Sufrexal Combi

Oral

Hypertension

Adult: 20 mg bid; increase to 40 mg bid after 2-4 wk as necessary. May also be given via IV/IM admin.

Hepatic impairment: Cirrhosis: Reduce dose or increase dosage interval. Severe hepatic impairment: A max of 20 mg bid is recommended.

Symptomatic Trichomoniasis

Metronidazole (Sufrexal Combi) is indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of thetrichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures).

Asymptomatic Trichomoniasis

Metronidazole (Sufrexal Combi) is indicated in the treatment of asymptomatic females when the organism is associated with endocervi-citis, cervicitis, or cervical erosion. Since there is evidence that presence of the trichomonad can interfere with accurate assessment of abnormal cytological smears, additional smears should be performed after eradication of the parasite.

Treatment of Asymptomatic Consorts.

T. vagi-nalis infection is a venereal disease. Therefore, asymptomatic sexual partners of treated patients should be treated simultaneously if the organism has been found to be present, in order to prevent reinfection of the partner. The decision as to whether to treat an asymptomatic male partner who has a negative culture or one for whom no culture has been attempted is an individual one. In making this decision, it should be noted that there is evidence that a woman may become reinfected if her consort is not treated. Also, since there can be considerable difficulty in isolating the organism from the asymptomatic male carrier, negative smears and cultures cannot be relied upon in this regard. In any event, the consort should be treated with Metronidazole (Sufrexal Combi) in cases of reinfection.

Amebiasis

Metronidazole (Sufrexal Combi) is indicated in the treatment of acute intestinal amebiasis (amebic dysen-tery)and amebic liver abscess.

In amebic liver abscess, Metronidazole (Sufrexal Combi) therapy does not obviate the need for aspiration or drainage of pus.

Anaerobic Bacterial Infections

Metronidazole (Sufrexal Combi) is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Indicated surgical procedures should be performed in conjunction with Metronidazole (Sufrexal Combi) therapy. In a mixed aerobic and anaerobic infection, antimicrobials appropriate for the treatment of the aerobic infection should be used in addition to Metronidazole (Sufrexal Combi).

In the treatment of most serious anaerobic infections, Metronidazole (Sufrexal Combi) I.V. (Metronidazole (Sufrexal Combi) hydrochloride) or Metronidazole (Sufrexal Combi) I.V. RTU® (Metronidazole (Sufrexal Combi)) is usually administered initially. This may be followed by oral ther-apy with Metronidazole (Sufrexal Combi) (Metronidazole (Sufrexal Combi)) at the discretion of the physician.

INTRA-ABDOMINAL INFECTIONS, including peritonitis, intra-abdominal abscess, and liver abscess, caused by Bacteroides species including the B. fragilis group (B. fragilis, B. distasonis,B. ovatus, B. thetaiotaomicron, B. vulgatus), Clostrid-ium species, Eubacterium species, Peptococcus niger, and Peptostreptococcus species.

SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcus niger,Peptostreptococcus species, and Fusobacte-rium species.

GYNECOLOGIC INFECTIONS, including endo-metritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusniger, and Pepto-streptococcus species.

BACTERIAL SEPTICEMIA caused by Bacteroides species including the B. fragilis group, and Clos-tridium species.

BONE AND JOINT INFECTIONS, as adjunctive therapy, caused by Bacteroides species including the B. fragilis group.

CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS, including meningitis and brain abscess, caused by Bacteroides species including the B.fragilis group.

LOWER RESPIRATORY TRACT INFECTIONS, including pneumonia, empyema, and lung abscess, caused by Bacteroides species including the B. fragilis group.

ENDOCARDITIS caused by Bacteroides species including the B.fragilis group.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Metronidazole (Sufrexal Combi) and other antibacterial drugs, Metronidazole (Sufrexal Combi) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Miconazole (Sufrexal Combi) Cream:

Topical treatment of fungal infections, including tinea pedis (athlete's foot), jock itch (groin rash), tinea corporis (ringworm), pityriasis versicolor (white spots), candidiasis (thrush), thrush infected napkin rash, and fungal infections where bacterial infections may be present. Helps protect the skin from chafing, water, urine and other irritants.

