Flagyl IV Side Effects

Generic Name: metronidazole

Note: This page contains information about the side effects of metronidazole. Some of the dosage forms included on this document may not apply to the brand name Flagyl IV.

Not all side effects for Flagyl IV may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to metronidazole: oral capsule, oral suspension, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by metronidazole (the active ingredient contained in Flagyl IV). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking metronidazole:

More common
  • Agitation
  • back pain
  • blindness
  • blurred vision
  • burning, numbness, tingling, or painful sensations in the hands or feet
  • changes in speech patterns
  • confusion
  • convulsions
  • decreased vision
  • depression
  • dizziness
  • drowsiness
  • eye pain
  • fever
  • hallucinations
  • headache
  • irritability
  • lack of coordination
  • nausea
  • seizures
  • shakiness and unsteady walk
  • slurred speech
  • stiff neck or back
  • trouble speaking
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual tiredness or weakness
  • vomiting
  • weakness in the arms, hands, legs, or feet
Less common
  • Black, tarry stools
  • blood in the urine or stools
  • body aches or pain
  • chills
  • clumsiness or unsteadiness
  • difficulty with breathing
  • ear congestion
  • feeling of pelvic pressure
  • frequent or painful urination
  • loss of voice
  • nasal congestion
  • pinpoint red spots on the skin
  • runny nose
  • skin rash, hives, redness, or itching
  • sneezing
  • stomach and back pain (severe)
  • unusual bleeding or bruising
  • vaginal irritation, discharge, or dryness not present before taking the medicine
Rare
  • Bleeding gums
  • bloating
  • chest pain
  • constipation
  • cough
  • dark-colored urine
  • fast heartbeat
  • indigestion
  • loss of appetite
  • painful or difficult urination
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • yellow eyes or skin
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • bloody or cloudy urine
  • burning while urinating
  • continuing diarrhea
  • continuing stomach pain
  • diarrhea
  • feeling of warmth
  • increased volume of pale, dilute urine
  • joint or muscle pain
  • loss of bladder control
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • redness of the face, neck, arms, and occasionally, upper chest
  • redness of the skin

Some of the side effects that can occur with metronidazole may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Abdominal or stomach cramps
  • dizziness or lightheadedness
  • feeling of constant movement of self or surroundings
  • heartburn
  • sensation of spinning
  • trouble sleeping
  • weight loss
Less common or rare
  • Change in taste sensation
  • congestion
  • dry mouth
  • pain or tenderness around the eyes and cheekbones
  • tender, swollen glands in the neck
  • trouble with swallowing
  • unpleasant or sharp metallic taste
  • voice changes
Incidence not known
  • Decreased interest in sexual intercourse
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance
  • painful sexual intercourse

For Healthcare Professionals

Applies to metronidazole: compounding powder, intravenous powder for injection, intravenous solution, oral capsule, oral tablet, oral tablet extended release

General

The most serious side effects reported with metronidazole (the active ingredient contained in Flagyl IV) have included convulsive seizures, encephalopathy, aseptic meningitis, optic and peripheral neuropathy (primarily characterized by numbness or paresthesia of an extremity). Persistent peripheral neuropathy has been reported with prolonged oral administration of metronidazole.

Nervous system

Headache (18%) and dizziness (4%) were reported in patients using the extended-release tablet formulation. Headaches were considered severe in 10% of these patients.

A rare but serious side effect of metronidazole (the active ingredient contained in Flagyl IV) was peripheral neuropathy which was thought to be related to dose and duration of therapy. Most cases occurred after doses of 1000 to 2400 mg per day for at least 30 days, or a total dose of 50 grams. Neuropathy was generally located in the lower extremities and presented with numbness, tingling, and paresthesias. Patients should be advised to discontinue metronidazole if they experience these effects. Neuropathy may be persistent despite discontinuation of metronidazole. Seizures associated with metronidazole were rare, but did occur.

Several cases of MRI abnormalities of the dentate nuclei associated with symptoms of ataxia and dysarthria have been reported. The symptoms and dentate nuclei lesions resolved several weeks after discontinuation of metronidazole. These symptoms and metronidazole-induced lesions in the brain stem and cerebellar nuclei have also been described in rat studies.

