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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Tinidazole

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-19-2010

Zambia Specific Information

  • Available formulation in Zambia: Tablets, film coated: 500mg
  • More expensive alternative to metronidazole for treatment of trichomoniasis, giardiasis, intestinal and liver amoebiasis.
  • Should be taken with food.
  • Trichomoniasis: tinidazole 2000 mg x1 or tinidazole 500 mg bid x 5 days (metronidazole preferred).

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Trichomoniasis
  • Giardiasis (including ages > 3yrs)
  • Intestinal and amebic liver abscess caused by E. histolytica (including ages > 3 yrs)
  • Bacterial vaginosis
NON-FDA APPROVED USES

  • C. difficile colitis

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
TindamaxTinidazolePresuttiPO
tab
250mg
$4.12
      PO
tab
500mg
$8.24

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • Adult dosing
  • Trichomoniasis: 2gm PO x 1 with food.
  • Giardiasis: 2gm PO x 1 with food.
  • Intestinal amebiasis: 2gm PO once daily with food x 3 days.
  • Liver amebiasis: 2gm PO once daily with food x 3-5 days.
  • Bacterial vaginosis: 1gm PO once-daily x 5 days or 2gm PO once-daily x 2 days.
  • Pediatric dosing: giardiasis and amebiasis for children >3yrs: 50mg/kg with food as a single dose.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Standard dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Standard dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Standard dose.

DOSING IN HEMODIALYSIS

43% removed with HD, supplement with 50% (1gm) post-HD.

DOSING IN PERITONEAL DIALYSIS

No data. Usual dose likely.

DOSING IN HEMOFILTRATION

No data. Usual dose likely.

ADVERSE DRUG REACTIONS

GENERAL

  • Generally well tolerated with occasional GI intolerance, but lower compared to metronidazole in clinical trials
OCCASIONAL

  • GI: nausea(9%), vomiting(3%), metallic/bitter taste (10%), anorexia (4.5%)
  • Candidiasis
RARE

  • Seizure
  • Peripheral neuropathy
  • Leukopenia and neutropenia

DRUG INTERACTIONS

Drug-to-Drug Interactions

Drug-to-Drug Interaction

DrugEffect of InteractionRecommendations/Comments
Alcohol and propylene glycol Potential for disulfiram reaction. Avoid co-administration.
Cholestyramine May decrease the absorption of tinidazole. Avoid co-administration or administer tinidazole 2 hours before cholestyramine.
Cyclosporine Tinidazole may increase serum level of cyclosporine (based on case reports). Monitor cyclosporine serum concentration closely.
CYP3A4 Inducers( e.g., rifampin, nevirapine, efavirenz, phenytoin, phenobarbital, carbamezapine..) May decrease tinidazole serum concentrations. Monitor for tinidazole therapeutic efficacy.
CYP3A4 Inhibitors (e.g., macrolides, azole anti-fungals, HIV-protease inhibitors...) May increase tinidazole serum concentrations. Usual dose likely with single dose administration.
Fluorouracil Tinidazole may increase serum level and toxicity of fluorouracil. Monitor for fluorouracil toxicity with co-administration.
Fosphenytoin Tinidazole may prolong the t½ of fosphenytoin. Fosphenytoin may decrease tinidazole serum concentrations. Monitor phenytoin serum concentrations and therapeutic effect of tinidazole.
Lithium Tinidazole may increase lithium serum level. Monitor lithium serum concentration and sign/symptoms of toxicity.
Tacrolimus Tinidazole may increase serum level of tacrolimus (based on case reports). Monitor tacrolimus closely with co-administration
Warfarin Tinidazole may enhance the anticoagulant effect of warfarin. Monitor INR closely with co-administration.

SPECTRUM

Trichomonas vaginalis, Giardia duodenalis (G. lamblia). Entamoeba histolytica, C. difficile, Anaerobes including  and clostridium.

Not FDA approved for C. difficile or anaerobes but has in vitro activity (Scand J Infect Dis Suppl 1981; 26: 42-5. AAC 1987; 31 (2): 183-6).

PHARMACOLOGY

Pharmacology

COMMENTS

Tinidazole can be used as an alternative to metronidazole, but is more expensive. It may be preferred for the treatment of intestinal amoebiasis and giardiasis due to better GI tolerance and superior efficacy.

REFERENCES

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