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Details

Stereochemistry ACHIRAL
Molecular Formula C13H13N3O4
Molecular Weight 275.26
Optical Activity NONE
Defined Stereocenters 0 / 0
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of METRONIDAZOLE BENZOATE

SMILES

CC1=NC=C(N1CCOC(=O)C2=CC=CC=C2)[N+]([O-])=O

InChI

InChIKey=CUUCCLJJOWSASK-UHFFFAOYSA-N
InChI=1S/C13H13N3O4/c1-10-14-9-12(16(18)19)15(10)7-8-20-13(17)11-5-3-2-4-6-11/h2-6,9H,7-8H2,1H3

HIDE SMILES / InChI

Description
Curator's Comment: description was created based on several sources, including http://www.emedexpert.com/facts/metronidazole-facts.shtml

Metronidazole was synthesized by France's Rhone-Poulenc laboratories and introduced in the mid-1950s under the brand name Flagel in the US, while Sanofi-Aventis markets metronidazole globally under the same trade name, Flagyl, and also by various generic manufacturers. Metronidazole is one of the rare examples of a drug developed as ant parasitic, which has since gained broad use as an antibacterial agent. Metronidazole, a nitroimidazole, exerts antibacterial effects in an anaerobic environment against most obligate anaerobes. Metronidazole is indicated for the treatment of the following infections due to susceptible strains of sensitive organisms: Trichomoniasis: symptomatic, asymptomatic, asymptomatic consorts; Amebiasis: acute intestinal amebiasis (amebic dysentery) and amebic liver abscess; Anaerobic bacterial infections; Intra-abdominal infections, including peritonitis, intra-abdominal abscess, and liver abscess; Skin and skin structure infections; Gynecologic infections, including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection; Bacterial septicemia; Bone and joint infections, as adjunctive therapy; Central Nervous System infections, including meningitis and brain abscess; Lower Respiratory Tract infections, including pneumonia, empyema, and lung abscess; Endocarditis. Metronidazole is NOT effective for infections caused by aerobic bacteria that can survive in the presence of oxygen. Metronidazole is only effective against anaerobic bacterial infections because the presence of oxygen will inhibit the nitrogen-reduction process that is crucial to the drug's mechanism of action. Once metronidazole enters the organism by passive diffusion and activated in the cytoplasm of susceptible anaerobic bacteria, it is reduced; this process includes intracellular electron transport proteins such as ferredoxin, transfer of an electron to the nitro group of the metronidazole, and formation of a short-lived nitroso free radical. Because of this alteration of the metronidazole molecule, a concentration gradient is created and maintained which promotes the drug’s intracellular transport. The reduced form of metronidazole and free radicals can interact with DNA leading to inhibition of DNA synthesis and DNA degradation leading to death of the bacteria. The precise mechanism of action of metronidazole is unknown. Metronidazole has a limited spectrum of activity that encompasses various protozoans and most Gram-negative and Gram-positive anaerobic bacteria. Metronidazole has activity against protozoans like Entamoeba histolytica, Giardia lamblia and Trichomonas vaginalis, for which the drug was first approved as an effective treatment.

CNS Activity

Curator's Comment: In animal studies, metronidazole readily penetrated the blood-CSF/blood-brain barrier, and data regarding the entry into human CSF and brain abscess confirmed this finding

Originator

Curator's Comment: was synthesized by France's Rhone-Poulenc laboratories and introduced in the mid-1950s under the brand name Flagyl

Approval Year

Targets

Targets

Primary TargetPharmacologyConditionPotency
Conditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Curative
FLAGYL

Approved Use

INDICATIONS & USAGE Metronidazole vaginal gel USP, 0.75% is indicated in the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis). NOTE: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4.5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination. Gram’s stain results consistent with a diagnosis of bacterial vaginosis include (a) markedly reduced or absent Lactobacillus morphology, (b) predominance of Gardnerella morphotype, and (c) absent or few white blood cells. Other pathogens commonly associated with vulvovaginitis, e.g., Trichomonas vaginalis, Chlamydia trachomatis, N. gonorrhoeae, Candida albicans, and Herpes simplex virus should be ruled out.

Launch Date

1963
Curative
FLAGYL

Approved Use

INDICATIONS & USAGE Metronidazole vaginal gel USP, 0.75% is indicated in the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis). NOTE: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4.5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination. Gram’s stain results consistent with a diagnosis of bacterial vaginosis include (a) markedly reduced or absent Lactobacillus morphology, (b) predominance of Gardnerella morphotype, and (c) absent or few white blood cells. Other pathogens commonly associated with vulvovaginitis, e.g., Trichomonas vaginalis, Chlamydia trachomatis, N. gonorrhoeae, Candida albicans, and Herpes simplex virus should be ruled out.