Miconazole (Sufrexal Combi) Powd: Treatment of fungal infections of the skin eg, athlete's foot, tinea, jock itch (groin rash) and napkin rash.

Metronidazole (Sufrexal Combi) is used to treat bacterial infections in different areas of the body. The extended-release tablets are used to treat women with vaginal infections (bacterial vaginosis).

Metronidazole (Sufrexal Combi) belongs to the class of medicines known as antibiotics. It works by killing bacteria or preventing their growth. However, Metronidazole (Sufrexal Combi) will not work for colds, flu, or other virus infections.

Metronidazole (Sufrexal Combi) is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Metronidazole (Sufrexal Combi) is used in certain patients with the following medical conditions:

• Clostridium difficile diarrhea or colitis (antibiotic-associated colitis).
• Crohn's disease (inflammatory bowel disease).
• Gastritis or stomach ulcers due to Helicobacter pylori.
• Giardiasis (parasite infection in the intestines).

Miconazole (Sufrexal Combi) topical is an antifungal medication. Miconazole (Sufrexal Combi) topical prevents fungus from growing on your skin.

Miconazole (Sufrexal Combi) topical (for the skin) is used to treat skin infections such as athlete's foot, jock itch, ringworm, tinea versicolor (a fungus that discolors the skin), and yeast infections of the skin.

Miconazole (Sufrexal Combi) topical may also be used for purposes not listed in this medication guide.

Oral

Hypertension

Adult: 20 mg bid; increase to 40 mg bid after 2-4 wk as necessary. May also be given via IV/IM admin.

Hepatic impairment: Cirrhosis: Reduce dose or increase dosage interval. Severe hepatic impairment: A max of 20 mg bid is recommended.

Usual Adult Dose for Acne Rosacea

Metronidazole (Sufrexal Combi) topical 1% gel or cream: Apply a thin film to the affected area once a day.

Metronidazole (Sufrexal Combi) topical 0.75% gel, cream, or lotion: Apply a thin film to the affected area twice a day.

Usual Adult Dose for Bacterial Vaginosis

Insert one applicatorful of Metronidazole (Sufrexal Combi) topical 0.75% vaginal gel intravaginally once (at bedtime) or twice a day for 5 consecutive days.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Gel, cream, lotion: Data not available

Vaginal gel: The manufacturer recommends caution when administering this drug to patients with severe hepatic disease.

Dose Adjustments

The duration of topical therapy is 4 to 10 weeks depending on the nature and severity of the condition.

Precautions

Patients should be advised to use Metronidazole (Sufrexal Combi) topical less frequently or discontinue use if a reaction suggesting local irritation occurs.

Convulsive seizures and peripheral neuropathy have been reported in patients receiving oral or IV Metronidazole (Sufrexal Combi). If abnormal neurologic signs appear, Metronidazole (Sufrexal Combi) topical vaginal gel should be discontinued at once. The use of Metronidazole (Sufrexal Combi) topical 1% gel should be reevaluated at once if abnormal neurologic signs appear. Metronidazole (Sufrexal Combi) topical should be used with caution in patients with central nervous system diseases.

Metronidazole (Sufrexal Combi) topical should be used with caution in patients with evidence of, or history of blood dyscrasia.

Although disulfiram-like reactions have not been reported in patients receiving vaginal Metronidazole (Sufrexal Combi), the manufacturer recommends that alcohol be avoided. Metronidazole (Sufrexal Combi) topical vaginal gel should not be used in patients who have taken disulfiram within the last 2 weeks.

Safety and efficacy have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

Metronidazole (Sufrexal Combi) topical may cause eye irritation if applied too close to the eyes. Contact with the eyes should be avoided.

Topical areas to be treated should be washed with a mild cleanser prior to application.

The manufacturer recommends avoidance of vaginal intercourse during treatment with Metronidazole (Sufrexal Combi) topical vaginal gel.

Usual Adult Dose for

Oral Thrush

Oropharyngeal candidiasis: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.

