FLAGYL I.V. (metronidazole hydrochloride) is to be administered by slow intravenous drip infusion only, either as a continuous or intermittent infusion. Intravenous admixtures containing metronidazole and other drugs should be avoided. If used with a primary intravenous fluid system, the primary solution should be discontinued during metronidazole infusion. DO NOT USE EQUIPMENT CONTAINING ALUMINUM (e.g., NEEDLES, CANNULAE) THAT WOULD COME IN CONTACT WITH THE DRUG SOLUTION. FLAGYL I.V. cannot be given by direct intravenous injection (I.V. bolus) because of the low pH (0.5-2.0) of the reconstituted product. FLAGYL I.V. MUST BE FURTHER DILUTED AND NEUTRALIZED FOR I.V. INFUSION.

Thanks Dr.Ali!

RAPID I.V. injection or infusion of mitronidzole may lead to RAPID accumulation and overdosage symptoms like

nausea, vomiting and neurotoxic effects, including ataxia, slight disorientation, confusion, seizures and peripheral neurophathy.

Also in cases of LIVER or renal impairment it may lead to toxic manifestations.

Also it may lead to hypersensitivity manifestations and anaphylactic shock.

So it is very important to dilute it and give it very slowly.

ADVERSE EFFECTS OF METRONIDAZOLE OVERDOSAGE

System Organ Class (SOC)

Blood and Lymphatic System Disorders

Leukopenia

Agranulocytosis

Pancytopenia

Neutropenia

Thrombocytopenia

Eosinophilia

uncommon

Immune System Disorder

Anaphylactic shock

Jarisch-Herxheimer reaction

Hypersensitivity

rare

Metabolism and Nutrition Disorders

Decreased appetite

Psychiatric Disorders

Hallucinations

Depression

Confusional state

Insomnia

rare

Nervous System Disorders

Dysgeusia

Headache

Encephalopathy

Meningitis aseptic

Seizure

Somnolence

Neuropathy peripheral

Ataxia

DizzinessDysarthria

Hypoaesthesia

Paraesthesia

common

rare

Eye Disorders

Optic neuropathy

Diplopia

Myopia

rare

rare

rare

Cardiac Disorders

Tachycardia

Palpitations

RARE

Respiratory, Thoracic and Mediastinal Disorders

Dyspnoea

not known

Gastrointestinal Disorders

Glossitis

Stomatitis

Dry mouth

Pancreatitis

Abdominal pain upper

Diarrhoea

Nausea

Vomiting

Constipation

Tongue discoloration

common

common

common

rare

rare

rare

rare

rare

Hepatobiliary disorders

Jaundice cholestatic

rare

Skin and Subcutaneous Disorders

Stevens-Johnson syndrome

Toxic epidermal necrolysis

Angioedema

Erythema multiforme

Pruritus

Swelling face

Urticaria

Hyperhidrosis

Rash

rare

rare

rare

rare

not known

not known

not known

not known

not known

Musculoskeletal and Connective Tissue Disorders

Myalgia

Muscle spasms

Arthralgia

common

not known

not known

Renal and urinary disorders

Chromaturia

Dysuria

rare

not known

General and Administration Site Conditions

Asthenia

Mucosal inflammation

Pyrexia

Injection site reaction

Malaise

Face oedema

Oedema peripheral

Chest pain

Chills

uncommon

rare

rare

not known

not known

not known

not known

not known

not known

Investigations

Hepatic enzyme increased

not known

Thanks Dr.Sarah!

For patients receiving Metronidazole IV for the first time, the first dose should be given in the hospital or other setting where the patient can be monitored for 2 hours. Rarely a profound neurological toxicity can occur. Should not be administered to patients with active neurological disorders.

Metronidazole should not be used in patients with active neurological disorders, or those with a history of hypothyroidism, hypoadrenalism, or blood dyscrasias.

(https://www.ismp-canada.org/SafeHomeInfusion/download/Monograph-IV-Metronidazole.pdf)

The mean maximum serum concentration of 18 µg / 1 ml is not reached until the end of 20 min. administration of the drug.

Metronidazole should be infused very slow due to its side effects of nausea, and vomiting, neurological toxicity.