Tindamax (Tinidazole) - Oral

What Is Tindamax?

Tindamax (tinidazole) is an antibiotic drug prescribed to treat bacterial vaginosis. The drug also treats certain parasitic diseases (specifically amebiasis and giardiasis) and the sexually transmitted infection trichomoniasis.

Tindamax belongs to a class of drugs called nitroimidazole antibiotics that are able to fight not only bacteria, but certain protozoan parasites as well. Protozoa are single-celled organisms that can survive as free-living organisms or can multiply in humans and cause parasitic infections.

The drug works by penetrating the wall of bacteria and damaging both their DNA and structural proteins. It is unclear how Tindamax acts against protozoan infections.

Tindamax is available in tablet form for both adults and children older than 3 years. There are several lower-cost generics available under the drug name tinidazole.

What Is Tindamax Used For?

Tindamax is used to treat infections caused by specific susceptible bacteria or protozoa. They do not work against all bacteria and protozoa, but mainly those with anaerobic properties (meaning that they don’t need oxygen to survive).

The Food and Drug Administration approved Tindamax to treat:

• Amebiasis, a diarrheal disease caused by the intestinal protozoa Entamoeba histolytica
• Bacterial vaginosis, a bacterial infection of the vulva and vagina
• Giardiasis, a diarrheal disease caused by the intestinal protozoan Giardia duodenalis
• Trichomoniasis, a sexually transmitted infection caused by the protozoa Trichomonas vaginalis
  

Tindamax only acts against susceptible bacteria and parasites. Your healthcare provider should identify the disease-causing organism for your infection and rule out all other causes (including vaginal yeast infections and sexually transmitted diseases like chlamydia, gonorrhea, and genital herpes).

Tindamax may be ineffective when used without proven or suspected bacterial infection. Unnecessary use of antibiotics like Tindmax can also contribute to the development of antibiotic resistance.

How to Take Tindamax

Tindamax is available as 500-milligram (mg), pink, oval tablets. The tablets are scored so that they can be split. Some generic manufacturers produce 250 mg tablets.

Depending on the infection, Tindamax may require only a single dose (for giardiasis and trichomoniasis) or up to five doses over five consecutive days (for amebiasis and bacterial vaginosis).

Tindamax is taken by mouth with food, which helps reduce stomach upset. If you need more than one dose, be sure to take the dose at the same time every day. Regular dosing helps maintain the right amount of tinidazole in the bloodstream.

Avoid drinking alcohol while taking Tindamax and for three days after completing therapy. Taking Tindamax with alcohol can lead to abdominal cramps, nausea, vomiting, headaches, and flushing.

If you or your child are unable to swallow pills, your pharmacist can compound the medication into a liquid suspension, typically using a cherry-flavored syrup.

It is important to take the full course of antibiotics even if you start to feel better. Stopping early can lead to antibiotic resistance, making Tindamax (and related antibiotics like metronidazole) far less effective if it is ever needed again.

Storage

Store Tindamax tablets at room temperature, ideally between 68 F and 77 F. Compounded Tindamax syrup can also be stored at this temperature but must be used within seven days of preparation by your pharmacist.

Avoid keeping the tablets or syrup on a sunny windowsill or in your glove compartment where temperatures can be excessive. If you need to take Tindamax with you on a trip, it is OK to expose the drug to temperatures of 59 F to 86 F.

Off-Label Uses

Healthcare providers may prescribe Tindamax to treat other medical conditions not listed on the product label. This is known as off-label use. 

Tindamax is used off-label for many medical purposes, including prophylactic (preventive) therapies. These include:

• Acute ulcerative gingivitis
• Balantidiasis, a diarrheal disease caused by the protozoa Balantidium coli
• Blastocystiasis, a diarrheal disease caused by the protozoa Blastycystis hominis
• Diabetic foot infections
• H. pylori infection
• Pelvic inflammatory disease (PID)
• Post-surgical prophylaxis to prevent anaerobic infections following abdominal surgery or hysterectomy
• Prophylaxis following sexual assault to prevent sexually transmitted infections
• Recurrent nongonococcal urethritis

What Are the Side Effects of Tindamax?

This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA atwww.fda.gov/medwatch or 1-800-FDA-1088.

As with many other medications, Tindamax may cause side effects. Most involve the gastrointestinal tract, which can be minimized by taking the drug with food. Other rare and potentially serious drug reactions have been reported. Even so, Tindamax is generally well tolerated when used for one to five days.

Common Side Effects

Common side effects include (by order of frequency):

• Metallic or bitter taste in the mouth
• Nausea
• Fatigue
• Malaise
• Loss of appetite
• Upset stomach or cramps
• Vomiting
• Headache
• Dizziness

The risk of side effects increases with the duration of therapy.

Moreover, research showed around one in 20 women treated for bacterial vaginosis with Tindamax experienced a yeast infection following treatment due to changes in the natural vaginal flora.

Severe Side Effects

On rare occasions, Tindamax has been known to trigger potentially severe neurological side effects, including seizures and peripheral neuropathy (numbness or pins-and-needles sensations in the hands or feet). Let your healthcare provider know immediately if any unusual nerve-related symptoms develop. They may recommend you stop treatment.

Arguably, the greater concern is the risk of drug hypersensitivity, which may not only affect first-time users but those previously treated with Tindamax. While these reactions are exceptionally rare, some are potentially life-threatening.