Usual Pediatric Dose for

Oral Thrush

Oropharyngeal candidiasis:

16 years or older: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Precautions

Miconazole (Sufrexal Combi) buccal tablets are contraindicated in patients with known hypersensitivity (e.g., anaphylaxis) to milk protein concentrate.

Allergic reactions (including anaphylactic reactions and hypersensitivity) have been reported with the use of Miconazole (Sufrexal Combi) products. Miconazole (Sufrexal Combi) should be discontinued at once at the first sign of hypersensitivity.

There are no data regarding cross-hypersensitivity between Miconazole (Sufrexal Combi) and other azole antifungal agents. Patients with a history of hypersensitivity to azoles should be monitored.

Safety and effectiveness have not been established in pediatric patients less than 16 years of age.

Dialysis

No adjustment recommended.

Other Comments

Miconazole (Sufrexal Combi) buccal tablets should be applied with dry hands each morning after brushing teeth. The tablets should be placed against the upper gum, above the incisor tooth, and held in place with slight pressure over the upper lip for 30 seconds to ensure adhesion. Once in place, the buccal tablet stays in position and gradually dissolves. Subsequent applications should be made to alternate sides of the mouth. Any remaining tablet material should be cleared away before the next tablet is applied.

Miconazole (Sufrexal Combi) buccal tablets should not be crushed, chewed, or swallowed. Food and drink can be taken normally when the buccal tablet is in place but chewing gum should be avoided.

If the Miconazole (Sufrexal Combi) buccal tablet does not adhere or falls off within the first 6 hours, the same tablet should be repositioned at once; however, if the tablet still does not adhere, a new tablet should be used. If the buccal tablet is swallowed within the first 6 hours, the patient should drink a glass of water and a new tablet should be applied only once. If the buccal tablet falls off or is swallowed after it was in place for at least 6 hours, a new tablet should not be applied until the next scheduled dose.

Hypotensive, dehydrated patienst

See also:
What is the most important information I should know about Metronidazole (Sufrexal Combi)?

Hypersensitivity

Metronidazole (Sufrexal Combi) Capsules 375 mg are contraindicated in patients with a prior history of hypersensitivity to Metronidazole (Sufrexal Combi) or other nitroimidazole derivatives.

In patients with trichomoniasis, Metronidazole (Sufrexal Combi) Capsules 375 mg are contraindicated during the first trimester of pregnancy.

Psychotic Reaction with Disulfiram

Use of oral Metronidazole (Sufrexal Combi) is associated with psychotic reactions in alcoholic patients who were using disulfiram concurrently. Do not administer Metronidazole (Sufrexal Combi) to patients who have taken disulfiram within the last two weeks.

Interaction with Alcohol

Use of oral Metronidazole (Sufrexal Combi) is associated with a disulfiram-like reaction to alcohol, including abdominal cramps, nausea, vomiting, headaches, and flushing. Discontinue consumption of alcohol or products containing propylene glycol during and for at least three days after therapy with Metronidazole (Sufrexal Combi).

See also:
What is the most important information I should know about Miconazole (Sufrexal Combi)?

Patients with any kind of liver disease; hypersensitivity to any of the ingredients of Daktarin

Oral Gel.

The effects and/or side effects of many prescription medications, when taken with Daktarin

Oral Gel, can be increased. Hence, patients taking or about to take any other medications, must consult the doctor or pharmacist before starting Daktarin

Oral Gel therapy.

Use in infants: Daktarin

Oral Gel is contraindicated in infants <6 months because of the risk of choking.