Launch Date

1963
Curative
FLAGYL

Approved Use

INDICATIONS & USAGE Metronidazole vaginal gel USP, 0.75% is indicated in the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis). NOTE: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4.5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination. Gram’s stain results consistent with a diagnosis of bacterial vaginosis include (a) markedly reduced or absent Lactobacillus morphology, (b) predominance of Gardnerella morphotype, and (c) absent or few white blood cells. Other pathogens commonly associated with vulvovaginitis, e.g., Trichomonas vaginalis, Chlamydia trachomatis, N. gonorrhoeae, Candida albicans, and Herpes simplex virus should be ruled out.

Launch Date

1963
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
12 μg/mL
500 mg single, oral
dose: 500 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
25 μg/mL
7.5 mg/kg 4 times / day steady-state, intravenous
dose: 7.5 mg/kg
route of administration: Intravenous
experiment type: STEADY-STATE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
40 μg/mL
2000 mg single, oral
dose: 2000 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
6 μg/mL
250 mg single, oral
dose: 250 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
6.77 μg/mL
250 mg single, oral
dose: 250 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: FASTED
16.54 mg/L
15 mg/kg single, intravenous
dose: 15 mg/kg
route of administration: intravenous
experiment type: single
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: unhealthy
age: ∞ants
sex:
food status:
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
75.23 μg × h/mL
250 mg single, oral
dose: 250 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: FASTED
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
8 h
500 mg single, oral
dose: 500 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
8 h
2000 mg single, oral
dose: 2000 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
8 h
250 mg single, oral
dose: 250 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: UNKNOWN
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
8 h
unknown, oral
METRONIDAZOLE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
7.76 h
250 mg single, oral
dose: 250 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
METRONIDAZOLE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: FASTED
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
80%
unknown, oral
METRONIDAZOLE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
12.5 g single, oral
Overdose
Dose: 12.5 g
Route: oral
Route: single
Dose: 12.5 g
Sources:
unhealthy, 58 years
n = 1
Health Status: unhealthy
Condition: chronic depressive illness
Age Group: 58 years
Sex: F
Population Size: 1
Sources:
Disc. AE: Hepatotoxicity...
AEs leading to
discontinuation/dose reduction:
Hepatotoxicity (9.6%)
Sources:
8.5 g single, oral
Overdose
Dose: 8.5 g
Route: oral
Route: single
Dose: 8.5 g
Sources:
unhealthy, 62 years
n = 1
Health Status: unhealthy
Condition: extensive past medical history, including end-stage renal disease
Age Group: 62 years
Sex: M
Population Size: 1
Sources:
1000 mg/m2 3 times / day steady, oral
Highest studied dose
Dose: 1000 mg/m2, 3 times / day
Route: oral
Route: steady
Dose: 1000 mg/m2, 3 times / day
Sources:
unhealthy, adult
n = 32
Health Status: unhealthy
Condition: advanced carcinoma of the colon or rectum
Age Group: adult
Sex: unknown
Population Size: 32
Sources:
DLT: Nausea and vomiting, Generalised onset motor seizure...
Dose limiting toxicities:
Nausea and vomiting (13.5%)
Generalised onset motor seizure (12.8%)
Neurotoxicity NOS (10.9%)
Sources:
5.3 mg/m2 3 times / week multiple, oral (mean)
Highest studied dose
Dose: 5.3 mg/m2, 3 times / week
Route: oral
Route: multiple
Dose: 5.3 mg/m2, 3 times / week
Co-administed with::
radiotherapy
Sources:
unhealthy, adult
n = 28
Health Status: unhealthy
Condition: malignant brain tumors
Age Group: adult
Sex: unknown
Population Size: 28
Sources:
DLT: Gastrointestinal toxicity, Central nervous system toxicity...
Dose limiting toxicities:
Gastrointestinal toxicity (14.5%)
Central nervous system toxicity (13.7%)
Sources:
1350 mg 3 times / day steady, oral
Overdose
Dose: 1350 mg, 3 times / day
Route: oral
Route: steady
Dose: 1350 mg, 3 times / day
Sources:
unhealthy, preterm newborn
n = 1
Health Status: unhealthy
Condition: bloody stools and apnoea
Age Group: preterm newborn
Sex: F
Population Size: 1
Sources:
AEs

