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Details

Stereochemistry RACEMIC
Molecular Formula C12H15N3O9
Molecular Weight 345.2622
Optical Activity ( + / - )
Defined Stereocenters 0 / 1
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of metronidazole citrate

SMILES

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

InChI

InChIKey=BSDGJHSABQWHHI-UHFFFAOYSA-N
InChI=1S/C12H15N3O9/c1-7-13-6-8(15(22)23)14(7)2-3-24-10(18)5-12(21,11(19)20)4-9(16)17/h6,21H,2-5H2,1H3,(H,16,17)(H,19,20)

HIDE SMILES / InChI

Molecular Formula C12H15N3O9
Molecular Weight 345.2622
Charge 0
Count
Stereochemistry RACEMIC
Additional Stereochemistry No
Defined Stereocenters 0 / 1
E/Z Centers 0
Optical Activity ( + / - )

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
Endpoints of spermatotoxicity in the rat after short duration exposures to fourteen reproductive toxicants.
1992
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
Treatment of experimental pneumocystosis: review of 7 years of experience and development of a new system for classifying antimicrobial drugs.
1992 Sep
[Antiamebic effect of metronidazole proved in a study conducted in Cienfuegos province].
2002 May-Aug
The importance of Bi-Digital O-Ring Test in the treatment of multiple hepatic abscesses: a case history.
2003
[Microbiologic characteristics of wound infectious process in use of ion-exchange sorbents].
2003
[Anaerobic bacteria in bronchoalveolar lavage fluid (BAL) after thoracic surgery].
2003
[Comparative clinical and epidemiological evaluation of beta-lactam antibiotics in the treatment of intraabdominal infections].
2003
An unexpected and severe neurological disorder with permanent disability acquired during short-course treatment with metronidazole.
2003
Superior mesenteric vein thrombosis following laparoscopic Nissen fundoplication.
2003 Apr-Jun
An open label crossover trial of effects of metronidazol on hyperlipidaemia.
2003 Aug
Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation.
2003 Aug
Renal papillary necrosis induced by naproxen.
2003 Aug
Analysis of antimicrobial susceptibility and virulence factors in Helicobacter pylori clinical isolates.
2003 Aug 11
Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps.
2003 Dec
Solvent effects in permeation assessed in vivo by skin surface biopsy.
2003 Dec 18
[Vulvar amebiasis. Report of a case and review of the literature].
2003 Feb
Molecular mechanisms and biological significance of CTL avidity.
2003 Jul
A triad of costimulatory molecules synergize to amplify T-cell activation in both vector-based and vector-infected dendritic cell vaccines.
2003 May
[Evaluation on monkeys of reactogenicity and effectiveness of the complex immunoglobulin preparation formulation].
2003 May-Jun
Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases.
2003 May-Jun
Bone defects of the facial skeleton - replacement with biomaterials.
2003 Nov
A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial.
2003 Nov
Modified vaccinia virus ankara recombinants are as potent as vaccinia recombinants in diversified prime and boost vaccine regimens to elicit therapeutic antitumor responses.
2003 Nov 15
Ruthenium(II) sulfoxide-maltolato and -nitroimidazole complexes: synthesis and MTT assay.
2003 Nov 17
Bronchospasm and laryngeal stridor as an adverse effect of oxytocin treatment.
2003 Oct
Cardiac diphtheria in a previously immunized individual.
2003 Sep
MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity.
2003 Sep
Crohn's disease--when to operate?
2004
[Clinical analysis of unsuccessful Helicobacter pylori eradication].
2004
[Use of arilin (Dr.Wolff) in the treatment of bacterial vaginosis and trichomoniasis during the period of 01.10.2003-31.12.2003].
2004
[Efficacy of two Helicobacter pylori eradication treatments in children with recurrent abdominal pain].
2004 Apr-Jun
Perforated appendicitis: is laparoscopy safe?
2004 Apr-Jun
TRICOM: enhanced vaccines as anticancer therapy.
2004 Aug
Nitazoxanide: a new broad spectrum antiparasitic agent.
2004 Feb
Lemierre's syndrome: the forgotten disease. An unusual presentation of sepsis.
2004 Feb
Reduced stem cell mobilization in mice receiving antibiotic modulation of the intestinal flora: involvement of endotoxins as cofactors in mobilization.
2004 Jan 1
[Tetanus in cats: 3 case descriptions].
2004 Jun
A case of clarithromycin-induced manic episode (antibiomania).
2004 Mar
Reproductive and cytogenetic toxicity of metronidazole in male mice.
2004 May
Experience with routine intraabdominal cultures during laparoscopic gastric bypass with implications for antibiotic prophylaxis.
2004 May
Reversible cerebellar lesions induced by metronidazole therapy for helicobacter pylori.
2004 Oct
Thoracic spondylitis from a mycotic (Streptococcus pneumoniae) aortic aneurysm: a case report.
2004 Sep 1
Metronidazole-induced encephalopathy.
2004 Sep 15
Phase I study of sequential vaccinations with fowlpox-CEA(6D)-TRICOM alone and sequentially with vaccinia-CEA(6D)-TRICOM, with and without granulocyte-macrophage colony-stimulating factor, in patients with carcinoembryonic antigen-expressing carcinomas.
2005 Feb 1
Analyses of recombinant vaccinia and fowlpox vaccine vectors expressing transgenes for two human tumor antigens and three human costimulatory molecules.
2005 Feb 15
Is operative management effective in treatment of perforated typhoid?
2005 Mar
[Two cases of metronidazole-induced encephalopathy].
2005 Mar
Abnormal enhancing lesion of dentate nuclei causing neurologic symptoms induced by metronidazole toxicity.
2005 Mar
Can antibiotics prevent preterm birth--the pro and con debate.
2005 Mar
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.
Substance Class Chemical
Created
by admin
on Sat Dec 16 18:43:03 GMT 2023
Edited
by admin
on Sat Dec 16 18:43:03 GMT 2023
Record UNII
8Y356BW999
Record Status Validated (UNII)
Record Version
  • Download
Name Type Language
metronidazole citrate
Common Name English
2-hydroxy-2-[2-[2-(2-methyl-5-nitro-imidazol-1-yl)ethoxy]-2-oxo-ethyl]butanedioic acid
Systematic Name English
Code System Code Type Description
FDA UNII
8Y356BW999
Created by admin on Sat Dec 16 18:43:04 GMT 2023 , Edited by admin on Sat Dec 16 18:43:04 GMT 2023
PRIMARY
PUBCHEM
165412102
Created by admin on Sat Dec 16 18:43:04 GMT 2023 , Edited by admin on Sat Dec 16 18:43:04 GMT 2023
PRIMARY
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ACTIVE MOIETY