Use Metronidazole (Sufrexal Combi) gel as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Metronidazole (Sufrexal Combi) gel. Talk to your pharmacist if you have questions about this information.
• If you are using Metronidazole (Sufrexal Combi) gel once daily, use it at bedtime.
• Remove the cap from the tube and break the metal seal on the tube with the pointed tip of the cap. Screw the end of the applicator onto the tube. Slowly squeeze gel out of the tube and into the applicator. The plunger will stop when the applicator is full. Unscrew applicator and replace the cap on the tube.
• You may insert Metronidazole (Sufrexal Combi) gel lying on your back with your knees bent or in any comfortable position. Hold the filled applicator by the barrel, and gently insert into the vagina as far as it will comfortably go. Slowly press the plunger until it stops, and then remove the applicator.
• If you will be using Metronidazole (Sufrexal Combi) gel twice daily, you will need to clean the applicator after your first dose of the day and use it again for your second dose. To clean the applicator, pull the plunger out of the barrel. Wash both the plunger and barrel in warm, soapy water and rinse well. To put the applicator back together, gently push the plunger back into the barrel.
• Wash your hands immediately after using Metronidazole (Sufrexal Combi) gel.
• When you throw the applicator away, be sure that it is out of the reach of children and pets.
• Using Metronidazole (Sufrexal Combi) gel at the same time each day will help you remember to use it.
• To clear up your infection completely, use Metronidazole (Sufrexal Combi) gel for the full course of treatment. Keep using it even if you feel better in a few days.
• If you miss a dose of Metronidazole (Sufrexal Combi) gel, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Metronidazole (Sufrexal Combi) gel.

Use Miconazole (Sufrexal Combi) suppositories as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Miconazole (Sufrexal Combi) suppositories comes with an additional patient leaflet. Read it carefully and reread it each time you get Miconazole (Sufrexal Combi) suppositories refilled.
• Miconazole (Sufrexal Combi) suppositories is for vaginal use only. Do not use in the eyes or take by mouth.
• Using the applicator provided, insert 1 suppository high into the vagina at bedtime for 7 days.
• Miconazole (Sufrexal Combi) suppositories comes with one applicator to be used for all 7 days of treatment. Do not throw away applicator after use. Separate the pieces of the applicator and wash with warm, soapy water immediately after use. Rinse thoroughly. Make sure the applicator is completely dry before the next use.
• Wash your hands immediately after using Miconazole (Sufrexal Combi) suppositories.
• To clear up your infection completely, continue using Miconazole (Sufrexal Combi) suppositories for the full course of treatment.
• If you miss a dose of Miconazole (Sufrexal Combi) suppositories, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Miconazole (Sufrexal Combi) suppositories.

Use: Labeled Indications

Amebiasis: Treatment of acute intestinal amebiasis (amebic dysentery) and extraintestinal amebiasis (liver abscess)

Limitations of use: When used for amebic liver abscess, may be used concurrently with percutaneous needle aspiration when clinically indicated.

Anaerobic bacterial infections (caused by Bacteroides spp., including the B. fragilis group):

Bacterial septicemia: Treatment of bacterial septicemia (also caused by Clostridium spp.)

Bone and joint infections: Treatment (adjunctive therapy) of bone and joint infections

CNS Infections: Treatment of CNS infections, including meningitis and brain abscess

Endocarditis: Treatment of endocarditis

Gynecologic infections: Treatment of gynecologic infections including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection (also caused by Clostridium spp., Peptococcus spp., Peptostreptococcus spp., and Fusobacterium spp.)

Intra-abdominal infections: Treatment of intra-abdominal infections, including peritonitis, intra-abdominal abscess, and liver abscess (also caused by Clostridium spp., Eubacterium spp., Peptococcus spp., and Peptostreptococcus spp.)

Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, empyema, and lung abscess

Skin and skin structure infections: Treatment of skin and skin structure infections (also caused by Clostridium spp., Peptococcus spp., Peptostreptococcus spp., and Fusobacterium spp.)

Surgical prophylaxis (colorectal surgery): Injection: Preoperative, intraoperative, and postoperative prophylaxis to reduce the incidence of postoperative infection in patients undergoing elective colorectal surgery classified as contaminated or potentially contaminated

Trichomoniasis: Treatment of infections caused by Trichomonas vaginalis, including treatment of asymptomatic sexual partners

Off Label Uses

Balantidiasis

Data from a single case report of one immunocompromised patient with pulmonary infection treated with Metronidazole (Sufrexal Combi) suggest that Metronidazole (Sufrexal Combi) may be beneficial for the treatment of balantidiasis.

