These Highlights Do Not Include All The Information Needed To Use Metronidazole Gel, 1% Safely And Effectively. See Full Prescribing Information For Metronidazole Gel, 1%

These Highlights Do Not Include All The Information Needed To Use Metronidazole Gel, 1% Safely And Effectively. See Full Prescribing Information For Metronidazole Gel, 1%
SPL v2
SPL
SPL Set ID 3c25a3f9-52fc-448e-a044-f63b9dadcd4a
Route
TOPICAL
Published
Effective Date 2024-10-31
Document Type 34391-3 HUMAN PRESCRIPTION DRUG LABEL

Drug Facts

Composition & Product

Active Ingredients
Metronidazole (10 mg)
Inactive Ingredients
Betadex Edetate Disodium Methylparaben Niacinamide Phenoxyethanol Propylene Glycol Propylparaben Water

Identifiers & Packaging

Marketing Status
NDA AUTHORIZED GENERIC Active Since 2023-11-10

Description

Metronidazole Gel, 1% is indicated for the topical treatment of inflammatory lesions of rosacea. 

Warnings and Precautions

Neurologic Disease: Peripheral neuropathy, characterized by numbness or paresthesia of an extremity has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediately reevaluate Metronidazole Gel if abnormal neurologic signs appear. ( 5.1 )  Blood Dyscrasias: Metronidazole Gel is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia. ( 5.2 )  Contact Dermatitis: If dermatitis occurs, patients may need to discontinue use. ( 5.3 )  Eye Irritation: Topical metronidazole has been reported to cause tearing of the eyes. Avoid contact with the eyes. ( 5.4 )

Contraindications

Metronidazole Gel is contraindicated in patients with a history of hypersensitivity to metronidazole or to any other ingredient in the formulation.

Adverse Reactions

The following clinically significant adverse reactions are described elsewhere in the labeling: Neurologic Disease [see Warnings and Precautions (5.1)] Contact Dermatitis [see Warnings and Precautions (5.3)]   Eye Irritation [see Warnings and Precautions (5.4)]

Drug Interactions

Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when prescribing for patients who are receiving anticoagulant treatment.

Storage and Handling

How Supplied Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows: 55 gram pump – NDC 68308-663-55 60 gram tube – NDC 68308-663-60 Storage and Handling Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

How Supplied

How Supplied Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows: 55 gram pump – NDC 68308-663-55 60 gram tube – NDC 68308-663-60 Storage and Handling Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

Patient Information

Metronidazole Gel Important: Metronidazole Gel  is for use on the skin only (topical use). Do not use Metronidazole Gel in your mouth, eyes, or vagina. What is Metronidazole Gel ? Metronidazole Gel is a prescription medicine used on the skin (topical) to treat pimples and bumps (inflammatory lesions) caused by a condition called rosacea. It is not known if Metronidazole Gel   is safe and effective in children. Do not use Metronidazole Gel  if you are allergic to metronidazole or any of the ingredients in Metronidazole Gel. See the end of this leaflet for a complete list of ingredients in Metronidazole Gel. Before using Metronidazole Gel , tell your healthcare provider about all your medical conditions, including if you: have tingling or numbness in your hands or feet have or have had a blood disorder or disease are pregnant or plan to become pregnant. It is not known if Metronidazole Gel will harm your unborn baby. are breastfeeding or plan to breastfeed. It is not known if Metronidazole Gel passes into your breast milk. Do not breastfeed during treatment with Metronidazole Gel. Talk to your healthcare provider about the best way to feed your baby during treatment with Metronidazole Gel. Tell your healthcare provider about all of the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. How should I use Metronidazole Gel ? Use Metronidazole Gel exactly as your healthcare provider tells you to. Cleanse the treated area before applying Metronidazole Gel. Apply and rub in a thin film of Metronidazole Gel 1 time a day to the affected area(s). You can apply cosmetics after applying Metronidazole Gel .  Avoid contact of Metronidazole Gel with your eyes. What are the possible side effects of Metronidazole Gel ? Metronidazole Gel  may cause serious side effects, including: Peripheral neuropathy. Tingling, burning, pain or numbness in the hands or feet (peripheral neuropathy) have happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tingling, burning, pain or numbness in your hands or feet during treatment with Metronidazole Gel. Skin reactions, including allergic reactions. Tell your healthcare provider if you develop any skin reactions, including rash, itching, redness, swelling, or blisters during treatment with Metronidazole Gel.  Eye irritation. Tearing from eye irritation has happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tearing, redness or discomfort of the eyes during treatment with Metronidazole Gel. The most common side effects of Metronidazole Gel include: sore throat and nasal congestion upper respiratory tract infections headache Tell your healthcare provider if you get any side effects during treatment with Metronidazole Gel. These are not all of the possible side effects of Metronidazole Gel. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Mayne Pharma at 1-844-825-8500. How should I store Metronidazole Gel ? Store Metronidazole Gel at room temperature between 68°F to 77°F (20°C to 25°C). Keep Metronidazole Gel  and all medicines out of the reach of children. General information about the safe and effective use of Metronidazole Gel . Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Metronidazole Gel for a condition for which it was not prescribed. Do not give Metronidazole Gel to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Metronidazole Gel that is written for health professionals. What are the ingredients in Metronidazole Gel? Active ingredient: metronidazole Inactive ingredients : betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water Distributed by: Mayne  Pharma Raleigh, NC 27609 P58252-0 Product of Canada US Patent No. 6,881,726 and 7,348,317 This Patient Information has been approved by the U.S. Food and Drug Administration. Revised 10/2024


