• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or your pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to you doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Flagyl is and what it is used for
2. What you need to know before you use Flagyl
3. How to use Flagyl
4. Possible side effects
5. How to store Flagyl
6. Contents of the pack and other information

• You are allergic (hypersensitive) to metronidazole, nitroimidazoles (e.g. tinidazole) or any of the other ingredients of this medicine (see section 6). Signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue.

Do not use Flagyl if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before using Flagyl.

Talk to your doctor or pharmacist before using Flagyl if:

• You have or have ever had a liver problem
• You are having kidney dialysis (see section 3: ‘People having kidney dialysis’)
• You have a disease of the nervous system

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using Flagyl. Do this even if they have applied in the past.

Tell your doctor immediately and stop taking Flagyl if you develop: stomach pain, anorexia (loss of appetite), nausea (feeling sick), vomiting (being sick), fever, malaise, fatigue, vertigo (spinning sensation), jaundice, dark urine, putty or mastic-coloured stools or itching.

Cases of severe liver toxicity/acute liver failure, including cases with a fatal outcome, in patients with Cockayne syndrome have been reported with Flagyl.

If you are affected by Cockayne syndrome, your doctor should also monitor your liver function frequently while you are being treated with Flagyl and afterwards.

Serious skin reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalised exanthematous pustulosis (AGEP) have been reported with the use of Flagyl:

• SJS/TEN can appear initially as reddish target-like spots or circular patches often with central blisters on the trunk. Also, ulcers of the mouth, throat, nose, genitals and eyes (red and swollen eyes) can occur. These serious skin rashes are often preceded by fever and/or flu-like symptoms. The rashes may progress to widespread peeling of the skin and life-threatening complications or be fatal.
• AGEP appears at the initiation of treatment as a red, scaly widespread rash with bumps under the skin and blisters accompanied by fever. The most common location: mainly localised on the skin folds, trunk and upper extremities.

The highest risk for occurrence of serious skin reactions is within one week, typically, within 48 hours after start of treatment. If you develop a serious rash or another of these skin symptoms, stop taking Flagyl and contact your doctor or seek medical attention immediately.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because Flagyl can affect the way some other medicines work. Also some medicines can affect the way Flagyl works.

In particular, tell your doctor if you are taking any of the following medicines:

• Medicines used to thin the blood such as warfarin
• Lithium for mental illness
• Phenobarbital or phenytoin for epilepsy
• 5-fluorouracil for cancer
• Busulfan for leukaemia (cancer of the blood cells)
• Ciclosporin – to prevent rejection of organs after a transplant
• Disulfiram for alcoholism
• Medicines that may cause heart rhythm disturbances (so-called QT prolongation which can be seen on ECG) such as:
  • certain anti-arrhythmics (medicines for heart rhythm disorders)
  • certain antibiotics
  • medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought)

If you are not sure, talk to your doctor or pharmacist before using Flagyl.

Do not drink any alcohol while you are using Flagyl and for 48 hours after finishing your course. Drinking alcohol while using Flagyl might cause unpleasant side effects, such as feeling sick (nausea), being sick (vomiting), stomach pain, hot flushes, very fast or uneven heartbeat (palpitations) and headache.

Ask your doctor or pharmacist for advice before using Flagyl if:

• You are pregnant, might become pregnant or think you may be pregnant. Flagyl should not be taken during pregnancy unless considered absolutely necessary.
• You are breast-feeding. It is better not to use Flagyl if you are breast-feeding. This is because small amounts may pass into the mother’s milk.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

While using Flagyl you may feel dizzy or experience vertigo (spinning sensation), confusion, hallucinations (seeing or hearing things that are not there), convulsions (fits) or temporary eyesight problems (such as blurred or double vision). If this happens, do not drive or use any machinery or tools.

Your doctor may wish to carry out some tests if you have been using this medicine for more than 10 days.

If you are going to have a blood test, tell the doctor or nurse performing the test that you are using Flagyl.

Flagyl can affect the results of some blood tests.

1. Tear off a section containing one suppository
2. Pull apart the plastic flaps
3. Use the flaps to peel the plastic away from the suppository

Always use this medicine exactly as your doctor or pharmacist has told you.

It is important to finish a full course of treatment. The length of a course will depend on your needs and the illness being treated.

Check with your doctor or pharmacist if you are not sure.

• Remember to wash your hands before and after you insert the suppository.
• Flagyl suppositories are used by putting them into your back passage (rectum).
• The dose of Flagyl will depend on your needs and the illness being treated.
• The length of your treatment will depend on the type of infection you have and how bad it is.

• Suppositories are normally used for 3 days.
• As soon as possible after starting treatment with the suppositories, your doctor will suggest changing to a medicine taken by mouth.
• However, after 3 days, if your doctor wants you or your child to carry on using the suppositories, you will probably be told to use the suppositories every 12 hours.