Miconazole (Sufrexal Combi) is used to treat skin infections such as athlete's foot, jock itch, ringworm, and other fungal skin infections (candidiasis). This medication is also used to treat a skin condition known as pityriasis (tinea versicolor), a fungal infection that causes a lightening or darkening of the skin of the neck, chest, arms, or legs. Miconazole (Sufrexal Combi) is an azole antifungal that works by preventing the growth of fungus.

How to use Miconazole (Sufrexal Combi) topical

Use this medication on the skin only. Clean and thoroughly dry the area to be treated. Apply this medication to the affected skin, usually twice a day or as directed by your doctor. If you are using the spray form, shake the bottle well before applying. Dosage and length of treatment depends on the type of infection being treated. Do not apply this more often than prescribed. Your condition will not clear faster, but side effects may be increased.

Apply enough medication to cover the affected area and some of the surrounding skin. After applying this medication, wash your hands. Do not wrap, cover or bandage the area unless directed to do so by your doctor.

Do not apply this medication in the eyes, nose, mouth, or vagina.

Use this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day.

Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after starting Miconazole (Sufrexal Combi). Stopping the medication too early may allow the fungus to continue to grow, which may result in a relapse of the infection.

Inform your doctor if your condition persists or worsens.

Hypotensive effects enhanced by diuretics and other antihypertensives.

Potentially Fatal: Increased risk of ventricular arrhythmias including torsade de pointes with antiarrhythmics or drugs that can cause hypokalaemia e.g. diuretics.

See also:
What other drugs will affect Metronidazole (Sufrexal Combi)?

Disulfiram

Psychotic reactions have been reported in alcoholic patients who are using Metronidazole (Sufrexal Combi) and disulfiram concurrently. Metronidazole (Sufrexal Combi) should not be given to patients who have taken disulfiram within the last two weeks.

Alcoholic Beverages

Abdominal cramps, nausea, vomiting, headaches, and flushing may occur if alcoholic beverages or products containing propylene glycol are consumed during or following Metronidazole (Sufrexal Combi) therapy.

Warfarin And Other

Oral Anticoagulants

Metronidazole (Sufrexal Combi) has been reported to potentiate the anticoagulant effect of warfarin and other oral coumarin anticoagulants, resulting in a prolongation of prothrombin time. When Metronidazole (Sufrexal Combi) is prescribed for patients on this type of anticoagulant therapy, prothrombin time and INR should be carefully monitored.

Lithium

In patients stabilized on relatively high doses of lithium, short-term Metronidazole (Sufrexal Combi) therapy has been associated with elevation of serum lithium and, in a few cases, signs of lithium toxicity. Serum lithium and serum creatinine levels should be obtained several days after beginning Metronidazole (Sufrexal Combi) to detect any increase that may precede clinical symptoms of lithium intoxication.

Busulfan

Metronidazole (Sufrexal Combi) has been reported to increase plasma concentrations of busulfan, which can result in an increased risk for serious busulfan toxicity. Metronidazole (Sufrexal Combi) should not be administered concomitantly with busulfan unless the benefit outweighs the risk. If no therapeutic alternatives to Metronidazole (Sufrexal Combi) are available, and concomitant administration with busulfan is medically needed, frequent monitoring of busulfan plasma concentration should be performed and the busulfan dose should be adjusted accordingly.

Drugs That Inhibit CYP450 Enzymes

The simultaneous administration of drugs that decrease microsomal liver enzyme activity, such as cimetidine, may prolong the half-life and decrease plasma clearance of Metronidazole (Sufrexal Combi).

Drugs That Induce CYP450 Enzymes

The simultaneous administration of drugs that induce microsomal liver enzymes, such as phenytoin or phenobarbital, may accelerate the elimination of Metronidazole (Sufrexal Combi), resulting in reduced plasma levels; impaired clearance of phenytoin has also been reported.