Medication Information

Warnings and Precautions

Neurologic Disease: Peripheral neuropathy, characterized by numbness or paresthesia of an extremity has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediately reevaluate Metronidazole Gel if abnormal neurologic signs appear. ( 5.1 )  Blood Dyscrasias: Metronidazole Gel is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia. ( 5.2 )  Contact Dermatitis: If dermatitis occurs, patients may need to discontinue use. ( 5.3 )  Eye Irritation: Topical metronidazole has been reported to cause tearing of the eyes. Avoid contact with the eyes. ( 5.4 )

Contraindications

Metronidazole Gel is contraindicated in patients with a history of hypersensitivity to metronidazole or to any other ingredient in the formulation.

Adverse Reactions

The following clinically significant adverse reactions are described elsewhere in the labeling: Neurologic Disease [see Warnings and Precautions (5.1)] Contact Dermatitis [see Warnings and Precautions (5.3)]   Eye Irritation [see Warnings and Precautions (5.4)]

Drug Interactions

Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when prescribing for patients who are receiving anticoagulant treatment.

Storage and Handling

How Supplied Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows: 55 gram pump – NDC 68308-663-55 60 gram tube – NDC 68308-663-60 Storage and Handling Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

How Supplied

How Supplied Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows: 55 gram pump – NDC 68308-663-55 60 gram tube – NDC 68308-663-60 Storage and Handling Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

Patient Information

Metronidazole Gel

Important: Metronidazole Gel is for use on the skin only (topical use). Do not use Metronidazole Gel in your mouth, eyes, or vagina.

What is Metronidazole Gel?

Metronidazole Gel is a prescription medicine used on the skin (topical) to treat pimples and bumps (inflammatory lesions) caused by a condition called rosacea.

It is not known if Metronidazole Gel is safe and effective in children.

Do not use Metronidazole Gel if you are allergic to metronidazole or any of the ingredients in Metronidazole Gel. See the end of this leaflet for a complete list of ingredients in Metronidazole Gel.

Before using Metronidazole Gel, tell your healthcare provider about all your medical conditions, including if you:

  • have tingling or numbness in your hands or feet
  • have or have had a blood disorder or disease
  • are pregnant or plan to become pregnant. It is not known if Metronidazole Gel will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Metronidazole Gel passes into your breast milk. Do not breastfeed during treatment with Metronidazole Gel. Talk to your healthcare provider about the best way to feed your baby during treatment with Metronidazole Gel.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I use Metronidazole Gel?

  • Use Metronidazole Gel exactly as your healthcare provider tells you to.
  • Cleanse the treated area before applying Metronidazole Gel.
  • Apply and rub in a thin film of Metronidazole Gel 1 time a day to the affected area(s).
  • You can apply cosmetics after applying Metronidazole Gel
  • Avoid contact of Metronidazole Gel with your eyes.

What are the possible side effects of Metronidazole Gel?

Metronidazole Gel may cause serious side effects, including:

  • Peripheral neuropathy. Tingling, burning, pain or numbness in the hands or feet (peripheral neuropathy) have happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tingling, burning, pain or numbness in your hands or feet during treatment with Metronidazole Gel.
  • Skin reactions, including allergic reactions. Tell your healthcare provider if you develop any skin reactions, including rash, itching, redness, swelling, or blisters during treatment with Metronidazole Gel. 
  • Eye irritation. Tearing from eye irritation has happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tearing, redness or discomfort of the eyes during treatment with Metronidazole Gel.

The most common side effects of Metronidazole Gel include:

  • sore throat and nasal congestion
  • upper respiratory tract infections
  • headache

Tell your healthcare provider if you get any side effects during treatment with Metronidazole Gel.

These are not all of the possible side effects of Metronidazole Gel.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

You may also report side effects to Mayne Pharma at 1-844-825-8500.

How should I store Metronidazole Gel?

  • Store Metronidazole Gel at room temperature between 68°F to 77°F (20°C to 25°C).

Keep Metronidazole Gel and all medicines out of the reach of children.

