TINIDAZOLE
(tin'i-da-zole)
Tindamax
Classifications: antiinfective; azole antibiotic; antiprotozoal; amebicide
Prototype: Metronidazole
Pregnancy Category: First trimester D, second and third trimesters C
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250 mg, 500 mg tablets
Made from cell extracts of Trichomonas. The free radicals generated as a result of this process may be responsible for its antiprotozoal activity; however, the
mechanism of action is unknown.
Demonstrates activity against infections caused by the following protozoa: Trichomonas vaginalis, Giardia duodenalis (also termed G. lamblia), and Entamoeba histolytica.
Treatment of trichomoniasis, giardiasis, amebiasis, and amebic liver abscess.
First trimester of pregnancy (category D), second and third trimesters pregnancy (category C); known hypersensitivity to tinidazole
or other azole antibiotics (e.g., metronidazole); lactation within 72 h of tinidazole use; children <3 y.
CNS diseases, liver dysfunction, alcoholism, ethanol intoxication; hematologic disease; neurologic disease; bone marrow depression;
dialysis; candidiasis.
Giardiasis
Adult: PO 2 g as single dose with food
Child: PO  3 y 50 mg/kg (up to 2 g) as single dose with food
Intestinal Amebiasis
Adult: PO 2 g once daily for 3 d
Child: PO 3 y 50 mg/kg/d (up to 2 g/d) once daily for 3 d
Amebic Liver Abscess
Adult: PO 2 g once daily for 3–5 d
Child: PO 3 y 50 mg/kg/d (up to 2 g/d) once daily for 3–5 d
Trichomoniasis
Adult: PO 2 g as single dose
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Oral
- Give with food to minimize GI distress; may be crushed in artificial cherry syrup if tablets cannot be swallowed whole.
- If given on a dialysis day, add a 50% dose of tinidazole at the end of hemodialysis.
- Separate the dosing of cholestyramine and tinidazole by 2–4 h when used concurrently.
- Do not give within 2 wk of the last dose of disulfiram.
- Store at 15°–30° C (59°–86° F). Protect from light.
Body as a Whole: Weakness, fatigue, malaise. CNS
: Dizziness, headache. GI
: Metallic/bitter taste, nausea, anorexia, dyspepsia, cramps, epigastric discomfort, vomiting, constipation.
Drug
: May increase INR with warfarin; alcohol may cause abdominal cramps, nausea, vomiting, headache, flushing; psychotic reactions with disulfiram
; may increase the half-life of fosphenytoin, phenytoin
; may increase levels and toxicity of lithium, fluorouracil, cyclosporine, tacrolimus; cholestyramine may decrease absorption of tinidazole.
Peak
: 2 h. Distribution
: Crosses blood–brain barrier, placenta and is excreted in breast milk. Metabolism
: Metabolized in the liver by CYP3A4. Elimination
: Primarily excreted in urine. Half-Life: 12–14 h.
Assessment & Drug Effects
- Withhold drug and notify physician for S&S of CNS dysfunction (e.g., seizures, numbness or paresthesia of extremities). Drug
should be discontinued if abnormal neurologic signs appear.
- Lab tests: baseline LTFs; CBC with differential, if retreatment is required.
- Monitor INR/PT frequently with concomitant oral anticoagulants. Continue monitoring for at least 8 d after discontinuation
of tinidazole.
- Monitor serum lithium levels with concurrent use.
- Monitor for phenytoin toxicity with concurrent IV phenytoin.
Patient & Family Education
- Stop taking the drug and report promptly: convulsions, numbness, tingling, pain, or weakness in the hands or feet; dizziness
or unsteadiness; fever.
- Harmless urine discoloration may occur while taking this drug.
- Do not breast feed while taking this drug. Wait at least 3 d after the last dose to resume breast-feeding.
Canadian drug name; 
Prototype drug