AEs

AESignificanceDosePopulation
Hepatotoxicity 9.6%
Disc. AE
12.5 g single, oral
Overdose
Dose: 12.5 g
Route: oral
Route: single
Dose: 12.5 g
Sources:
unhealthy, 58 years
n = 1
Health Status: unhealthy
Condition: chronic depressive illness
Age Group: 58 years
Sex: F
Population Size: 1
Sources:
Neurotoxicity NOS 10.9%
DLT
1000 mg/m2 3 times / day steady, oral
Highest studied dose
Dose: 1000 mg/m2, 3 times / day
Route: oral
Route: steady
Dose: 1000 mg/m2, 3 times / day
Sources:
unhealthy, adult
n = 32
Health Status: unhealthy
Condition: advanced carcinoma of the colon or rectum
Age Group: adult
Sex: unknown
Population Size: 32
Sources:
Generalised onset motor seizure 12.8%
DLT
1000 mg/m2 3 times / day steady, oral
Highest studied dose
Dose: 1000 mg/m2, 3 times / day
Route: oral
Route: steady
Dose: 1000 mg/m2, 3 times / day
Sources:
unhealthy, adult
n = 32
Health Status: unhealthy
Condition: advanced carcinoma of the colon or rectum
Age Group: adult
Sex: unknown
Population Size: 32
Sources:
Nausea and vomiting 13.5%
DLT
1000 mg/m2 3 times / day steady, oral
Highest studied dose
Dose: 1000 mg/m2, 3 times / day
Route: oral
Route: steady
Dose: 1000 mg/m2, 3 times / day
Sources:
unhealthy, adult
n = 32
Health Status: unhealthy
Condition: advanced carcinoma of the colon or rectum
Age Group: adult
Sex: unknown
Population Size: 32
Sources:
Central nervous system toxicity 13.7%
DLT
5.3 mg/m2 3 times / week multiple, oral (mean)
Highest studied dose
Dose: 5.3 mg/m2, 3 times / week
Route: oral
Route: multiple
Dose: 5.3 mg/m2, 3 times / week
Co-administed with::
radiotherapy
Sources:
unhealthy, adult
n = 28
Health Status: unhealthy
Condition: malignant brain tumors
Age Group: adult
Sex: unknown
Population Size: 28
Sources:
Gastrointestinal toxicity 14.5%
DLT
5.3 mg/m2 3 times / week multiple, oral (mean)
Highest studied dose
Dose: 5.3 mg/m2, 3 times / week
Route: oral
Route: multiple
Dose: 5.3 mg/m2, 3 times / week
Co-administed with::
radiotherapy
Sources:
unhealthy, adult
n = 28
Health Status: unhealthy
Condition: malignant brain tumors
Age Group: adult
Sex: unknown
Population Size: 28
Sources:
OverviewDrug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
no
no
no
no
no
no
no
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
PubMed

PubMed

TitleDatePubMed
The effect of therapeutic drugs used in inflammatory bowel disease on the incidence and growth of colonic cancer in the dimethylhydrazine rat model.
1992 Nov
Acute encephalopathy associated with metronidazole therapy.
1997 Mar-Jun
Bactericidal activity of nitrofurans against growing and dormant Mycobacterium bovis BCG.
2000 Dec
Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure.
2000 May
[Pneumatosis cystoides intestinalis: the first case in Congo].
2001 Apr-Jun
Clinical onset of the Crohn's disease after eradication therapy of Helicobacter pylori infection. Does Helicobacter pylori infection interact with natural history of inflammatory bowel diseases?
2001 Jan-Feb
Azole-antifungal binding to a novel cytochrome P450 from Mycobacterium tuberculosis: implications for treatment of tuberculosis.
2001 Jun 15
Pectin-based microspheres: a preformulatory study.
2001 Nov
Retrospective analysis of drug-induced urticaria and angioedema: a survey of 2287 patients.
2001 Nov
Synthesis, biological evaluation, and binding mode of novel 1-[2-(diarylmethoxy)ethyl]-2-methyl-5-nitroimidazoles targeted at the HIV-1 reverse transcriptase.
2002 Apr 11
Metronidazol as a probable cause of severe liver injury.
2002 Jan-Feb
Local antimicrobial therapy after initial periodontal treatment.
2002 Jun
[Antiamebic effect of metronidazole proved in a study conducted in Cienfuegos province].
2002 May-Aug
[Microbiologic characteristics of wound infectious process in use of ion-exchange sorbents].
2003
[Comparative clinical and epidemiological evaluation of beta-lactam antibiotics in the treatment of intraabdominal infections].
2003
Metronidazole and mental confusion.
2003 Apr
Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps.
2003 Dec
[Vulvar amebiasis. Report of a case and review of the literature].
2003 Feb
Role of bacteria and inducible nitric oxide synthase activity in the systemic inflammatory microvascular response provoked by indomethacin in the rat.
2003 Feb 7
Molecular mechanisms and biological significance of CTL avidity.
2003 Jul
[Evaluation on monkeys of reactogenicity and effectiveness of the complex immunoglobulin preparation formulation].
2003 May-Jun
MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity.
2003 Sep
Crohn's disease--when to operate?
2004
Perforated appendicitis: is laparoscopy safe?
2004 Apr-Jun
Patents