General information about the safe and effective use of Metronidazole Gel.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Metronidazole Gel for a condition for which it was not prescribed. Do not give Metronidazole Gel to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Metronidazole Gel that is written for health professionals.

What are the ingredients in Metronidazole Gel?

Active ingredient:
metronidazole

Inactive ingredients: betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water



Distributed by:

Mayne  Pharma

Raleigh, NC 27609

P58252-0

Product of Canada

US Patent No. 6,881,726 and 7,348,317



This Patient Information has been approved by the U.S. Food and Drug Administration.

Revised 10/2024

Description

Metronidazole Gel, 1% is indicated for the topical treatment of inflammatory lesions of rosacea. 

8.1 Pregnancy

Risk Summary

Available data have not established an association with metronidazole use during pregnancy and major birth defects, miscarriage or other adverse maternal or fetal outcomes. No fetotoxicity was observed after oral administration of metronidazole in pregnant rats or mice. The available data do not allow the calculation of relevant comparisons between the systemic exposures of metronidazole observed in animal studies to the systemic exposures that would be expected in humans after topical use of Metronidazole Gel.



The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

8.2 Lactation

Risk Summary

It is not known whether metronidazole is present in human milk after topical administration. Published literature reports the presence of metronidazole in human milk after oral administration. There are no data on the effects of metronidazole on milk production. Because of the potential for serious adverse reactions, advise patients that breastfeeding is not recommended during treatment with Metronidazole Gel.

11 Description

Metronidazole topical gel, 1% is a nitroimidazole for topical use. Metronidazole Gel is a clear, colorless to pale yellow, aqueous gel. Each gram contains 10 mg of metronidazole. Chemically, metronidazole is 2-methyl-5-nitro-1 H -imidazole-1-ethanol. The molecular formula for metronidazole is C6H9N3O3. It has the following structural formula:

Metronidazole has a molecular weight of 171.16. It is a white to pale yellow crystalline powder. It is slightly soluble in alcohol and has solubility in water of 10 mg/mL at 20˚C. Metronidazole belongs to the nitroimidazole class of compounds.

The inactive ingredients are betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water.

8.4 Pediatric Use

Safety and effectiveness of Metronidazole Gel have not been established in pediatric patients.

8.5 Geriatric Use

Sixty-six subjects aged 65 years and older were treated with Metronidazole Gel in the clinical study. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out..

5.4 Eye Irritation

Topical metronidazole has been reported to cause tearing of the eyes.  Avoid contact with the eyes.

14 Clinical Studies

In a randomized, vehicle-controlled trial, 746 subjects with rosacea were treated with Metronidazole Gel or vehicle once daily for 10 weeks. Most subjects had a disease severity score of 3 (“moderate”) on the 5-point Investigator Global Assessment (IGA) scale, with 8 to 50 inflammatory lesions and no more than two nodules at baseline. The co-primary efficacy endpoints were the percent reduction in inflammatory lesion counts and percentage of subjects with success on IGA, defined as an IGA score of 0 (“clear”) or 1 ( “almost clear”) at Week 10.



The efficacy results are shown in the following table:



Table 3: Inflammatory Lesion Counts and Global Scores in Subjects with Rosacea at Week 10 in a Clinical Trial
  Metronidazole Gel Vehicle
N Results N (%) N Results N (%)
Inflammatory lesions 557   189  
Baseline, mean count   18.3   18.4
Week-10, mean count   8.9   12.8
Reduction   9.4 (50.7)   5.6 (32.6)
Investigator Global Assessment 557   189  
Subject clear or almost clear   214 (38.42)   52 (27.51)
Subject with no change   159 (28.5)   77 (40.7)

Subjects treated with Metronidazole Gel experienced a mean reduction of 9.4 inflammatory lesions in the Week-10 LOCF group, compared to a reduction of 5.6 for those treated with vehicle, or a difference in means of 3.8 lesions.

4 Contraindications

Metronidazole Gel is contraindicated in patients with a history of hypersensitivity to metronidazole or to any other ingredient in the formulation.

6 Adverse Reactions

The following clinically significant adverse reactions are described elsewhere in the labeling:

  • Neurologic Disease [see Warnings and Precautions (5.1)]

    Contact Dermatitis [see Warnings and Precautions (5.3)] 
  • Eye Irritation [see Warnings and Precautions (5.4)]


7 Drug Interactions

Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when prescribing for patients who are receiving anticoagulant treatment.

5.2 Blood Dyscrasias

Metronidazole is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia.

12.2 Pharmacodynamics

The pharmacodynamics of metronidazole in association with the treatment of rosacea are unknown.

Cardiac Electrophysiology: The effect of Metronidazole Gel on the QTc interval has not been adequately characterized.

