Parenteral Manual

MetroNIDAZOLE

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
FLAGYL®
Classification: 
Antibiotic
Original Date: 
August 2005
Revised Date: 
April 2023
Indications: 
  • Treatment of serious abdominal infections or other infections due to susceptible anaerobic bacteria
Reconstitution and Stability: 
  • Available in 5 mg/mL single-dose PVC plastic bags
  • Does not require further dilution
  • Store at room temperature
  • Stable for 30 days once outer wrap is removed
  • Crystals form upon refrigeration; crystals redissolve upon warming to room temperature
  • 100 mL bags contain 10 mL overfill. Remove 10 mL overfill from bags except for doses of 100 mL (500 mg)
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, ringer's lactate

- Additives/Above Cassette Compatible: ciprofloxacin, clindamycin

- Y-site Compatible: fluconazole, KCl (up to 100 mmol/L), meperidine, midazolam, morphine, TPN (amino acids/dextrose)

- Incompatible: G-CSF (filgrastim), dopamine

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

YES
Usual dilution: 5 mg/mL
Infusion time: 20-30 minutes
Infusion rate: do not exceed 25 mg/minute
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • 30 mg/kg/day IV Q8H
  • Maximum: 1500 mg/day
  • CNS Infections: may be divided Q6H - Maximum: 2000 mg/day
  • Clostridium difficile colitis infection: 35-50 mg/kg/day divided Q6H - Maximum: 2000 mg/day

Adolescent/Adult:

  • 500 mg IV Q8H
  • Clostridium difficile colitis infection: 500 mg IV Q6H
     

 Adjust dosage in severe hepatic disease: 50-67% decrease in dosage

- CrCl <10 mL/minute: Give 50% of the normal dose 

Potential hazards of parenteral administration: 
  • Thrombophlebitis
  • Peripheral neuropathy, paresthesias
  • Diarrhea, nausea, vomiting, anorexia, metallic taste
  • Headache, dizziness, drowsiness
  • Transient eosinophilia and leukopenia
Notes: 
  • Monitor WBC
  • Use with caution in patients with liver impairment, blood dyscrasias, CNS disease; in patients receiving corticosteroids or predisposed to edema
  • Potentiates anticoagulant effect of warfarin
  • Sodium content of 500 mg bag = 14 mEq

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