The usual doses for adults and children using suppositories are provided below:

Adults and children over 10 years

• Use one 1g suppository, every 8 hours for 3 days.
  See above for dosing after 3 days.

Children aged 5 - 10 years

• Use one 500mg suppository, every 8 hours for 3 days. See above for dosing after 3 days.

Children aged 1 - 5 years

• Use one half of a 500mg suppository, every 8 hours for 3 days. See above for dosing after 3 days.

Infants under 1 year old

• Use one quarter of a 500mg suppository, every 8 hours for 3 days. See above for dosing after 3 days.

Adults and children over 10 years

• Use one 1g suppository 2 hours before surgery.
• Repeat every 8 hours for up to 3 days. See above for dosing after 3 days.

Children aged 5 - 10 years

• Use one 500mg suppository 2 hours before surgery.
• Repeat every 8 hours for up to 3 days. See above for dosing after 3 days.

Your doctor may tell you to stop using Flagyl during your dialysis and start using it again when your dialysis is finished.

Your doctor may tell you to use a lower dose or to use the medicine less often.

If you have used more suppositories than you should or if you or a child swallow any suppositories, tell a doctor or go to a hospital casualty department straight away. Take the pack and any suppositories left with you. This is so that the doctors know what you have used.

If you forget to use a Flagyl suppository, use it as soon as you remember. However if it is nearly time for the next dose, skip the missed dose. Do not use a double dose to make up for a forgotten dose.

You should only stop using Flagyl if your doctor tells you to. It is essential to take the medicine and not stop and start as this could cause unwanted side effects.

• You have an allergic reaction. The signs may include: swelling of the hands, feet, ankles, face, lips or throat which may cause difficulty in swallowing or breathing, an itchy, lumpy rash (hives) or nettle rash (urticaria).
• A serious but very rare side effect is a brain disease (encephalopathy). Symptoms vary but you might get a fever, stiff neck, headache, or see or hear things that aren’t there. You might also have problems using your arms and legs, problems with speaking or feel confused.
• You develop skin rashes including Stevens-Johnson syndrome or toxic epidermal necrolysis. These can appear as reddish target-like spots or circular patches often with central blisters on the trunk, skin peeling, ulcers of the mouth, throat, nose, genitals and eyes and can be preceded by fever and flu-like symptoms. Stop using Flagyl if you develop these symptoms and contact your doctor or seek medical attention immediately. See also section 2.
• You develop a red, scaly widespread rash with bumps under the skin and blisters accompanied by fever at the initiation of treatment (acute generalised exanthematous pustulosis). Stop using Flagyl if you develop these symptoms and contact your doctor or seek medical attention immediately. See also section 2.
• Yellowing of the skin and eyes. This could be due to a liver problem (jaundice).
• Unexpected infections, mouth ulcers, bruising, bleeding gums, or severe tiredness.

This could be caused by a blood problem.

• Severe stomach pain which may reach through to your back (pancreatitis)

Tell your doctor or pharmacist if any of the following side effects get serious or lasts longer than a few days, or if you notice any side effects not listed in this leaflet:

Very rare (affects less than 1 in 10,000 people)

• Fits (convulsions)
• Mental problems such as feeling confused and seeing or hearing things that are not there (hallucinations)
• Problems with your eyesight such as blurred or double vision
• Skin rash or flushing
• Headache
• Darkening of the urine
• Feeling sleepy or dizzy
• Pains in the muscles or joints
• Liver problems including life-threatening liver failure (hepatocellular liver injury)

Not known (frequency cannot be estimated from the available data)

• Numbness, tingling, pain, or a feeling of weakness, in the arms or legs
• Unpleasant taste in the mouth, furred tongue
• Feeling sick (nausea), being sick (vomiting), upset stomach, stomach pain or diarrhoea
• Loss of appetite
• Fever
• Feeling depressed
• Pain in your eyes (optic neuritis)
• A group of symptoms together including: fever, nausea, vomiting, headache, stiff neck and extreme sensitivity to bright light. This may be caused by an inflammation of the membranes that cover the brain and spinal cord (meningitis)
• Hearing impairment / hearing loss
• Ringing in the ears (tinnitus)
• Vertigo (spinning sensation)
• You get a rash or skin discolouration with or without raised areas which often reoccurs at the same location each time the drug is used.
• Acute liver failure in patients with Cockayne Syndrome (see section 2 ‘Warnings and precautions’)
• Heart rhythm disturbances (so-called QT prolongation which can be seen on ECG), particularly when Flagyl is used with other medicines that may cause heart rhythm disturbances

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

Each suppository contains 500mg or 1g of metronidazole as the active substance.

Other ingredients are: suppository bases E75 and W35, which are vegetable fats.

Flagyl 500mg and 1g Suppositories are cream coloured, smooth surfaced and torpedo shaped.

They are available in blister packs of 10 suppositories

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