Flagyl refers to nitro-5-imidazoles. The mechanism of action of metronidazole consists in the biochemical reduction of the 5-nitrogroup of metronidazole by intracellular transport proteins of anaerobic microorganisms and protozoa. The reduced 5-nitro group of metronidazole interacts with the DNA of the microorganism cell, inhibiting the synthesis of their nucleic acids, which leads to the death of microorganisms. The main metabolite (2-oxymetronidazole) also has an antiprotozoic and antimicrobial effect. Flagyl is an effective antimicrobial and protozoic agent with a wide range of effects. The drug is highly active against Trichomonas vaginalis, Giardia intestinalis, Entamoeba histolytica, Lamblia intestinalis.
Flagyl is used to treat patients with infectious diseases caused by strains sensitive to metronidazole. In particular, Flagil is used in the treatment of amoebiasis, nonspecific vaginitis, urogenital trichomoniasis, surgical infections, giardiasis. Flagil tablets can also be used as a continuation of parenteral therapy with metronidazole.
Data on Flagyl use during pregnancy are limited. No teratogenic or fetotoxic effects of metronidazole have been detected in animal studies, but metronidazole should be administered to pregnant women with particular caution. Further research is needed to completely eliminate the possible risks of metronidazole administration during pregnancy. Flagil can only be administered to pregnant women by the prescribing physician if it is medically indicated and if the fetus develops and the course of the pregnancy is constantly monitored. Metronidazole is defined in breast milk. If treatment with Flagil is necessary during lactation, it is recommended that breastfeeding be stopped (possibly temporarily).
Flagyl, when used in conjunction with alcohol, can lead to a disulfiramptoid reaction (skin hyperemia, vomiting, nausea, headache, tachycardia). If metronidazole and disulfiram are taken simultaneously, delirium and confusion may develop. Flagyl may increase plasma concentrations and toxicity of busulfan. Metronidazole may increase plasma concentrations of anticoagulants and increase the risk of bleeding. If a combination of these drugs is necessary, prothrombin time should be monitored and, if necessary, the anticoagulant dose should be adjusted. Flagyl may increase the toxicity of 5-fluorouracil due to a decrease in its clearance. During metronidazole treatment it is possible to obtain a false-positive Nelson test result.
Flagyl is taken orally. Flagyl tablets should be taken as a whole, regardless of meals, drinking enough water. The duration of the therapy, the regimen and the dose of metronidazole are determined by the physician, taking into account the nature of the disease, the tolerability of the drug and the associated therapy. In amoebiasis, adults are usually prescribed 500 mg of metronidazole three times a day. Course - 7 days. In amoebiasis in children weighing more than 20 kg, the dose of metronidazole is calculated according to the formula 30-40 mg/kg of weight and the dose is divided into 3 doses. Course - 7 days. In case of liver abscess against a background of amoebiasis pus aspiration and drainage should be combined with Flagil therapy. In giardiasis adults are usually prescribed to take 375-500 mg of metronidazole twice a day. The course is 5 days. In giardiasis, children over 10 years of age are usually prescribed 250 mg of metronidazole twice a day. Course - 5 days. Women with trichomoniasis (vaginitis or urethritis) are usually prescribed 250 mg of metronidazole twice a day (with simultaneous intravaginal administration of metronidazole). Course - 10 days. The partner should also take metronidazole (regardless of laboratory tests). Men with trichomoniasis (urethritis) are usually prescribed 250 mg of metronidazole twice a day. In some cases, it is rational to increase the dose to 750-1000 mg of metronidazole per day. Course - 10 days. In non-specific vaginitis, it is usually prescribed to take 500 mg of metronidazole twice a day. Course - 7 days. The partner should also receive appropriate therapy. In case of anaerobic infections (as a first-line or substitution therapy), adults are usually prescribed to take 500-750 mg of metronidazole twice a day. In anaerobic infections (as a first-line drug or substitution therapy), children over 6 years of age are usually prescribed 10-15 mg of metronidazole twice a day.