12.3 Pharmacokinetics

Topical administration of a one gram dose of Metronidazole Gel to the face of 13 patients with moderate to severe rosacea once daily for 7 days resulted in a mean ± SD Cmax of metronidazole of 32 ± 9 ng/mL.  The mean ± SD AUC(0-24) was 595 ± 154 ng*hr/mL. The mean Cmax and AUC(0-24) are less than 1% of the value reported for a single 250 mg oral dose of metronidazole. The time to maximum plasma concentration (Tmax) was 6-10 hours after topical application.

5.1 Neurologic Disease

Peripheral neuropathy, characterized by numbness or paresthesia of an extremity, has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediately reevaluate Metronidazole Gel therapy if abnormal neurologic signs appear. Administer metronidazole with caution to patients with central nervous system diseases.

5.3 Contact Dermatitis

Irritant and allergic contact dermatitis have been reported with Metronidazole Gel. If dermatitis occurs, patients may need to discontinue use.

1 Indications and Usage

Metronidazole Gel, 1% is indicated for the topical treatment of inflammatory lesions of rosacea. 

12 Clinical Pharmacology


12.1 Mechanism of Action

The mechanism of action of metronidazole in the treatment of rosacea is unknown.

Package Label 55g Pump

NDC 68308-663-55



Metronidazole Gel 1%



Pump



For topical use only





Rx Only



NET WT. 55g

maynepharma





For topical use only.

Not for oral, ophthalmic or intravaginal use.



Store at controlled room temperature, 68° to 77°F (20° - 25°C), excursions permitted between 59° to 86°F (15° - 30°C).

Keep out of reach of children.



Usual dosage: Apply a thin film once a day to the affected areas.  See package insert for complete prescribing instructions.





Each gram contains: 10 mg (1%) metronidazole as active ingredient in a gel base consisting of betadex, edetate disodium, hydroxyethl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparben, and purified water.







Distributed by:

Mayne Pharma

Raleigh, NC 27609

Product of Canada.



P57418-0

Package Label 60g Tube

NDC 68308-663-60

Metronidazole Gel

1% 

For Topical Use Only



Rx Only

Net Wt. 60 g



maynepharma



Product of Canada

Distributed by:

MaynePharma

Raleigh, NC 27609



P58251-0





FOR TOPICAL USE ONLY. NOT FOR ORAL, OPHTHALMIC OR INTRAVAGINAL USE.

STORE AT CONTROLLED ROOM TEMPERATURE 68º TO 77ºF(20º - 25º C)

EXCURSIONS PERMITTED BETWEEN 59º AND 86ºF (15º - 30ºC)




Usual dosage: Apply a thin film once a day to the affected areas. 

See package insert for complete prescribing instructions.



Each gram contains: Active: 10 mg (1%) metronidazole as active ingredient in a gel base consisting of betadex, edetate disodium, hydroxyethl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparben, and purified water.



See crimp of tube for lot number and expiration date.





13 Nonclinical Toxicology


5 Warnings and Precautions


2 Dosage and Administration
  • Cleanse treated areas before the application of Metronidazole Gel.
  • Apply and rub in a thin film of Metronidazole Gel once daily to affected area(s). 
  • Cosmetics may be applied after the application of Metronidazole Gel. 
  • For topical use only, not for oral, ophthalmic, or intravaginal use.
3 Dosage Forms and Strengths

Gel, 1%. Metronidazole Gel is a clear, colorless to pale yellow gel. Each gram of Metronidazole Gel contains 10 mg (1%) of metronidazole.

6.2 Post Marketing Experience

The following adverse reaction has been identified during post- approval use of topical metronidazole. Because this reaction is reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate the frequency or establish a causal relationship to drug exposure.



Nervous System Disorders: Peripheral neuropathy 

Ophthalmic Adverse Reactions: Tearing of the eyes

8 Use in Specific Populations


6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In a controlled clinical trial, 557 subjects used Metronidazole Gel and 189 subjects used the gel vehicle once daily for up to 10 weeks. The following table summarizes selected adverse reactions that occurred at a rate of ≥1% and at a higher rate than vehicle:

