Flamyd V

Indications

Flamyd V is prescribed for the following medical conditions:

• Prevention of Post-operative Infections: Effective against anaerobic bacteria, particularly Bacteroides species and anaerobic streptococci.
• Treatment of Severe Infections: Used for managing septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis, and post-operative wound infections caused by anaerobic organisms.

Always consult a registered healthcare professional before using this medication.

Pharmacology

Flamyd V contains Metronidazole, an antibiotic belonging to the imidazole class and therapeutically categorized as an antiprotozoal agent. The drug’s 5-nitro group is metabolically reduced by anaerobic bacteria. Research indicates that this reduced form interacts with bacterial DNA, resulting in its bactericidal effect.

Dosage & Administration

Tablet and Suspension Dosage:

• Trichomoniasis:
  • Adults & Children over 10 years: 200 mg three times daily (tid) or 400 mg twice daily (bid) for 7 days; 800 mg in the morning and 1-2 g at night for 2 days; or a single dose of 2 g.
  • Children:
    • Ages 7-10 years: 100 mg tid.
    • Ages 3-7 years: 100 mg bid.
    • Ages 1-3 years: 50 mg tid.
• Intestinal Amoebiasis:
  • Adults & Children over 10 years: 800 mg tid for 5 days.
  • Children:
    • Ages 7-10 years: 400 mg tid.
    • Ages 3-7 years: 200 mg four times daily (qid).
    • Ages 1-3 years: 200 mg tid.
• Giardiasis:
  • Adults & Children over 10 years: 2 g once daily for 3 days.
  • Children:
    • Ages 7-10 years: 1 g once daily.
    • Ages 3-7 years: 600-800 mg once daily.
    • Ages 1-3 years: 500 mg once daily.
• Anaerobic Infections:
  • Adults & Children over 10 years: 800 mg initially, then 400 mg tid for 7 days.
  • Children (1-10 years): 7.5 mg/kg tid.
• Surgical Prophylaxis:
  • Adults & Children over 10 years: 400 mg tid, starting 24 hours before surgery for 1 day.
  • Children (1-10 years): 7.5 mg/kg tid.

Vaginal Gel Dosage: Administer one full applicator of Metronidazole gel (approx. 5 grams containing 37.5 mg of Metronidazole) intravaginally once or twice daily for 5 days. For once-daily dosing, apply at bedtime.

Suppository Dosage:

• Anaerobic Infections:
  • Adults: 1 g every 8 hours for 3 days, then every 12 hours.
  • Children (5-10 years): 500 mg every 8 hours for 3 days, then every 12 hours; over 10 years use adult dosage.
• Surgical Prophylaxis:
  • Adults: 1 g 2 hours before surgery; up to 3 additional doses of 1 g may be given every 8 hours for high-risk procedures.
  • Children (5-10 years): 500 mg 2 hours before surgery; up to 3 additional doses may be given.

IV Infusion: Metronidazole IV infusion requires no dilution and should not be mixed with other drugs before administration.

• Adults and Children over 12 years: Infuse 500 mg every 8 hours at a rate of 5 ml/minute; maximum dosage of 4 g in 24 hours. Treatment for 7 days is generally sufficient, but may be extended for patients at risk of reinfection.
• Children under 12 years: 7.5 mg/kg body weight per day every 8 hours at a rate of 5 ml/minute.

Always consult a registered healthcare professional before using this medication.

Drug Interactions

• Disulfiram: Concurrent use can lead to psychotic reactions.
• Alcohol: Avoid alcoholic beverages during treatment and for at least one day afterward due to possible disulfiram-like reactions (flushing, vomiting, tachycardia).
• Oral Anticoagulants (e.g., Warfarin): May enhance anticoagulant effects, necessitating more frequent monitoring of prothrombin time.
• Lithium: May increase plasma levels of lithium.
• Cyclosporin: Monitor serum cyclosporin and creatinine levels closely.
• Phenytoin/Phenobarbital: May reduce plasma levels of Flamyd V.
• 5-Fluorouracil: Can increase toxicity due to reduced clearance.
• Busulfan: May increase plasma levels, leading to toxicity.

Contraindications

Metronidazole is contraindicated in individuals with a known hypersensitivity to Metronidazole or other Nitroimidazole derivatives.

Side Effects

Common side effects may include metallic taste, nausea, vomiting, diarrhea, drowsiness, and skin rashes.

Pregnancy & Lactation

Metronidazole is classified as FDA Pregnancy Category B. Adequate studies in pregnant women are lacking. It should only be used during pregnancy if clearly needed. Metronidazole is excreted in human milk; exercise caution when administering to nursing mothers.

Precautions & Warnings

• If Flamyd V must be administered beyond the recommended duration, regular hematological tests (especially leukocyte counts) should be conducted, monitoring for adverse reactions such as peripheral or central neuropathy (e.g., paresthesia, ataxia, dizziness, convulsive seizures).
• Administer with caution in patients with hepatic encephalopathy.
• Patients should be informed that Flamyd V may cause urine to darken.

Use in Special Populations

• Hepatic Impairment: Metronidazole is primarily metabolized through the liver. Significant impairment can lead to accumulation; dosage should be reduced to one-third and administered once daily.
• Renal Impairment: The elimination half-life remains unchanged in renal failure; no dosage adjustment is necessary. Patients on hemodialysis may require re-administration post-dialysis.

Overdose Effects

Single oral doses of up to 12 g have been reported in cases of suicide attempts or accidental overdoses, with symptoms primarily including vomiting, ataxia, and slight disorientation. There is no specific antidote; supportive treatment is recommended.

Therapeutic Class

Amoebicides, Anti-diarrheal Antiprotozoal.

Storage Conditions

Store below 30°C, protected from light. Keep out of reach of children. Do not use past the expiry date.