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560 | Metoprolol tartrate | Metronidazole

Risk rating: GREEN Score = 2


Lower-risk product. Risk-reduction strategies should be considered.

This assessment is based on the full range of preparation and administration options described in the
monograph. These may not all be applicable in some clinical situations.

Bibliography
SPC Betaloc IV injection (accessed 8 February 2009).

Metronidazole
5 mg/mL solution in 100-mL infusion bags
*
Metronidazole is a synthetic, nitroimidazole-derivative antibacterial with activity against
anaerobes, facultative anaerobes and protozoa.
*
It is used in the treatment and prophylaxis of anaerobic infections and in the treatment of
susceptible protozoal infections such as amoebiasis, giardiasis and trichomoniasis.

Pre-treatment checks
*
Avoid in acute porphyria.
*
Caution in hepatic impairment and hepatic encephalopathy.

Biochemical tests
LFTs
FBC

Dose
Anaerobic infections (if oral therapy is inappropriate): 500 mg by IV infusion every 8 hours
(usually for 7 days; for 10 days in antibiotic-associated colitis). Oral medication should be substituted
as soon as is practical.
Surgical prophylaxis (if oral or rectal administration is inappropriate): 500 mg by IV
infusion at induction, with up to three further doses of 500 mg given every 8 hours for high-risk
procedures. Check local policies.
Dose in hepatic encephalopathy: 500 mg once daily - this is usually only when hepatic function
is very poor, and particularly when renal function is also impaired.

Intermittent intravenous infusion


Preparation and administration

Metronidazole is incompatible with Gluc 10% and Hartmann’s.


Metronidazole | 561

1. The infusion is pre-prepared for use and should be clear and colourless to pale yellow. Inspect
visually for particulate matter or discoloration prior to administration and discard if present.
2. Give by IV infusion at a rate of about 5 mL/minute (i.e. 500 mg over 20 minutes).

Technical information

Incompatible with Metronidazole is incompatible with Gluc 10% and Hartmann’s.


Amphotericin, aztreonam, benzylpenicillin, drotrecogin alfa (activated),
filgrastim, pantoprazole.

Compatible with Flush: NaCl 0.9%


Solutions: NaCl 0.9%, Gluc 5%, Gluc-NaCl
Y-site: Aciclovir, cefotaxime (in the same bag), ceftazidime (in the same
bag), cefuroxime (in the same bag), cisatracurium, clarithromycin,
dopamine, esmolol, fluconazole, foscarnet, granisetron, labetalol,
linezolid, magnesium sulfate, methylprednisolone sodium succinate,
midazolam, piperacillin with tazobactam, remifentanil

pH 4.5--7

Sodium content 13--14 mmol/100 mL

Storage Store below 25 C in original packaging. Do not refrigerate.


Once opened, use immediately. Discard any unused solution.

Monitoring

Measure Frequency Rationale

LFTs Periodically *
Significant accumulation may occur in patients with
hepatic encephalopathy and the resulting high
plasma concentrations of metronidazole may
contribute to the symptoms of the encephalopathy.

FBC *
Leucopenia, agranulocytosis, neutropenia,
thrombocytopenia and pancytopenia have occurred
rarely and usually reversibly.

Signs of supra-infection Throughout *


May result in oral, vaginal, or intestinal candidiasis --
or superinfection treatment appropriate therapy should be commenced.

Symptoms of peripheral *
Incidence is rare and therapy should be
neuropathy or transient discontinued. Symptoms usually reverse.
seizures

Additional information

Common and serious Infusion-related: Local: Thrombophlebitis may occur (rarely) and can be
undesirable effects minimised by avoiding prolonged use of in-dwelling IV catheters.
Other: Taste disorders (metallic taste), oral mucositis, furred tongue, nausea,
vomiting, GI disturbances, anorexia, pruritus, rash, urticaria.

Pharmacokinetics Elimination half-life is 8.5 hours.

(continued)
562 | Metronidazole | Mexiletine hydrochloride

Additional information (continued )

Significant *
Metronidazole may "levels or effect of the following drugs (or "side-effects):
interactions busulfan ("risk of toxicity), coumarin anticoagulants (monitor INR), phenytoin
(monitor levels).

Action in case of Antidote: No known antidote, stop administration and give supportive therapy
overdose as appropriate.

Counselling Avoid alcoholic beverages for up to 2 days after completing a course: risk of
flushing, nausea, vomiting, "pulse and shortness of breath.
Urine may become dark or reddish-brown owing to the presence of water-
soluble pigments resulting from its metabolism.
Patients should be warned about the potential for drowsiness, dizziness,
confusion, hallucinations, convulsions, transient visual disorders and advised not
to drive or operate machinery (if in a position to do so) if these symptoms present.

Risk rating: GREEN Score = 0


Lower-risk product: Risk-reduction strategies should be considered.

This assessment is based on the full range of preparation and administration options described in the
monograph. These may not all be applicable in some clinical situations.

Bibliography
SPC Flagyl 500 mg/100 mL solution for infusion (accessed 1 April 2009).

Mexiletine hydrochloride
25 mg/mL solution in 10-mL ampoules
*
Mexiletine hydrochloride is a class Ib antiarrhythmic with actions similar to those of lidocaine.
*
It has been used for the treatment of life-threatening ventricular arrhythmias.
*
It is no longer marketed in the UK as toxicity is common even at therapeutic blood concentrations,
but it is available from ‘special-order’ manufacturers or specialist-importing companies.

Pre-treatment checks
*
Do not give in cardiogenic shock and in second- or third-degree AV block (unless the patient has a
pacemaker).
*
Caution in patients with sinus node dysfunction, other conduction disorders, #pulse, #BP, heart
failure, or hepatic impairment.

Biochemical and other tests (not all are necessary in an emergency situation)
Blood pressure and pulse
ECG
LFTs