Drug/Laboratory Test Interactions

Metronidazole (Sufrexal Combi) may interfere with certain types of determinations of serum chemistry values, such as aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), lactate dehydrogenase (LDH), triglycerides, and glucose hexokinase. Values of zero may be observed. All of the assays in which interference has been reported involve enzymatic coupling of the assay to oxidation-reduction of nicotinamide adenine dinucleotide (NAD- NADH). Interference is due to the similarity in absorbance peaks of NADH (340 nm) and Metronidazole (Sufrexal Combi) (322 nm) at pH 7.

See also:
What other drugs will affect Miconazole (Sufrexal Combi)?

Interaction with other medicinal products and other forms of interaction: When using any concomitant medication, the corresponding label should be consulted for information on the route of metabolism. Miconazole (Sufrexal Combi) can inhibit the metabolism of drugs metabolized by the CYP3A4 and CYP2C9 enzyme systems. This can result in an increase and/or prolongation of their effects, including adverse effects.

Drugs which should not be used during treatment with Miconazole (Sufrexal Combi):

Oral Miconazole (Sufrexal Combi) is contraindicated with the co-administration of the following drugs that are subject to metabolism by CYP3A4 : Substrates known to prolong QT-interval eg, astemizole, bepridil, cisapride, dofetilide, halofantrine, mizolastine, pimozide, quinidine, sertindole and terfenadine; ergot alkaloids; HMG-CoA reductase inhibitors eg, simvastatin and lovastatin; triazolam and oral midazolam.

When co-administered with oral Miconazole (Sufrexal Combi), the following drugs should be used with caution because of a possible increase or prolongation of the therapeutic outcome and/or adverse effects. If necessary, their dosage should be reduced and when appropriate, plasma levels monitored: Others:

Oral hypoglycemics (CYP2C9), phenytoin (CYP2C9), carbamazepine, buspirone, alfentanil, sildenafil, alprazolam, brotizolam, midazolam IV, rifabutin, methylprednisolone, trimetrexate, ebastine and reboxetine.

Drugs subject to metabolism by CYP2C9 :

Oral anticoagulants eg, warfarin; oral hypoglycemics eg, sulfonylureas; phenytoin.

Other drugs subject to metabolism by CYP3A4: HIV protease inhibitors eg, saquinavir; certain antineoplastic agents eg, vinca alkaloids, busulfan and docetaxel; certain calcium channel blockers eg, dihydropyridines and verapamil; certain immunosuppressive agents: cyclosporine, tacrolimus, sirolimus (rapamycin); others: alfentanil, alprazolam, brotizolam, buspirone, carbamazepine, cilostasol, disopyramide, ebastin, methylprednisolone, midazolam IV, reboxetine, rifabutin, sildenafil and trimetrexate.

Sedation, fatigue, lightheadedness, dizziness, headache, dry mouth, GI disturbances, oedema, ventricular arrhythmias.

See also:
What are the possible side effects of Metronidazole (Sufrexal Combi)?

Two serious adverse reactions reported in patients treated with Metronidazole (Sufrexal Combi) (Metronidazole (Sufrexal Combi)) have been convulsive seizures and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity. Since persistent peripheral neuropathy has been reported in some patients receiving prolonged administration of Metronidazole (Sufrexal Combi), patients should be specifically warned about these reactions and should be told to stop the drug and report immediately to their physicians if any neu-rologic symptoms occur.

The most common adverse reactions reported have been referable to the gastrointestinal tract, particularly nausea reported by about 12% of patients, sometimes accompanied by headache, anorexia, and occasionally vomiting; diarrhea; epi-gastric distress; and abdominal cramping. Constipation has also been reported.

The following reactions have also been reported during treatment with Metronidazole (Sufrexal Combi) (Metronidazole (Sufrexal Combi)):

Mouth: A sharp, unpleasant metallic taste is not unusual. Furry tongue, glossitis, and sto-matitis have occurred; these may be associated with a sudden overgrowth of Candida which may occur during therapy.

Hematopoietic: Reversible neutropenia (leuko-penia); rarely, reversible thrombocytopenia.

Cardiovascular: Flattening of the T-wave may be seen in electrocardiographic tracings.

Central Nervous System: Convulsive seizures, peripheral neuropathy, dizziness, vertigo, incoordination, ataxia, confusion, irritability, depression, weakness, and insomnia.

