Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (267 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(me-troe-ni′da-zole)
Flagyl, Flagyl ER, Flagyl IV, Flagyl IV RTU, Florazone ER
, Novo-Nidazol
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Nitroimidazole derivative
Direct-acting amebicide/trichomonacide binds and disrupts DNA structure, thereby inhibiting bacterial nucleic acid synthesis
Intestinal amebiasis, amebic abscess, trichomoniasis, refractory trichomoniasis, bacterial anaerobic infections, giardiasis, septicemia, endocarditis; bone, joint, lower respiratory tract infections; rosacea
Unlabeled uses:
Crohn’s disease, urethritis, amebiasis due to
Dientamoeba fragilis, Entamoeba polecki
, giardiasis, pruritus; gastric ulcer, dyspepsia
(H. pylori)
, pseudomembranous colitis, guinea worm disease, periodontitis
Pregnancy 1st trimester, breastfeeding, hypersensitivity to this product
Precautions:
Pregnancy (B) 2nd/3rd trimesters, geriatric patients,
Candida
infections, heart failure, fungal infection, dental disease, bone marrow suppression, hematologic disease, GI/renal/hepatic disease, contracted visual or color fields, blood dyscrasias, CNS disorders
Black Box Warning:
Secondary malignancy
Calculator
• Adult:
PO
500 mg bid × 7 days or 2 g as single dose; do not repeat treatment for 4-6 wk
• Child (unlabeled):
PO
15 mg/kg/day in 3 divided doses × 7-10 days
• Infant (unlabeled):
PO
10-30 mg/kg/day × 5-8 days
• Adult:
PO
250 mg bid × 10 days
• Adult:
PO
500-750 mg tid × 5-10 days
• Child:
PO
35-50 mg/kg/day in 3 divided doses × 10 days
• Adult:
PO
750 mg tid × 5-10 days
• Child:
PO
35-50 mg/kg/day in 3 divided doses × 10 days then oral iodoquinol
• Adult:
IV INF
15 mg/kg over 1 hr then 7.5 mg/kg
IV
or
PO
q6hr, not to exceed 4 g/day; 1st maintenance dose should be administered 6 hr after loading dose
• Adult:
PO
regular rel 500 mg bid or 250 mg tid × 7 days; ext rel 750 mg/day × 7 days
• Adult and adolescent:
PO
2 g as single dose with azithromycin
(unlabeled)
• Child:
PO
250 mg tid × 7 days
(unlabeled)
• Adult:
PO
750 mg tid × 10 days
• Child:
PO
30-50 mg/kg/day in 3 divided doses × 5-10 days
• Adult:
PO
250 mg tid × 10 days
• Child:
PO
25 mg/kg/day in 3 divided doses × 10 days
• Adult:
PO
250 mg tid-qid
• Adult:
PO
250 mg tid × 5-7 days
• Child:
PO
15 mg/kg/day in 3 divided doses × 5 days
• Adult:
PO
500 mg 3-4×/day × 10-14 days;
IV
500 mg q8hr
• Child:
PO/IV
30 mg/kg/day (max 2 g) divided q6hr × 10 days
Available forms:
Tabs 250, 500 mg; ext rel tab (ER) 750 mg; caps 375 mg; inj 500 mg/100 ml; powder for inj 500-mg single dose
•
Do not break, crush, or chew ext rel product
•
PO with or after meals to avoid GI symptoms, metallic taste; crush tabs if needed
•
Prediluted, ready to use; inf over 30-60 min
•
Lyophilized vials: dilute with 4.4 ml sterile water, 0.9% NaCl; must be diluted further with ≥8 mg/ml 0.9% NaCl, D
5
W, or LR; must neutralize with 5 mEq NaCO
3
/500 mg; CO
2
gas will be generated and may require venting; run over ≥1 hr; primary IV must be discontinued; may be given as cont inf; do not use aluminum products; IV may require venting
•
Do not use aluminum needles or other products to prepare product
Y-site compatibilities:
Acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amiodarone, ampicillin, ampicillin/sulbactam, anidulafungin, atracurium, bivalirudin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, dimenhyDRINATE, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluo
rouracil, foscarnet, fosphenytoin, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, inamrinone, insulin, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, midazolam, milrinone, mitoXANtrone, morphine, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pancuronium, pentamidine, pentazocine, PENTobarbital, perphenazine, PHENobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium chloride/phosphates, prochlorperazine, promethazine, propranolol, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, trastuzumab, trimethobenzamide, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Headache, dizziness
, confusion, irritability, restlessness, ataxia, depression, fatigue, drowsiness, insomnia, paresthesia, peripheral neuropathy,
seizures,
incoordination, depression, encephalopathy,
aseptic meningitis
CV:
Flattening of T waves
EENT:
Blurred vision, sore throat, retinal edema, dry mouth, metallic taste, furry tongue, glossitis, stomatitis, photophobia, optic neuritis
GI:
Nausea, vomiting, diarrhea
, epigastric distress,
anorexia
, constipation,
abdominal cramps
,
pseudomembranous colitis
GU:
Darkened urine, vaginal dryness, polyuria,
albuminuria,
dysuria, cystitis, decreased libido,
nephrotoxicity,
incontinence, dyspareunia, candidiasis
HEMA:
Leukopenia, bone marrow, depression, aplasia, thrombocytopenia
INTEG:
Rash, pruritus, urticaria, flushing,
Stevens-Johnson syndrome
Crosses placenta, enters breast milk, metabolized by liver 30%-60%, excreted in urine (60%-80%), half-life 6-8 hr
PO:
Peak 1-2 hr, absorbed 80%-85%
IV:
Onset immediate, peak end of inf
•
Avoid use with zalcitabine, bortezomib, norfloxacin
•
Do not use with amprenavir
Decrease:
metroNIDAZOLE half-life—barbiturates
Decrease:
metroNIDAZOLE—cholestyramine
Increase:
disulfiram reaction—alcohol
Increase:
busulfan toxicity—busulfan; avoid concurrent use
Increase:
metroNIDAZOLE level—cimetidine
Increase:
lithium, CYP3A4 substrates
Increase:
action of warfarin, phenytoin, lithium, fosphenytoin
Increase:
leukopenia—azaTHIOprine, fluorouracil
Altered:
AST, ALT, LDH
Decrease:
WBC, neutrophils
False decrease:
triglycerides
•
Infection:
WBC, wound symptoms, fever, skin or vaginal secretions; start treatment after C&S; for opportunistic fungal infections; superinfection: fever, monilial growth, fatigue, malaise
•
Stools during entire treatment; should be clear at end of therapy; stools should
be free of parasites for 1 yr before patient considered cured (amebiasis)
•
Vision by ophthalmic exam during, after therapy; vision problems often occur
Neurotoxicity:
peripheral neuropathy, seizures, dizziness, uncoordination, pruritus, joint pain; product may be discontinued
•
Allergic reaction:
fever, rash, itching, chills; product should be discontinued if these occur
•
Renal, reproductive dysfunction: dysuria, polyuria, impotence, dyspareunia, decreased libido, I&O; weight daily
Black Box Warning:
Secondary malignancy:
use only when indicated; avoid unnecessary use
•
Storage in light-resistant container; do not refrigerate
•
Therapeutic response: decreased symptoms of infection
•
That urine may turn dark reddish brown; that product may cause metallic taste
•
About proper hygiene after bowel movement; handwashing technique
•
To notify physician about numbness or tingling of extremities
•
To avoid hazardous activities because dizziness can occur
•
About need for compliance with dosage schedule, duration of treatment
•
To use condoms if treatment for trichomoniasis or cross-contamination may occur; to notify prescriber if pregnant or planning to become pregnant; that treatment of both partners is necessary for trichomoniasis
•
To use frequent sips of water, sugarless gum, candy for dry mouth
•
Not to drink alcohol or use preparations containing alcohol during use or for 48 hr after use of product; disulfiram-like reaction can occur
•
To notify if pregnancy is planned or suspected, pregnancy (B) 2nd/3rd trimester in trichomoniasis