Flagystatin (Metronidazole and Nystatin) is used as a topical intravaginal ovule for the treatment of mixed vaginal infections.

Metronidazole and nystatin Uses:

• Mixed vaginal infection:
  • It is indicated for the treatment of mixed vaginal infections caused by Trichomonas vaginalis and Candida albicans.

Metronidazole and Nystatin Dose in Adults:

Flagystatin (Metronidazole and Nystatin) Dose in the treatment of mixed vaginal infection:

• Form: It comes as a vaginal tablet (ovule).
• How to Use: At bedtime, put one tablet into your vagina every day for 10 days in a row.
• If Needed: If your infection doesn't go away after the first 10 days, you can do another 10 days of treatment.

Important Note: If you're pregnant, don't use the applicator (the tool to put the tablet in) after the seventh month of pregnancy. If the infection caused by a specific parasite called Trichomonas (T. vaginalis) isn't completely gone, you might need to take metronidazole as a pill that you swallow.

Use in Children:

Not indicated.

Pregnancy Risk Category: C/ D

• Metronidazole can reach the baby in the womb, but we don't know about nystatin, though it probably doesn't since it doesn't go into the bloodstream easily.
• The company making these drugs says don't use metronidazole in the first three months of pregnancy and don't use the applicator to insert it after the seventh month.
• This medicine might make condoms or diaphragms work less well, so use different birth control while taking it.
• Always check details for each drug separately.

Use of nystatin and metronidazole during breastfeeding

• Metronidazole can get into breast milk, but we're unsure about nystatin.
• However, it's likely nystatin doesn't enter the bloodstream much.
• The company that makes these drugs suggests that breastfeeding women shouldn't use them.
• Always check details for each drug on its own.

Metronidazole and Nystatin Dose in Kidney Disease:

• The company that makes the drug doesn't give specific instructions on adjusting the dosage for people with kidney problems.

Metronidazole and Nystatin Dose in Liver disease:

• The company that makes the drug doesn't give clear instructions about changing the dosage for people with liver problems.
• But, they do suggest a smaller dose for those with serious liver issues.

Side effects of Flagystatin (Metronidazole and Nystatin):

• Central nervous system:
  • Bitter taste
  • Fatigue
  • Headache
• Dermatologic:
  • Pruritus
  • Skin rash (located around the knee)
  • Urticaria
• Gastrointestinal:
  • Coated tongue
  • Nausea
  • Vomiting
• Genitourinary:
  • Vaginal discomfort (granular sensation)
  • Vulvovaginal burning
• Neuromuscular & skeletal:
  • Arthralgia (including ankles, wrists)
  • Joint swelling (including ankles, wrists)

Contraindication to Flagystatin (Metronidazole and Nystatin):

• Don't use this medicine if you're allergic to metronidazole, nystatin, imidazoles, or any part of the drug.
• If you have active brain problems, a history of blood disorders, or issues with your thyroid or adrenal glands, you shouldn't mix this with oral metronidazole.
• For more details on metronidazole, check its main information guide.

Caution and Alert

Carcinogenic:

• Metronidazole might cause cancer based on tests done on animals.

CNS effects

• Metronidazole can affect the nervous system, possibly causing nerve problems.
• If someone taking it starts to feel unsteady or shows other brain-related symptoms, they should be watched closely.
• It might be best to stop the medication.
• Be extra careful using it in people with brain diseases.

Hematologic effects

• While long-term blood issues haven't been seen in studies, it's still important to check white blood cell counts before and after using metronidazole, especially if a person needs a second round of the medication.

Hypersensitivity

• Allergic reactions to the medicine can happen.
• Serious skin reactions like AGEP, SJS, and TEN have been reported.
• There might also be local irritation or sensitivity where the medicine is applied.
• If someone shows signs of an allergy or irritation, stop the medicine and treat the reaction properly.

Superinfection

• Using this medicine for a long time can lead to other infections, including dangerous diarrhea from C.
• difficile or an inflamed colon.
• These problems can even appear more than 2 months after stopping the antibiotic.
• If the infection doesn't get better after 20 days (two rounds of 10-day treatments), doctors should test to find out what's causing it.

Systemic effects

• Even if metronidazole is given in the vagina, some of it might enter the body's system.
• This means side effects usually seen when taking metronidazole by mouth or injection might also happen with vaginal use.

Urine discoloration:

• Patients should know that this medicine might make their urine a darker color.

Cockayne syndrome:

• Be very careful when using metronidazole in patients with Cockayne syndrome.
• These patients can experience serious liver damage, which can happen quickly after starting the medicine, and can even be deadly.
• If a patient shows signs of liver problems, stop the medicine immediately.

Hepatic impairment

• For people with serious liver problems, be cautious when using this medicine as it might build up in their system.
• It's advised to adjust the dose for them.
• Also, be careful in patients with brain issues related to liver problems and those who had liver issues from metronidazole in the past.

Metronidazole and Nystatin (United States: Not available): Drug Interaction

Monitoring Parameters:

None mentioned. Monitor the response to treatment.

How to administer Flagystatin (Metronidazole and Nystatin)?

Using the Medicine in the Vagina

• For Vaginal Use Only: This medicine is meant to be used inside the vagina.
• How to Use the Applicator:
  • Use only the applicator given with the medicine.
  • Pull the applicator's plunger back about an inch.
  • Put a tablet into the cup at the end of the tube.
  • Fill the applicator with one tablet.
• How to Insert:
  • Lie down on your back, bending your knees.
  • Gently push the applicator into the vagina as far as you can without it hurting.
  • Once it's in the right place, push the plunger.
  • Pull out the applicator.
• After Using:
  • Clean the applicator with warm water.
• Note: Don't use other products in the vagina, like tampons or douches, while you're on this treatment.

Mechanism of action of Flagystatin (Metronidazole and Nystatin):

See individual agents (Nystatin and Metronidazole)

International Brand Names of Metronidazole and nystatin:

• Flagystatin
• Amrizole N
• Bio-Vagin
• Colpatrin
• Etron nistatina
• Farm-X Duo
• Fladystin
• Flagyl Comp
• Flagyl Nistatina
• Flagystatin
• Flagystatin V
• Flagystatine
• Linfol
• Metanis
• Metrocaps N
• Metrozin Nistatina
• Neo Gynoxa
• Nistatina Metronidazol L.C.H.
• Nystazole
• Provagin
• Tratomax
• Vagistin
• Vanestrin
• Vaxi

Metronidazole and Nystatin Brand Names in Pakistan:

Update soon.