Sunday, December 7, 2008

Prescription Medication #1: Metronidazole

IMPORTANT: My reason for including entries about prescription medication is to simply share some basic information, and the experiences of those who used them. But nothing in this blog is a substitute for a discussion with your doctor, and reading the literature that you get from your doctor/pharmacist.

Currently, there are three types of antibiotics widely used to treat BV. I'm going to cover some basic information about each.

This is an overview of the most prescribed medication for BV: Metronidazole, which comes in two forms.

Metronidazole, a.k.a. Flagyl (oral)

  • Description: oral tablets - typical regimen is 500 mg, 2x a day, for 7 days or 2000 mg single-dose
  • Cure Rate: 95%, single-dose 84%
  • Pros: the first-line-of-defense for BV, has high cure rate; generic version is inexpensive
  • Cons: causes metallic taste in mouth; do not drink even a drop of alcohol while taking this, and for 3 days afterwards (not even cough syrup, or even a bite of tiramisu - it will make you very nauseous!)

Metrogel (vaginal gel)

  • Description: Vaginal gel
  • Cure Rate: 75% for 3-day regimen
  • Pros: you can avoid some of the side effects of the oral Flagyl (although you should still avoid alcohol)
  • Cons: the cure rate is lower than with the oral medication according to some sources

My Recommendation:

Whether you choose the Flagyl or Metrogel for your treatment is up to you and your doctor. However, I think it is better to take the oral medication if possible. In recent years, there are more and more research that shows that BV germs can travel from your lower genital tract to your upper genital tract and cause problems. So for that reason, taking the oral medication instead of the intra-vaginal gel/cream may be a better choice.

Many Bust Lounge members have used both types of these medications. Some have shared that after taking it several times, Flagyl makes them nauseous, even when alcohol is not consumed. Some members have also reported that they feel depressed after taking Flagyl.


The cure rate information is from this source.


Anonymous said...

I'm allergic to Flagyl. Are there any other alternative prescription medications that can used (besides the ones you listed_?

Lori said...

The three antibiotics that are designated for BV are: Flagyl, Clindamycin, and Tindamax (which I will write about in a future post).

Tindamax is in the same class of antibiotics as Flagyl, so if you're allergic to Flagyl, you are very likely also allergic to Tindamax.

I don't want to make any suggestions about what prescription drugs you should take. You absolutely should discuss this with your doctor, and see if s/he can suggest any alternatives for you.

My only suggestion is: if your doctor suggests Clindamycin for you - the oral capsules should be more effective than the vaginal cream. So you may want to ask him/her about that. (And you might also want to read my blog post about Clindamycin, to get an overview of the experience of others who have taken it.)

Good luck!

Anonymous said...

Hi - I am enjoying your blog, thanks for writing it! I'm currently just a few weeks pregnant, and my doc just diagnosed me with BV (i have very few symptoms - only occasional itching/burning). She prescribed to me Metrogel inserts (1x/day for 5 days). I have read lots about this and how it is not recommended (because there are very few studies about it on 1st trimester pregnant women) for 1st trimester use. I questioned my doc and pharm about this, and they both said it was ok, as it is ranked as a "B" medicine for prenancy (same as tylenol). I'm still concerned though, as I don't want to risk anything. i plan to start taking Fem-dophilus in the meantime, but do you have any insights into Metrogel use during 1st trimester? Thank you.

Lori said...

I have read that Metronidazole is in Pregnancy Category B. Basically, it should only be used if it's clearly needed.

On the other hand, I've also read that BV can cause pre-term birth sometimes, although I don't think the exact cause for this has been established. (This will be covered in a future post.)

Maybe your doctor wants to treat you for this reason? And maybe s/he prescribed you Metrogel instead of Flagyl, because it's less likely to be systemically absorbed? (But then, I've also heard that vaginal creams/gels are usually best avoided during pregnancy, so doctors are more likely to prescribe pills to pregnant women. Ah, so confusing.)

My suggestion - tell your doctor that you are concerned, and want to know if you can put off using Metrogel until you're past the 1st trimester. Ask him/her if it's something you need to use right now. See what s/he says about that.

Crys said...

I am taking Flagyl and i don't know if it is actually working. When will i see results? It has been a week and nothing has changed.

Lori said...

Hi Crys. Assuming that you're taking Flagyl for 7 days, you should feel better at some point during the week.

Anonymous said...

Am I allowed to take tylenol PM while taking Tindamax?

Anonymous said...

I was prescribed metronidazole rectal suppositories for a suspected intestinal infection. What the doctor didn't realize,though, even after doing a sonogram, was that I was pregnant (something like 3 weeks). Unfortunately my son was born without kidneys...he died two hours after birth...All experts agreed, it was because of the's poison for a fetus.

Lori said...

Thank you for sharing your story. I'm so sorry that you've had to suffer such a terrible ordeal.

I hope that your story will help women everywhere be more vigilant about their medical care, and not always leave it up to the doctors. All women should be tested for pregnancy before being administered prescription medication.

Thank you for being brave enough to share your story, again.