Hypersensitivity: Urticaria, erythematous rash, flushing, nasal congestion, dryness of the mouth (or vagina or vulva), and fever.

Renal: Dysuria, cystitis, polyuria, incontinence, and a sense of pelvic pressure. Instances of darkened urine have been reported by approximately one patient in 100,000. Although the pigment which is probably responsible for this phenomenon has not been positively identified, it is almost certainly a metabolite of Metronidazole (Sufrexal Combi) and seems to have no clinical significance.

Other: Proliferation of Candida in the vagina, dyspareunia, decrease of libido, proctitis, and fleeting joint pains sometimes resembling &ldquoserum sickness.” If patients receiving Metronidazole (Sufrexal Combi) drink alcoholic beverages, they may experience abdominal distress, nausea, vomiting, flushing, or headache. A modification of the taste of alcoholic beverages has also been reported. Rare cases of pan-creatitis, which generally abated on withdrawal of the drug, have been reported.

Crohn’s disease patients are known to have an increased incidence of gastrointestinal and certain extraintestinal cancers. There have been some reports in the medical literature of breast and colon cancer in Crohn’s disease patients who have been treated with Metronidazole (Sufrexal Combi) at high doses for extended periods of time. A cause and effect relationship has not been established. Crohn’s disease is not an approved indication for Metronidazole (Sufrexal Combi).

See also:
What are the possible side effects of Miconazole (Sufrexal Combi)?

Applies to Miconazole (Sufrexal Combi): buccal mucosa tablet

In addition to its needed effects, some unwanted effects may be caused by Miconazole (Sufrexal Combi). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Miconazole (Sufrexal Combi):

Less common:

• Body aches or pain
• cough
• difficulty with breathing
• ear congestion
• fever or chills
• headache
• loss of voice
• lower back or side pain
• nasal congestion
• painful or difficult urination
• pale skin
• runny nose
• sneezing
• sore throat
• troubled breathing with exertion
• unusual bleeding or bruising
• unusual tiredness or weakness

• Black, tarry stools
• pale skin
• shortness of breath
• ulcers, sores, or white spots in the mouth

Minor Side Effects

Some of the side effects that can occur with Miconazole (Sufrexal Combi) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Change in taste
• diarrhea
• dry mouth
• headache
• itching skin
• loss of taste
• nausea
• pain, redness, and swelling of the gums
• sores on the tongue
• toothache

• Abdominal or stomach pain
• loss of appetite
• pain
• upper abdominal or stomach pain
• weakness

Each 100 mL contains Metronidazole (Sufrexal Combi) USP 500 mg, sodium chloride USP 0.72% w/v, water for injection USP as needed.

Metronidazole (Sufrexal Combi) injection, USP is a parenteral dosage form of the synthetic antibacterial agent 1-(β-hydroxyethyl)-2-methyl-5-nitroimidazole. The empirical formula is C₆H₉N₃O₃ and the molecular weight is 171.15.

Metronidazole (Sufrexal Combi) injection, USP in 100 mL is a sterile, nonpyrogenic, iso-osmotic, buffered solution of 500 mg Metronidazole (Sufrexal Combi), USP, 790 mg sodium chloride, USP, 47.6 mg dried dibasic sodium phosphate, USP and 22.9 mg anhydrous citric acid, USP. Metronidazole (Sufrexal Combi) injection, USP has an osmolarity of 310 mOsmol/L (calc) and a pH of 5.5 (4.5 to 7).

Miconazole (Sufrexal Combi) is an antifungal medication of the Imidazole class used to treat infections caused by a fungus or yeast. Miconazole (Sufrexal Combi) topical (skin) preparations are also available for ringworm, jock itch, athlete's foot, and tinea versicolor or "sun fungus". Miconazole (Sufrexal Combi) interacts with 14-± demethylase, a cytochrome P-450 enzyme that converts lanosterol to ergosterol, an essential component of the yeast membrane. In this way, tioconazole inhibits ergosterol synthesis, resulting in increased cellular permeability.