Metronidazole topical Side Effects
More frequently reported side effects include: cervical candidiasis and vaginitis. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to metronidazole topical: topical cream, topical emulsion, topical gel/jelly, topical lotion
Other dosage forms:
In addition to its needed effects, some unwanted effects may be caused by metronidazole topical. In the event that any of these side effects do occur, they may require medical attention.
Minor Side Effects
Some of the side effects that can occur with metronidazole topical 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:Less common:
- Dry skin
- redness or other signs of skin irritation not present before use of this medicine
- stinging or burning of the skin
- watering of eyes
- Metallic taste in the mouth
- tingling or numbness of arms, legs, hands, or feet
For Healthcare Professionals
Applies to metronidazole topical: topical cream, topical gel, topical kit, topical lotion, vaginal gel with applicator
Local side effects associated with topical use have included skin irritation, dryness, transient redness, burning, and stinging. Dryness (mild: 17.1%; moderate: 7.7%; severe: 0.6%), scaling (mild: 16.2%; moderate: 7.9%; severe: 0.6%), pruritus (mild: 9.7%; moderate: 5%; severe: 1.1%), and stinging/burning (mild: 7.2%; moderate: 1.3%; severe: 1.8%) have been reported with the 1% gel. Application site reaction and local allergic reaction have been reported with the 1% cream and 0.75% lotion, respectively. At times, the local effects of metronidazole may be difficult to distinguish from the clinical characteristics of acne rosacea.[Ref]
Genitourinary side effects associated with the 0.75% vaginal gel have included vaginal discharge (12%), symptomatic Candida cervicitis/vaginitis (10%), vulva/vaginal irritative symptoms (9%), pelvic discomfort (3%), uterine cramping, and vaginal or vulvar burning, irritation, or itching. Urinary tract infection (1.1%) and vaginal mycosis (0.2%) have been reported with the 1% gel. Dyspareunia, dysuria, cystitis, polyuria, incontinence, darkened urine, and overgrowth of Candida in the vagina have been reported with oral or parenteral administration of metronidazole.[Ref]
Gastrointestinal side effects associated with the 0.75% vaginal gel have included gastrointestinal discomfort (7%), nausea and/or vomiting (4%), unusual taste (2%), diarrhea/loose stools (1%), decreased appetite (1%), abdominal bloating/gas (less than 1%), dry mouth (less than 1%), abdominal cramping, cramps/pain, and metallic or bad taste. Nausea and dry mouth have been reported with the 1% cream. Nausea and metallic taste have been reported with topical administration of metronidazole. Abdominal discomfort, nausea, vomiting, diarrhea, unpleasant metallic taste, anorexia, epigastric distress, abdominal cramping, constipation, "furry" tongue, glossitis, stomatitis, pancreatitis, proctitis, and modified taste of alcoholic beverages have been reported with oral or parenteral administration of metronidazole.[Ref]
Nervous system side effects associated with the 0.75% vaginal gel have included headache (5%) and dizziness (2%). Headache (2.2%) has been reported with the 1% gel. Tingling or numbness of extremities and headache have been reported with the 1% cream. Tingling or numbness of extremities has been reported with topical administration of metronidazole. Headache, dizziness, syncope, ataxia, convulsive seizures, peripheral neuropathy, vertigo, incoordination, weakness, and insomnia have been reported with oral or parenteral administration of metronidazole. Peripheral neuropathy has been associated with the 1% gel during postmarketing experience.
Respiratory side effects associated with the 1% gel have included nasopharyngitis (3.1%), upper respiratory tract infection (2.5%), sinusitis (1.4%), bronchitis (1.1%), and nasal congestion (1.1%).