Sample Use Guides

Trichomoniasis: In the Female: One-day treatment − two grams of FLAGYL, given ither as a single dose or in two divided doses of one gram each, given in the same day. Anaerobic Bacterial Infections: In the treatment of most serious anaerobic infections, intravenous metronidazole is usually administered initially. The usual adult oral dosage is 7.5 mg/kg every six hours (approx. 500 mg for a 70-kg adult). A maximum of 4 g should not be exceeded during a 24-hour period. Amebiasis: Adults: For acute intestinal amebiasis (acute amebic dysentery): 750 mg orally three times daily for 5 to 10 days. For amebic liver abscess: 500 mg or 750 mg orally three times daily for 5 to 10 days. Pediatric patients: 35 to 50 mg/kg/24 hours, divided into three doses, orally for 10 days.
Route of Administration: Other
Cells incubated with lethal drug (Metronidazole (MTZ)) concentration exhibit unchanged DNA profile, only about 50% of cells are positive for γH2A and lose an ability to attach to a surface after few hours of incubation. It is likely that the early reaction of cells to lethal concentration of MTZ is not primarily initiated by the reaction to DNA damage but rather by the immediate interaction of MTZ with biomolecules where activated MTZ is generated.
Name Type Language
METRONIDAZOLE BENZOATE
EP   MART.   USP   USP-RS   WHO-DD   WHO-IP  
Common Name English
METRONIDAZOLE BENZOATE [USP MONOGRAPH]
Common Name English
METRONIDAZOLE BENZOATE [MART.]
Common Name English
Metronidazole benzoate [WHO-DD]
Common Name English
2-(2-METHYL-5-NITROIMIDAZOL-1-YL)ETHYL BENZOATE
Systematic Name English
METRONIDAZOLE BENZOATE [WHO-IP]
Common Name English
METRONIDAZOLE BENZOATE [USP-RS]
Common Name English
METRONIDAZOLI BENZOAS [WHO-IP LATIN]
Common Name English
KLION SUSPENSION
Common Name English
BENZOYL METRONIDAZOLE
Common Name English
METRONIDAZOLE BENZOATE [EP MONOGRAPH]
Common Name English
Classification Tree Code System Code
NCI_THESAURUS C279
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
Code System Code Type Description
RXCUI
103866
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY RxNorm
SMS_ID
100000084889
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
FDA UNII
A355C835XC
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
WHO INTERNATIONAL PHARMACOPEIA
METRONIDAZOLE BENZOATE
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY Description: A white or slightly yellowish, crystalline powder. Solubility: Practically insoluble in water; freely soluble in dichloromethane R; soluble in acetone R; slightly soluble in ethanol (~750 g/l) TS; very slightly soluble in ether R. Category: Anti-infective drug. Storage: Metronidazole benzoate should be kept in a well-closed container, protected from light. Requirements: Metronidazole benzoate contains not less than 98.5% and not more than 101.0% of C13H13N3O4, calculated with reference to the dried substance.
RS_ITEM_NUM
1442100
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
EPA CompTox
DTXSID60157221
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
DAILYMED
A355C835XC
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
CAS
13182-89-3
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
ChEMBL
CHEMBL137
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
NCI_THESAURUS
C87387
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
EVMPD
SUB14569MIG
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
PUBCHEM
83213
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY
ECHA (EC/EINECS)
236-131-7
Created by admin on Fri Dec 15 15:40:29 GMT 2023 , Edited by admin on Fri Dec 15 15:40:29 GMT 2023
PRIMARY