Table 1: Adverse Reactions That Occurred at a Rate of ≥1% and Higher Than Vehicle in Subjects Treated with Metronidazole Gel for Up to 10 Weeks
Preferred Term Metronidazole Gel Gel Vehicle
   Influenza 8 (1.4) 1 (0.5)
   Upper respiratory tract infection 14 (2.5) 4 (2.1)
   Urinary tract infection 6 (1.1) 1 (0.5)
   Headache 12 (2.2) 1 (0.5)
   Contact dermatitis 7 (1.3) 1 (0.5)
   Hypertension 6 (1.1) 1 (0.5)
Table 2: Local Cutaneous Signs and Symptoms of Irritation That Were Worse Than Baseline in Subjects Treated with Metronidazole Gel for Up to 10 Weeks
Metronidazole Gel Gel Vehicle
Sign/Symptom N= 544 N (%) N= 184 N (%)
Dryness 138 (25.4) 63 (34.2)
   Mild 93 (17.1) 41 (22.3)
   Moderate 42 (7.7) 20 (10.9)
   Severe 3 (0.6) 2 (1.1)
Scaling 134 (24.6) 60 (32.6)
   Mild 88 (16.2) 32 (17.4)
   Moderate 43 (7.9) 27 (14.7)
   Severe 3 (0.6) 1 (0.5)
Pruritus 86 (15.8) 35 (19.0)
   Mild 53 (9.7) 21 (11.4)
   Moderate 27 (5.0) 13 (7.1)
   Severe 6 (1.1) 1 (0.5)
Stinging/burning 56 (10.3) 28 (15.2)
   Mild 39 (7.2) 18 (9.8)
   Moderate 7 (1.3) 9 (4.9)
   Severe 10 (1.8) 1 (0.5)

The following additional adverse experiences have been reported with the topical use of metronidazole: transient redness, metallic taste, tingling or numbness of extremities, and nausea.

17 Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Patient Information).

Administration Instructions

Use as directed. Avoid contact with the eyes [see Warnings and Precautions (5.4)].

Cleanse treated areas before the application of Metronidazole Gel [see Dosage and Administration (2)]

Advise patients to report any adverse reaction to their healthcare providers.



Neurologic Disease

Advise patients to immediately report any abnormal neurologic signs to their healthcare provider [see Warnings and Precautions (5.1)].



Lactation

Advise women not to breastfeed during treatment with Metronidazole Gel [see Use in Specific Populations (8.2)].

Rx Only

US Patent No. 6,881,726 and 7,348,317

Distributed by:

Mayne Pharma

Raleigh, NC 27609 

P58252-0

Product of Canada

All trademarks are the property of their respective owners.



16 How Supplied/storage and Handling

How Supplied

Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows:

55 gram pump – NDC 68308-663-55

60 gram tube – NDC 68308-663-60



Storage and Handling

Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Metronidazole has shown evidence of carcinogenic activity in a number of studies involving chronic, oral administration in mice and rats, but not in studies involving hamsters.

In several long-term studies in mice, oral doses of approximately 225 mg/m2/day or greater were associated with an increase in pulmonary tumors and lymphomas. Several long-term oral studies in the rat have shown statistically significant increases in mammary and hepatic tumors at doses >885 mg/m2/day.

Metronidazole has shown evidence of mutagenic activity in several in vitro bacterial assay systems. In addition, a dose-related increase in the frequency of micronuclei was observed in mice after intraperitoneal injections. An increase in chromosomal aberrations in peripheral blood lymphocytes was reported in patients with Crohn’s disease who were treated with 200 to 1200 mg/day of metronidazole for 1 to 24 months. However, in another study, no increase in chromosomal aberrations in circulating lymphocytes was observed in patients with Crohn’s disease treated with the drug for 8 months.


Structured Label Content

8.1 Pregnancy

Risk Summary

Available data have not established an association with metronidazole use during pregnancy and major birth defects, miscarriage or other adverse maternal or fetal outcomes. No fetotoxicity was observed after oral administration of metronidazole in pregnant rats or mice. The available data do not allow the calculation of relevant comparisons between the systemic exposures of metronidazole observed in animal studies to the systemic exposures that would be expected in humans after topical use of Metronidazole Gel.



The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

8.2 Lactation

Risk Summary

It is not known whether metronidazole is present in human milk after topical administration. Published literature reports the presence of metronidazole in human milk after oral administration. There are no data on the effects of metronidazole on milk production. Because of the potential for serious adverse reactions, advise patients that breastfeeding is not recommended during treatment with Metronidazole Gel.

11 Description (11 DESCRIPTION)

Metronidazole topical gel, 1% is a nitroimidazole for topical use. Metronidazole Gel is a clear, colorless to pale yellow, aqueous gel. Each gram contains 10 mg of metronidazole. Chemically, metronidazole is 2-methyl-5-nitro-1 H -imidazole-1-ethanol. The molecular formula for metronidazole is C6H9N3O3. It has the following structural formula:

Metronidazole has a molecular weight of 171.16. It is a white to pale yellow crystalline powder. It is slightly soluble in alcohol and has solubility in water of 10 mg/mL at 20˚C. Metronidazole belongs to the nitroimidazole class of compounds.

The inactive ingredients are betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water.

8.4 Pediatric Use

Safety and effectiveness of Metronidazole Gel have not been established in pediatric patients.

8.5 Geriatric Use

Sixty-six subjects aged 65 years and older were treated with Metronidazole Gel in the clinical study. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out..

5.4 Eye Irritation

Topical metronidazole has been reported to cause tearing of the eyes.  Avoid contact with the eyes.

