tinidazole
Regulatory sources consulted
Approved indications
- Trichomoniasis, giardiasis, amebiasis, and bacterial vaginosis in nonpregnant adult women.
Contraindications
Absolute
- Hypersensitivity to tinidazole or nitroimidazoles; Cockayne syndrome.
Clinical warnings
- There is a potential carcinogenicity risk observed with drugs in this class; limit tinidazole to approved indications and avoid chronic use. — DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- Major warning · It may cause seizures, peripheral neuropathy, and cytopenias; discontinue with neurologic symptoms and avoid chronic treatment. — DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
Drug interactions
- ModerateAlcohol or propylene glycol
Mechanism: It may cause a disulfiram-like reaction.
Recommendation: Avoid during treatment and for 3 days afterward.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- ModerateDisulfiram
Mechanism: It increases the risk of psychotic reactions.
Recommendation: Do not use if disulfiram was taken in the previous 2 weeks.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- HighWarfarin
Mechanism: It potentiates anticoagulant effect.
Recommendation: Adjust and monitor INR during treatment and for up to 8 days afterward.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- HighLithium, cyclosporine, or tacrolimus
Mechanism: Tinidazole may increase their concentrations and toxicity.
Recommendation: Monitor concentrations, renal function, and toxicity; adjust if needed.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- High5-fluorouracil
Mechanism: It may reduce clearance and increase toxicity.
Recommendation: Monitor toxicity and adjust cancer therapy with the responsible team.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- HighPhenytoin or fosphenytoin
Mechanism: The interaction may alter concentrations of both therapies.
Recommendation: Monitor concentrations and clinical response and adjust if needed.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
- HighCYP3A4 inducers or inhibitors
Mechanism: Inducers may reduce exposure and inhibitors may increase it.
Recommendation: Monitor for loss of efficacy or toxicity and adjust or use an alternative if needed.
DailyMed, set_id 6f3ce597-64c1-4204-a67a-8b6f6e7e8bca
Adverse events
Common (≥1%)
Nausea, metallic taste, abdominal pain, and headache
Rare but serious
Seizures, peripheral neuropathy, and severe cytopenias
Pregnancy and lactation
During pregnancy, use only if benefit outweighs risk; the local label does not establish a specific first-trimester prohibition. Stop breastfeeding during treatment and for 72 hours after the last dose.
Recent literature (PubMed)
Vaginitis is a general term for inflammation of the vagina with symptoms such as vulvovaginal itching, burning, irritation, dyspareunia, odor, or abnormal vaginal discharge. It is a common condition that results in 5 million to 10 million office visits annually. The leading infectious causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Noninfectious causes include atrophic, irritant, and inflammatory vaginitis. Bacterial vaginosis usually presents with a thin, homogenous vaginal discharge and a fishy odor. Vulvovaginal candidiasis often manifests with a white, thick, curd-like discharge, pruritus, and vulvar erythema. Trichomoniasis usually presents with a green or yellow frothy discharge, and speculum examination may reveal cervical erythema with petechiae. Noninfectious vaginitis can present with clear or purulent discharge and can be pruritic depending on the etiology. Bacterial vaginosis can be diagnosed using Amsel criteria, Gram stain, or a nucleic acid amplification test (NAAT). Vulvovaginal candidiasis can be diagnosed by visualization of yeast hyphae or budding yeast on microscopy, vaginal fungal culture, polymerase chain reaction testing, or NAAT. Trichomoniasis can be diagnosed with visualization of motile, flagellated protozoa on saline microscopy, NAAT, or DNA probe test. Bacterial vaginosis is treated with oral or intravaginal metronidazole or intravaginal clindamycin. Vulvovaginal candidiasis is managed with topical or oral antifungals. Trichomoniasis is treated with oral metronidazole or tinidazole. When treating trichomoniasis, testing for reinfection, as well as other sexually transmitted infections, is recommended. Treatments for noninfectious vaginitis include vaginal lubricants and moisturizers, topical hormones, and topical steroids, depending on the cause.
Amoebiasis, caused by Entamoeba histolytica, remains a major public health issue, particularly in developing countries with poor sanitation. It is also a significant challenge among those who travel to endemic areas, causing, in many cases, so-called traveler diarrhea. Approximately 10 percent of the global population is estimated to be affected by this parasitic infection. The primary route of transmission is the consumption of food or water contaminated with E. histolytica cysts. While most infected individuals may remain asymptomatic, some develop severe complications, including hemorrhagic colitis, liver abscesses, and, in extreme cases, colonic perforation. It has been estimated that amoebiasis is responsible for nearly 100,000 deaths annually. Standard treatment for amoebic colitis involves a combination of luminal agents (such as paromomycin, diloxanide furoate, and diiodohydroxyquin) and tissue amoebicides (including metronidazole and tinidazole). Although these treatments are effective, new therapeutic options to improve patient outcomes are needed. One promising avenue for drug discovery is the β-carbonic anhydrase enzyme (EhiCA) of E. histolytica, which has emerged as a potential target for novel antiamoebic therapies. EhiCA was recently produced as a recombinant protein and has been used in kinetic and inhibition studies with various sulfonamides and anions, with promising results.
The spontaneous cure rate of chronic endometritis is very low, and doxycycline alone or a combination of levofloxacin and tinidazole are the 2 most widely used antibiotic regimens for treating chronic endometritis. However, there is currently no consensus regarding the optimal antibiotic regimen. This study aimed to assess the effectiveness and safety of doxycycline alone and levofloxacin combined with tinidazole as antibiotic therapies for chronic endometritis. In this parallel randomized controlled trial comparing 2 antibiotic therapies for chronic endometritis, 172 patients with chronic endometritis diagnosed using CD138 were randomly divided into treatment and control groups. Levofloxacin combined with tinidazole was administered to the treatment group, whereas doxycycline alone was administered to the control group. Repeated hysteroscopy and endometrial biopsies were performed during the first menstrual proliferative period after antibiotic therapy to evaluate the resolution of chronic endometritis. The one-course cure rate for chronic endometritis, based on the conversion of CD138 expression from positive to negative, and the incidence of adverse reactions were compared between the groups. A total of 160 patients were enrolled, with 79 in the treatment group and 81 in the control group. After one course of antibiotic therapy, there was no difference in the chronic endometritis cure rate between the groups (84.8% vs 77.8%) (P=.255). In the subgroup analysis based on chronic endometritis severity, there were no differences between the groups regardless of whether chronic endometritis was mild (88.9% vs 83.7%) (P=.464) or severe (79.4% vs 68.8%) (P=.322). In the intent-to-treat analysis (n=172), the cure rates were 77.9% (67/86) and 73.3% (63/86) in the treatment and control groups, respectively, showing no difference between the groups (P=.595). The incidence of adverse reactions was significantly higher in the treatment group (11.6% vs 2.3%, P=.032) in the safe
Trichomoniasis is the most common sexually transmitted infection. It is caused by the parasite Trichomonas vaginalis. Nitroimidazoles, particularly metronidazole and tinidazole, have been the main treatment options for decades. They still remain the standard treatment, and resistance to them is relatively rare. However, cases of resistance do occur, and the side effects can be significant. This highlights the urgent need for new drugs with different mechanisms of action. Promisingly, several innovative leads have emerged. Interesting drug targets in T. vaginalis include two β-carbonic anhydrases, which have been recently described. These enzymes have been characterized in terms of their structural and kinetic properties, and potential inhibitors have been identified. This new knowledge on β-carbonic anhydrases offers hope for the development of novel antitrichomonal agents to effectively combat this parasitic disease in the future.