylene glycol. Use of oral metronidazole is associated with a disulfiram-like reaction to alcohol, including abdominal cramps, nausea, vomiting, headaches, and flushing. Discontinue consumption of alcohol or products containing propylene glycol during and for at least three days after therapy with metronidazole (see Section 4.4 Special warnings and precautions for use and Section 4.5 Interactions with other medicines and other forms of interactions).
Metronidazole Intravenous Injection is contraindicated in patients with Cockayne syndrome. Severe irreversible hepatotoxicity/acute liver failure with fatal outcomes have been reported after initiation of metronidazole in patients with Cockayne syndrome (see Section 4.8 Adverse effects (undesirable effects)).