Reported drug reactions have included:

• Anaphylaxis
• Erythema multiforme
• Urticaria (hives)
• Angioedema
• Stevens-Johnson syndrome (SJS)
• Toxic epidermal necrolysis (TEN)

Call your provider right away if you have serious side effects while taking Tindamax. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. These include symptoms of anaphylaxis, such as:

• Hives or rash
• Shortness of breath
• Wheezing
• Swelling of the face, lips, tongue, or throat
• Difficulty swallowing
• Rapid heart rate
• Abdominal cramps
• Vomiting
• Diarrhea
• Chest tightness
• A feeling of impending doom

If not treated immediately, anaphylaxis can lead to shock, coma, heart or respiratory failure, and death.

Long-Term Side Effects

The main concern about the overuse of Tindamax is the risk of antibiotic resistance.

Although this is more commonly associated with Flagyl (metronidazole), which is an earlier generation nitroimidazole, growing resistance to Tindamax has been seen among people treated for Trichomonas vaginalis.

Dosage: How Much Tindamax Should I Take?

Modifications

Tindamax is mainly metabolized (broken down) by the liver and excreted from the body in urine and stool. Because the course of treatment is short, the drug doesn’t have any notable effect on either kidney function or liver function.

With that said, people with end-stage kidney disease may lose as much as 43% of the circulating drug during hemodialysis. There are currently no guidelines directing the appropriate use of Tindamax in cases like this. Your healthcare provider will decide if your dose needs to be changed.

Missed Dose

If you miss a dose of Tindamax, take it as soon as you remember. If it is almost time for your next dose, skip the original dose and continue as normal. Never double-up doses.

Because the half-life of Tindamax is relatively short (12 to 14 hours), you need to make every effort to take the drug on schedule. Try to take it at the same time every day to maintain the optimal drug concentration in the blood.

To avoid missing doses, set a daily alarm on your cell phone and/or ask a friend or family member to serve as an “adherence buddy” during treatment.

Overdose: What Happens If I Take Too Much Tindamax?

According to the manufacturer, there are no reported cases of a Tindamax overdose.1 If one does occur—say, if someone takes all their pills at once—the risk of side effects might increase.

In such instances, supportive care can help treat side effects like upset stomach, nausea, or vomiting. If more significant side effects occur, hemodialysis could be used to quickly remove as much of the drug from the bloodstream.

Precautions

What Are Reasons I Shouldn’t Take Tindamax?

You should not take Tindamax if you have a known hypersensitivity to tinidazole or any other ingredient in the drug. The same applies if you have a hypersensitive reaction to other nitroimidazole antimicrobials like Flagyl (metronidazole), Dovprela (pretomanid), Solosec (secnidazole), and fexinidazole.

Based on the available evidence, Tindamax does not appear to pose significant health risks to an unborn baby during pregnancy. Animal studies have shown no evidence of birth defects or pregnancy complications when Tindamax was delivered at three to six times the maximum dose used in humans.

Even so, if you are pregnant or trying to get pregnant, speak with your healthcare provider to fully understand the benefits and potential risks of treatment.

Studies have shown that tinidazole can pass through human breast milk. Because of this, temporarily stop breastfeeding during treatment and for 72 hours after treatment to fully clear the medication from your system.

What Other Medications Interact With Tindamax?

A number of drugs can potentially interact with Tindamax. Some might decrease the concentration of tinidazole in the blood (reducing its effectiveness), while others might increase the concentration (along with the risk of side effects).

There are also drugs that may “compete” for the same liver enzyme—called CYP450—that Tindamax uses for metabolization.

Let your healthcare provider know if you use any of the following before starting Tindamax:

• Adrucil (fluorouracil)
• Cerebyx (fosphenytoin)
• Warfarin
• Dilantin (phenytoin)
• Lithium
• Nizoral (ketoconazole)
• Phenobarbital
• Prevalite (cholestyramine)
• Protopic (tacrolimus)
• Sandimmune (cyclosporine)
• Tagamet (cimetidine)
• Rifampin
• Alcohol

To avoid interactions, always tell your healthcare provider about any drugs you take, whether they are prescription, over-the-counter, nutritional, herbal, or recreational.

What Medications Are Similar?

Tindamax is classified as a second-generation nitroimidazole and is often used as an alternative to the first-generation nitroimidazole Flagyl (metronidazole). It treats a broader range of bacterial infections, including serious bone, joint, brain, skin, heart, gastrointestinal, and lung infections.

Flagyl generally remains the drug of choice for bacterial vaginosis and other bacterial infections. Even so, it requires a higher dose and dose frequency (in some cases, up to six doses per day for 10 days). It is also more likely to cause side effects.

Tindamax is typically used when Flagyl is either unavailable or causes intolerable side effects. However, some health providers will prescribe it as the first therapy if a susceptible bacteria is identified.

In 2017, the FDA approved a newer nitroimidazole agent, called Solosec (secnidazole), specifically used for the treatment of bacterial vaginosis. Other nitroimidazole agents, like Dovprela (pretomanid) and fexinidazole, are indicated for the treatment of multidrug-resistant tuberculosis and African sleeping sickness, respectively.

How Can I Stay Healthy While Taking Tindamax?

If you are prescribed Tindamax, it is because you have a specific bacterial or parasitic infection. To ensure the optimal response, it is up to you to take the drug as prescribed. Never stop early no matter how well you may feel; doing so can lead to antibiotic resistance.

If you are being treated for trichomoniasis, it is important to get your sex partner tested and treated if they test positive. The same consideration should be made if you have bacterial vaginosis and a female sex partner. Male sex partners don’t require testing or treatment.

If you have been diagnosed with amebiasis or giardiasis, it is important to stay healthy by ensuring ample hydration and eating a soft, plain diet until you are recovered. To avoid infecting others, wash your hands after using the bathroom and before preparing meals, clean toilet seats and surfaces regularly, and avoid sharing towels or face cloths.