14 Clinical Studies (14 CLINICAL STUDIES)

In a randomized, vehicle-controlled trial, 746 subjects with rosacea were treated with Metronidazole Gel or vehicle once daily for 10 weeks. Most subjects had a disease severity score of 3 (“moderate”) on the 5-point Investigator Global Assessment (IGA) scale, with 8 to 50 inflammatory lesions and no more than two nodules at baseline. The co-primary efficacy endpoints were the percent reduction in inflammatory lesion counts and percentage of subjects with success on IGA, defined as an IGA score of 0 (“clear”) or 1 ( “almost clear”) at Week 10.



The efficacy results are shown in the following table:



Table 3: Inflammatory Lesion Counts and Global Scores in Subjects with Rosacea at Week 10 in a Clinical Trial
  Metronidazole Gel Vehicle
N Results N (%) N Results N (%)
Inflammatory lesions 557   189  
Baseline, mean count   18.3   18.4
Week-10, mean count   8.9   12.8
Reduction   9.4 (50.7)   5.6 (32.6)
Investigator Global Assessment 557   189  
Subject clear or almost clear   214 (38.42)   52 (27.51)
Subject with no change   159 (28.5)   77 (40.7)

Subjects treated with Metronidazole Gel experienced a mean reduction of 9.4 inflammatory lesions in the Week-10 LOCF group, compared to a reduction of 5.6 for those treated with vehicle, or a difference in means of 3.8 lesions.

4 Contraindications (4 CONTRAINDICATIONS)

Metronidazole Gel is contraindicated in patients with a history of hypersensitivity to metronidazole or to any other ingredient in the formulation.

6 Adverse Reactions (6 ADVERSE REACTIONS)

The following clinically significant adverse reactions are described elsewhere in the labeling:

  • Neurologic Disease [see Warnings and Precautions (5.1)]

    Contact Dermatitis [see Warnings and Precautions (5.3)] 
  • Eye Irritation [see Warnings and Precautions (5.4)]


7 Drug Interactions (7 DRUG INTERACTIONS)

Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when prescribing for patients who are receiving anticoagulant treatment.

Patient Information (PATIENT INFORMATION)

Metronidazole Gel

Important: Metronidazole Gel is for use on the skin only (topical use). Do not use Metronidazole Gel in your mouth, eyes, or vagina.

What is Metronidazole Gel?

Metronidazole Gel is a prescription medicine used on the skin (topical) to treat pimples and bumps (inflammatory lesions) caused by a condition called rosacea.

It is not known if Metronidazole Gel is safe and effective in children.

Do not use Metronidazole Gel if you are allergic to metronidazole or any of the ingredients in Metronidazole Gel. See the end of this leaflet for a complete list of ingredients in Metronidazole Gel.

Before using Metronidazole Gel, tell your healthcare provider about all your medical conditions, including if you:

  • have tingling or numbness in your hands or feet
  • have or have had a blood disorder or disease
  • are pregnant or plan to become pregnant. It is not known if Metronidazole Gel will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Metronidazole Gel passes into your breast milk. Do not breastfeed during treatment with Metronidazole Gel. Talk to your healthcare provider about the best way to feed your baby during treatment with Metronidazole Gel.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I use Metronidazole Gel?

  • Use Metronidazole Gel exactly as your healthcare provider tells you to.
  • Cleanse the treated area before applying Metronidazole Gel.
  • Apply and rub in a thin film of Metronidazole Gel 1 time a day to the affected area(s).
  • You can apply cosmetics after applying Metronidazole Gel
  • Avoid contact of Metronidazole Gel with your eyes.

What are the possible side effects of Metronidazole Gel?

Metronidazole Gel may cause serious side effects, including:

  • Peripheral neuropathy. Tingling, burning, pain or numbness in the hands or feet (peripheral neuropathy) have happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tingling, burning, pain or numbness in your hands or feet during treatment with Metronidazole Gel.
  • Skin reactions, including allergic reactions. Tell your healthcare provider if you develop any skin reactions, including rash, itching, redness, swelling, or blisters during treatment with Metronidazole Gel. 
  • Eye irritation. Tearing from eye irritation has happened in people treated with metronidazole used on the skin. Tell your healthcare provider if you experience tearing, redness or discomfort of the eyes during treatment with Metronidazole Gel.

The most common side effects of Metronidazole Gel include:

  • sore throat and nasal congestion
  • upper respiratory tract infections
  • headache

Tell your healthcare provider if you get any side effects during treatment with Metronidazole Gel.

These are not all of the possible side effects of Metronidazole Gel.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

You may also report side effects to Mayne Pharma at 1-844-825-8500.

How should I store Metronidazole Gel?

  • Store Metronidazole Gel at room temperature between 68°F to 77°F (20°C to 25°C).

Keep Metronidazole Gel and all medicines out of the reach of children.

