How Long Do My Meds Last? A Look at Metronidazole

Metronidazole is in a class of medications called nitroimidazole antimicrobials. It was initially developed at Rhone-Poulenc labs in France in 1959 to treat Trichomonas vaginalis, a parasitic infection. In 1962, it was discovered to be effective against both Trichomonas vaginalis  and bacterial gingivitis (bacteria). By the 1970s metronidazole was used for treatment of infections caused by gram-negative anaerobes such as bacteroides or gram-positive anaerobes such as clostridia. It is now widely used as a prophylaxis following bowel surgery to prevent infection. Metronidazole does not treat viruses or yeast infections- only bacterial and parasitic infections.

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How long does Metronidazole remain potent?

When stored in a cool, dry, and dark area away from sunlight and capped, metronidazole can retain much of its potency well past expiration date. Exposure to UV light seems to degrade metronidazole more than extreme heat or cold.

Expiration dates reflect the time during which the product is expected to remain stable, or retain its identity, strength, quality, and purity, when it is properly stored according to its labeled storage conditions. Metronidazole can be used up to a year  past expiration date; however potency is affected. Contact your care provider before starting metronidazole if using past expiration date for further guidance. Metronidazole does not become toxic, just less potent.

Metronidazole is listed in the World Health Organization Model List of Essential Medications for the newly released 2023 edition:

FIRST CHOICE (From WHO 2023 list)

  • Difficile infection
  • Complicated intraabdominal infections (mild to moderate)
  • Complicated intrabdominal infections (severe)
  • Necrotizing fasciitis
  • Surgical prophylaxis
  • Trichomoniasis

SECOND CHOICE (From WHO 2023 list)

  • Complicated intraabdominal infections (mild to moderate)

Other uses include

  • Bacterial vaginosis
  • Tetanus infection if no other better options are present.

How to take

Take metronidazole with food to avoid stomach upset. DO NOT consume alcohol or products containing propylene glycol  for 3 days after last metronidazole dose.  Do NOT take if you have taken disulfiram (Antabuse) within past 2 weeks.

Side Effects

Mild side effects include (can mostly be alleviated by taking with food)

  • Vomiting nausea, diarrhea
  • Stomach cramps
  • Constipation
  • Loss of appetite
  • Headache
  • Metallic taste in mouth
  • Mouth or tongue irritation

Discontinue and contact your primary care provider if you experience the following

  • Numbness, pain, burning, or tingling in your hands or feet
  • Seizures
  • Hives, peeling or blistering of skin
  • Problems with coordination,
  • Difficulty speaking, confusion, or agitation
  • Signs of infection such as sore throat, fever, or stuffy nose
  • Tarry stools

Consult with your care provider before taking if you are taking any of the following:

  • Let your care provider know if you are taking any of the following: anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven), busulfan (Busulfex, Myleran), cimetidine (Tagamet HB), lithium (Lithobid), phenobarbital, and phenytoin (Dilantin, Phenytek)

Make your care provider aware if you currently have (or history of)

  • Pregnant or breastfeeding. Metronidazole has a pregnancy category B rating -Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. A substantial amount of metronidazole does pass into breast milk and can be passed to infant. There is some evidence that metronidazole can cause diarrhea and thrush in breastfed infants,, but studies are inconclusive. If metronidazole must be given, avoid breastfeeding foe 12-24 hours after dose.
  • Allergy to metronidazole, secnidazole (Solosec), tinidazole (Tindamax), any other medications, or any of the ingredients in metronidazole preparations.
  • Have history of Crohn’s disease, or blood, kidney, or liver disease.

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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How do Antibiotics Work? Part 4

The best way to take antibiotics is to never need them. But that isn’t always an option. However, there are some steps you can take to strengthen your immune system so that you and your loved ones can fight off illness. The recent outbreak of deaths from group A strep– which is usually treated with Amoxicillin, is currently in short supply. This highlights the fragility of our nations drug supply. Check this site for current drug shortages- if a medication you are taking is on the list contact your care provider to get your medications refilled, and if available ask for a years supply of your meds.

8 tips to strengthen your immune system

  1. Get good quality sleep

According to the Sleep foundation good quality sleep enhances both the innate and adaptive immune system responses. Non rapid eye movement, known as NREM is deep sleep slows the body’s processes allowing more energy to be directed at healing. Sleep is such an important topic that it really needs its own post.

  1. Cut back on sugar

Professor of immunobiology at Yale, Ruslan Medzhitov performed experiments on mice- after infecting the mice with the bacteria Listeria monocytogenes he fed one group fat and proteins. They lived. The group he fed simple carbohydrates died.  Conversely, when the mice were infected with an influenzas virus and fed fats and proteins, they were more likely to die compared to the mice fed simple carbohydrates. In other words, balance is the key. If unsure if you have a viral or bacterial infection it is best to just cut out excess sugar.

  1. Increase fresh fruits and vegetables

Up to 80% of our immune system is housed in lymphoid tissue in your intestines, It is called gut associated lymph tissue (GALT) By eating fiber rich foods the beneficial bacteria help the immune system do its job. In addition, a study found that eating a diverse diet high in fiber rich foods can help combat antibiotic resistance. There needs to be more research in this area of study, however initial results are promising.

In addition, several varieties of mushrooms are known to improve immune system function and are being studied for their cancer fighting properties.

  1. Drink plenty of water

Water helps flush toxins out of the body, both through elimination and mucus membranes.

The bloodstream is comprised mostly of water. To help the body fight infection keeping hydrated helps the white blood cells do their job- fight infections.

  1. Avoid alcohol and smoking

Both can decrease immunity

  1. Keep your vitamin D levels up

Vitamin D is well known to help fight infections. Be sure that when you take vitamin D (which is really not a vitamin, it is a steroid hormone) be sure to add vitamin K2, also known as MK 7, This is important, because this helps avoid calcium buildup in your arteries.

  1. Reduce and manage stress

Stress raises our cortisol levels which in turn suppresses the immune response to pathogenic invaders.

  1. Exercise to boost immunity

Research shows that 20–40 minutes of moderate-intensity exercise per day is adequate to provide a positive boost to the immune system. Exercise helps circulate the infection fighting cells in the body.

If you still need an antibiotic Jase has you covered

The 5 antibiotics in the Jase case can cover a wide range of bacterial illnesses. If in doubt contact Jase provider for guidance, part of the outstanding service Jase offers is unlimited follow up for questions about antibiotic use.

 Let’s take a look at some of the infections Jase antibiotics cover:

  • Amoxicillin-clavulanate 875 mg tablets (28 tablets)

When amoxicillin is not available due to current shortages this antibiotic can be substituted. Other uses include group A strep, sinusitis, pneumonia, ear infections, bronchitis, urinary tract infections, and infections of the skin

  • Azithromycin 250 mg tablets (6 tablets)

Bacterial pneumonia, ear and sinus infections, skin infections, Travelers diarrhea, urinary tract infection

  • Ciprofloxacin 500 mg tablets (28 tablets)

Bioterrorism infections from anthrax, Tularemia or plague exposure

Travelers diarrhea

  • Doxycycline 100 mg capsules (120 capsules)

Bioterrorism infections from anthrax, Tularemia, or plague exposure

Skin infection, tetanus, bites (animal or human)

  • Metronidazole 500 mg tablets (30 tablets)

bacterial vaginosis, diarrhea (caused by giardia and clostridioides difficile), giardiasis, tetanus, and trichomoniasis


- Brooke Lounsbury

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

Join Our Newsletter

Our mission is to help you be more medically prepared. Join our newsletter and follow us on social media for health and safety tips each week!

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