Very common (10% or more): Headache
Common (1% to 10%): Dizziness
Frequency not reported: Encephalopathy, aseptic meningitis, peripheral neuropathy (characterized mainly by numbness or paresthesia of an extremity), convulsive seizures, vertigo, syncope, incoordination, ataxia, confusion, dysarthria, weakness, reversible abnormalities in the cerebellar dentate nuclei

Gastrointestinal

Very common (10% or more): Nausea
Common (1% to 10%): Taste perversion (metallic taste), abdominal pain, diarrhea, dry mouth
Rare (less than 0.1%): Pseudomembranous colitis, pancreatitis
Frequency not reported: Sharp unpleasant metallic taste, vomiting, abdominal discomfort, epigastric distress, abdominal cramping, constipation, proctitis, coating of the tongue (furry tongue), glossitis, stomatitis, taste of alcoholic beverages modified

Nausea (10%), taste perversion (metallic taste; 9%), abdominal pain (4%), diarrhea (4%), and dry mouth (2%) in patients using the extended-release tablet formulation. Nausea was considered severe in less than 2% of these patients.

Furry tongue, glossitis, and stomatitis may be associated with sudden overgrowth of Candida.

Although metronidazole has been used to treat pseudomembranous colitis, it has rarely also been implicated as a causative agent. These rare cases have been successfully treated with vancomycin.

Genitourinary

Very common (10% or more): Vaginitis
Common (1% to 10%): Genital pruritus, abnormal urine, dysmenorrhea, urinary tract infection
Rare (less than 0.1%): Darkened urine
Frequency not reported: Dysuria, cystitis, polyuria, incontinence, vulvovaginal candidiasis, vaginal itching, dyspareunia, sense of pelvic pressure

Vaginitis (15%), genital pruritus (5%), abnormal urine (3%), dysmenorrhea (3%), and urinary tract infection (2%) were reported in patients using the extended-release tablet formulation.

Instances of darkened urine have been investigated. The pigment responsible has not been positively identified; however, it is most likely a metabolite of metronidazole and appears to have no clinical significance.

Other

Bacterial infection (7%), influenza-like symptoms (6%), and moniliasis (3%) were reported in patients using the extended-release tablet formulation.

A disulfiram-like reaction has been reported in some patients drinking ethanol while taking metronidazole (the active ingredient contained in Flagyl IV) Patients have experienced abdominal distress, vomiting, flushing, nausea, headache, and hypotension. Patients should be advised to refrain from all forms of ethanol while taking metronidazole and for at least 72 hours after the last dose.

Common (1% to 10%): Bacterial infection, influenza-like symptoms, moniliasis
Frequency not reported: Fever, overgrowth of Candida, disulfiram-like reaction (abdominal distress, nausea, vomiting, flushing, hypotension, or headache) with ethanol

Respiratory

Upper respiratory tract infection (4%), rhinitis (4%), sinusitis (3%), and pharyngitis (3%) were reported in patients using the extended-release tablet formulation.

Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, pharyngitis

Hypersensitivity

Metronidazole (the active ingredient contained in Flagyl IV) has rarely been associated with a serum sickness-like reaction which presented as arthralgias, malaise, fever, chills, pruritus, and rash.

Rare (less than 0.1%): Serum sickness-like reaction
Frequency not reported: Hypersensitivity (including urticaria, erythematous rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, flushing, nasal congestion, dryness of the mouth [or vagina or vulva], fever), fixed drug eruptions, cross-sensitivity to other nitroimidazole derivatives

Hematologic

Rare (less than 0.1%): Reversible thrombocytopenia
Frequency not reported: Reversible neutropenia (leukopenia)

Cardiovascular

Frequency not reported: Flattening of the T-wave in ECG tracings

Dermatologic

Frequency not reported: Erythematous rash, pruritus

Local

Frequency not reported: Thrombophlebitis (after IV infusion)

Thrombophlebitis can be minimized or avoided by avoiding prolonged use of indwelling IV catheters.

Psychiatric

Frequency not reported: Irritability, depression, decreased libido, insomnia, disorientation, agitation, hallucinations

Ocular

Frequency not reported: Optic neuropathy

Metabolic

Frequency not reported: Anorexia

Musculoskeletal

Frequency not reported: Fleeting joint pains (sometimes resembling "serum sickness")

Oncologic

Breast and colon cancer have been reported in Crohn's disease patients treated with high doses of metronidazole (the active ingredient contained in Flagyl IV) for extended periods of time.

Frequency not reported: Breast cancer, colon cancer

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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