General information about the safe and effective use of Metronidazole Gel.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Metronidazole Gel for a condition for which it was not prescribed. Do not give Metronidazole Gel to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Metronidazole Gel that is written for health professionals.

What are the ingredients in Metronidazole Gel?

Active ingredient:
metronidazole

Inactive ingredients: betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water



Distributed by:

Mayne  Pharma

Raleigh, NC 27609

P58252-0

Product of Canada

US Patent No. 6,881,726 and 7,348,317



This Patient Information has been approved by the U.S. Food and Drug Administration.

Revised 10/2024

5.2 Blood Dyscrasias

Metronidazole is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia.

12.2 Pharmacodynamics

The pharmacodynamics of metronidazole in association with the treatment of rosacea are unknown.

Cardiac Electrophysiology: The effect of Metronidazole Gel on the QTc interval has not been adequately characterized.

12.3 Pharmacokinetics

Topical administration of a one gram dose of Metronidazole Gel to the face of 13 patients with moderate to severe rosacea once daily for 7 days resulted in a mean ± SD Cmax of metronidazole of 32 ± 9 ng/mL.  The mean ± SD AUC(0-24) was 595 ± 154 ng*hr/mL. The mean Cmax and AUC(0-24) are less than 1% of the value reported for a single 250 mg oral dose of metronidazole. The time to maximum plasma concentration (Tmax) was 6-10 hours after topical application.

5.1 Neurologic Disease

Peripheral neuropathy, characterized by numbness or paresthesia of an extremity, has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediately reevaluate Metronidazole Gel therapy if abnormal neurologic signs appear. Administer metronidazole with caution to patients with central nervous system diseases.

5.3 Contact Dermatitis

Irritant and allergic contact dermatitis have been reported with Metronidazole Gel. If dermatitis occurs, patients may need to discontinue use.

1 Indications and Usage (1 INDICATIONS AND USAGE)

Metronidazole Gel, 1% is indicated for the topical treatment of inflammatory lesions of rosacea. 

12 Clinical Pharmacology (12 CLINICAL PHARMACOLOGY)


12.1 Mechanism of Action

The mechanism of action of metronidazole in the treatment of rosacea is unknown.

Package Label 55g Pump (PACKAGE LABEL - 55g pump)

NDC 68308-663-55



Metronidazole Gel 1%



Pump



For topical use only





Rx Only



NET WT. 55g

maynepharma





For topical use only.

Not for oral, ophthalmic or intravaginal use.



Store at controlled room temperature, 68° to 77°F (20° - 25°C), excursions permitted between 59° to 86°F (15° - 30°C).

Keep out of reach of children.



Usual dosage: Apply a thin film once a day to the affected areas.  See package insert for complete prescribing instructions.





Each gram contains: 10 mg (1%) metronidazole as active ingredient in a gel base consisting of betadex, edetate disodium, hydroxyethl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparben, and purified water.







Distributed by:

Mayne Pharma

Raleigh, NC 27609

Product of Canada.



P57418-0

Package Label 60g Tube (PACKAGE LABEL - 60g Tube)

NDC 68308-663-60

Metronidazole Gel

1% 

For Topical Use Only



Rx Only

Net Wt. 60 g



maynepharma



Product of Canada

Distributed by:

MaynePharma

Raleigh, NC 27609



P58251-0





FOR TOPICAL USE ONLY. NOT FOR ORAL, OPHTHALMIC OR INTRAVAGINAL USE.

STORE AT CONTROLLED ROOM TEMPERATURE 68º TO 77ºF(20º - 25º C)

EXCURSIONS PERMITTED BETWEEN 59º AND 86ºF (15º - 30ºC)




Usual dosage: Apply a thin film once a day to the affected areas. 

See package insert for complete prescribing instructions.



Each gram contains: Active: 10 mg (1%) metronidazole as active ingredient in a gel base consisting of betadex, edetate disodium, hydroxyethl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparben, and purified water.



See crimp of tube for lot number and expiration date.





13 Nonclinical Toxicology (13 NONCLINICAL TOXICOLOGY)


5 Warnings and Precautions (5 WARNINGS AND PRECAUTIONS)


2 Dosage and Administration (2 DOSAGE AND ADMINISTRATION)
  • Cleanse treated areas before the application of Metronidazole Gel.
  • Apply and rub in a thin film of Metronidazole Gel once daily to affected area(s). 
  • Cosmetics may be applied after the application of Metronidazole Gel. 
  • For topical use only, not for oral, ophthalmic, or intravaginal use.
3 Dosage Forms and Strengths (3 DOSAGE FORMS AND STRENGTHS)

Gel, 1%. Metronidazole Gel is a clear, colorless to pale yellow gel. Each gram of Metronidazole Gel contains 10 mg (1%) of metronidazole.