A 58-year-old female with possible vaginal infection experienced TTP coincident with metronidazole therapy. She presented to the hospital with chest pain and blood in her urine three days after she was administered metronidazole 0.75% vaginal gel. She was diagnosed with TTP based on her laboratory and clinical findings. Her condition resolved after treatment.[Ref]
Hematological side effects associated with the 0.75% vaginal gel have included increased/decreased white blood cell counts (1.7%) and at least one case of thrombotic thrombocytopenic purpura (TTP). Reversible neutropenia and reversible thrombocytopenia have been reported with oral or parenteral administration of metronidazole.[Ref]
Cardiovascular side effects associated with the 1% gel have included hypertension (1.1%). Flattening of the T-wave may be seen in electrocardiographic tracings during oral or parenteral administration of metronidazole.
Dermatologic side effects associated with the 0.75% vaginal gel have included generalized itching or rash (less than 1%). Contact dermatitis (1.3%) and dry skin (1.1%) have been reported with the 1% gel. Condition aggravated, acne, severe flare of comedonal acne, rosacea aggravated, skin irritation, and rash have been reported with the 1% cream. Skin discomfort (burning and stinging), erythema, skin irritation, pruritus, and worsening of rosacea have been reported in less than 3% of patients using the 0.75% cream. Erythema (6%), contact dermatitis (3%), pruritus (1%), skin discomfort (burning and stinging; 1%), and worsening of rosacea (1%) have been reported with the 0.75% lotion. Skin irritation, transient skin erythema, mild skin dryness, and bullous fixed drug eruption have been reported with topical administration of metronidazole.[Ref]
Other side effects associated with the 0.75% vaginal gel have included unspecified cramping (1%), thirsty (less than 1%), fatigue (less than 1%), and darkened urine (less than 1%). Influenza (1.4%) has been reported with the 1% gel. A sense of pelvic pressure has been reported with oral or parenteral administration of metronidazole.
Psychiatric side effects associated with the 0.75% vaginal gel have included depression (less than 1%). Confusion, irritability, depression, and decreased libido have been reported with oral or parenteral administration of metronidazole.
Musculoskeletal side effects associated with the 1% gel have included back pain (0.5%).
Oncologic side effects associated with the 1% gel have included basal cell carcinoma (0.2%).
Hypersensitivity side effects associated with the 1% cream have included allergic reactions. Hypersensitivity reactions associated with oral or parenteral administration of metronidazole have included urticaria, erythematous rash, flushing, nasal congestion, fever, pruritus, fleeting joint pains, and dryness of the mouth, vagina, or vulva.
Ocular side effects associated with the 1% cream have included eye irritation. Watering or tearing may occur when metronidazole topical is applied too close to the eyes.
1. Lowe NJ, Henderson T, Millikan LE, Smith S, Turk K, Parker F "Topical metronidazole for severe and recalcitrant rosacea: a prospective open trial." Cutis 43 (1989): 283-6
2. Vincenzi C, Lucente P, Ricci C, Tosti A "Facial contact dermatitis due to metronidazole." Contact Dermatitis 36 (1997): 116-7
3. Tong D, Peters W, Barnetson RS "Evaluation of 0.75% metronidazole gel in acne--a double-blind study." Clin Exp Dermatol 19 (1994): 221-3
4. Veien NK, Christiansen JV, Hjorth N, Schmidt H "Topical metronidazole in the treatment of rosacea." Cutis 38 (1986): 209-10
5. "Product Information. Metrogel (metronidazole)." Galderma Laboratories Inc, Fort Worth, TX.
6. Schmadel LK, McEvoy GK "Topical metronidazole: a new therapy for rosacea." Clin Pharm 9 (1990): 94-101
7. "Product Information. Metrogel-Vaginal (metronidazole)." Curatek Pharmaceuticals Ltd, Elk Grove Village, IL.
8. Rivkin A "Thrombotic thrombocytopenic purpura induced by metronidazole vaginal gel." Pharmacotherapy 27 (2007): 1058-61
9. Hermida MD, Consalvo L, Lapadula MM, Della Giovanna P, Cabrera HN "Bullous fixed drug eruption induced by intravaginal metronidazole ovules, with positive topical provocation test findings." Arch Dermatol 147 (2011): 250-1
Not all side effects for metronidazole topical may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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