6.2 Post Marketing Experience

The following adverse reaction has been identified during post- approval use of topical metronidazole. Because this reaction is reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate the frequency or establish a causal relationship to drug exposure.



Nervous System Disorders: Peripheral neuropathy 

Ophthalmic Adverse Reactions: Tearing of the eyes

8 Use in Specific Populations (8 USE IN SPECIFIC POPULATIONS)


6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In a controlled clinical trial, 557 subjects used Metronidazole Gel and 189 subjects used the gel vehicle once daily for up to 10 weeks. The following table summarizes selected adverse reactions that occurred at a rate of ≥1% and at a higher rate than vehicle:

Table 1: Adverse Reactions That Occurred at a Rate of ≥1% and Higher Than Vehicle in Subjects Treated with Metronidazole Gel for Up to 10 Weeks
Preferred Term Metronidazole Gel Gel Vehicle
   Influenza 8 (1.4) 1 (0.5)
   Upper respiratory tract infection 14 (2.5) 4 (2.1)
   Urinary tract infection 6 (1.1) 1 (0.5)
   Headache 12 (2.2) 1 (0.5)
   Contact dermatitis 7 (1.3) 1 (0.5)
   Hypertension 6 (1.1) 1 (0.5)
Table 2: Local Cutaneous Signs and Symptoms of Irritation That Were Worse Than Baseline in Subjects Treated with Metronidazole Gel for Up to 10 Weeks
Metronidazole Gel Gel Vehicle
Sign/Symptom N= 544 N (%) N= 184 N (%)
Dryness 138 (25.4) 63 (34.2)
   Mild 93 (17.1) 41 (22.3)
   Moderate 42 (7.7) 20 (10.9)
   Severe 3 (0.6) 2 (1.1)
Scaling 134 (24.6) 60 (32.6)
   Mild 88 (16.2) 32 (17.4)
   Moderate 43 (7.9) 27 (14.7)
   Severe 3 (0.6) 1 (0.5)
Pruritus 86 (15.8) 35 (19.0)
   Mild 53 (9.7) 21 (11.4)
   Moderate 27 (5.0) 13 (7.1)
   Severe 6 (1.1) 1 (0.5)
Stinging/burning 56 (10.3) 28 (15.2)
   Mild 39 (7.2) 18 (9.8)
   Moderate 7 (1.3) 9 (4.9)
   Severe 10 (1.8) 1 (0.5)

The following additional adverse experiences have been reported with the topical use of metronidazole: transient redness, metallic taste, tingling or numbness of extremities, and nausea.

17 Patient Counseling Information (17 PATIENT COUNSELING INFORMATION)

Advise the patient to read the FDA-approved patient labeling (Patient Information).

Administration Instructions

Use as directed. Avoid contact with the eyes [see Warnings and Precautions (5.4)].

Cleanse treated areas before the application of Metronidazole Gel [see Dosage and Administration (2)]

Advise patients to report any adverse reaction to their healthcare providers.



Neurologic Disease

Advise patients to immediately report any abnormal neurologic signs to their healthcare provider [see Warnings and Precautions (5.1)].



Lactation

Advise women not to breastfeed during treatment with Metronidazole Gel [see Use in Specific Populations (8.2)].

Rx Only

US Patent No. 6,881,726 and 7,348,317

Distributed by:

Mayne Pharma

Raleigh, NC 27609 

P58252-0

Product of Canada

All trademarks are the property of their respective owners.



16 How Supplied/storage and Handling (16 HOW SUPPLIED/STORAGE AND HANDLING)

How Supplied

Metronidazole Gel is clear, colorless to pale yellow in color, and supplied as follows:

55 gram pump – NDC 68308-663-55

60 gram tube – NDC 68308-663-60



Storage and Handling

Store at controlled room temperature: 20° to 25°C (68° to 77°F), excursions permitted between 15° and 30°C (59° and 86°F).

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Metronidazole has shown evidence of carcinogenic activity in a number of studies involving chronic, oral administration in mice and rats, but not in studies involving hamsters.

In several long-term studies in mice, oral doses of approximately 225 mg/m2/day or greater were associated with an increase in pulmonary tumors and lymphomas. Several long-term oral studies in the rat have shown statistically significant increases in mammary and hepatic tumors at doses >885 mg/m2/day.

Metronidazole has shown evidence of mutagenic activity in several in vitro bacterial assay systems. In addition, a dose-related increase in the frequency of micronuclei was observed in mice after intraperitoneal injections. An increase in chromosomal aberrations in peripheral blood lymphocytes was reported in patients with Crohn’s disease who were treated with 200 to 1200 mg/day of metronidazole for 1 to 24 months. However, in another study, no increase in chromosomal aberrations in circulating lymphocytes was observed in patients with Crohn’s disease treated with the drug for 8 months.


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