Satranidazole

Usage

Satranidazole is an antiprotozoal and antibacterial medication primarily used to treat infections caused by anaerobic bacteria and certain protozoa. It is prescribed for:

• Amebiasis: Specifically, amebic liver abscess, intestinal amebiasis.
• Giardiasis: Infection of the small intestine.
• Trichomoniasis: A sexually transmitted infection.
• Anaerobic bacterial infections: Infections caused by bacteria that thrive in the absence of oxygen.

Pharmacological Classification: Antiprotozoal, Antibacterial (Nitroimidazole derivative)

Mechanism of Action: Satranidazole enters the microorganisms and undergoes reductive activation. This activated form then interacts with the DNA of the susceptible organisms, causing damage and ultimately leading to their death.

Alternate Names

While satranidazole is the generic name, brand names may vary depending on region. Some examples of brand names include Satrogyl, Satracid and Tranim.

How It Works

Pharmacodynamics: Satranidazole exerts its therapeutic effect by damaging the DNA, RNA, and proteins of susceptible anaerobic bacteria and protozoa, inhibiting their growth and replication.

Pharmacokinetics:

• Absorption: Satranidazole is well-absorbed after oral administration.
• Metabolism: Hepatic metabolism plays a role, but specific details on metabolites or CYP enzyme involvement are limited in the current sources.
• Elimination: Primarily eliminated via the kidneys. The half-life is approximately 14 hours.

Mode of Action: Inside the anaerobic microorganisms, satranidazole is reduced by low redox potential electron transport proteins like ferredoxin. This reduced form then creates reactive metabolites and free radicals, which directly damage the cellular components of the anaerobic bacteria and protozoa. Specific receptor binding, enzyme inhibition, or neurotransmitter modulation is not its primary mechanism.

Dosage

Standard Dosage

Adults:

• Amebiasis (Amebic liver abscess): 300 mg twice daily for 5-10 days.
• Giardiasis and Trichomoniasis: A single dose of 600 mg.
• Anaerobic infections: Dosage and duration depend on the severity and location of the infection; consultation with an infectious disease specialist is recommended.

Children:

Satranidazole is generally not recommended for children under 18 years of age. However, a doctor might prescribe it in specific cases where the benefits clearly outweigh the risks. Pediatric dosing should be carefully determined by a doctor, based on the child’s weight and the specific infection.

Special Cases:

• Elderly Patients: While specific dose adjustments are not universally recommended, caution is advised, especially in patients with renal or hepatic impairment. Monitoring for adverse effects is essential.
• Patients with Renal Impairment: Dose adjustments may be necessary in patients with severe renal dysfunction. Close monitoring of kidney function is recommended.
• Patients with Hepatic Dysfunction: Use with caution in patients with severe liver disease. Monitor liver function tests as appropriate.
• Patients with Comorbid Conditions: Exercise caution and monitor for potential drug interactions in patients with comorbid conditions, particularly those affecting drug metabolism.

Clinical Use Cases

The provided sources do not provide dosage recommendations for specific medical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Please consult with specialists for dosage recommendations in such cases.

Dosage Adjustments

Adjustments may be necessary in renal or hepatic impairment. The presence of other medical conditions may also necessitate dose modifications. Therapeutic drug monitoring can be valuable in some situations to optimize efficacy and minimize the risk of side effects.

Side Effects

Common Side Effects

• Headache
• Dizziness
• Dry mouth
• Weakness
• Metallic taste
• Nausea (less common with satranidazole compared to other nitroimidazoles)
• Vomiting (less common with satranidazole compared to other nitroimidazoles)

Rare but Serious Side Effects

• Severe skin reactions (rash, itching, swelling)
• Peripheral neuropathy (numbness, tingling, pain in extremities)
• Seizures (rare)
• Blood dyscrasias (rare)

Long-Term Effects

Limited data exists on long-term effects. Prolonged use might increase the risk of peripheral neuropathy.

Adverse Drug Reactions (ADR)

Any signs of hypersensitivity, severe gastrointestinal upset, neurological symptoms, or blood disorders should be considered serious ADRs and warrant immediate medical attention.

Contraindications

• Hypersensitivity to satranidazole or other nitroimidazole derivatives.
• History of blood dyscrasias.
• Active organic neurological disorders.
• Pregnancy (unless absolutely necessary, after careful risk-benefit assessment).
• Breastfeeding (safer alternatives should be considered).

Drug Interactions

• Alcohol: Avoid alcohol during and up to 72 hours after satranidazole therapy due to the risk of a disulfiram-like reaction (flushing, headache, nausea, vomiting).
• Anticoagulants (e.g., warfarin): Satranidazole may potentiate the effects of warfarin, necessitating close monitoring of prothrombin time (PT) and INR and potential dose adjustment.
• Disulfiram: Concurrent use may cause psychotic reactions.
• Lithium: Serum levels may be increased.

Pregnancy and Breastfeeding

Satranidazole is generally contraindicated during pregnancy and breastfeeding. While animal studies have not shown teratogenicity, the potential risk to the fetus or nursing infant is not fully understood. If the use of satranidazole is considered essential during pregnancy, it should only be done after careful risk-benefit assessment by a physician. Safer alternatives are preferred whenever possible.

Drug Profile Summary

• Mechanism of Action: Damages DNA of susceptible anaerobic bacteria and protozoa.
• Side Effects: Headache, dizziness, dry mouth, metallic taste, nausea (rare). Serious side effects: peripheral neuropathy, seizures (rare), blood dyscrasias (rare).
• Contraindications: Hypersensitivity, blood dyscrasias, active neurological disorders, pregnancy, breastfeeding.
• Drug Interactions: Alcohol, warfarin, disulfiram.
• Pregnancy & Breastfeeding: Contraindicated.
• Dosage: Varies based on the infection; see detailed dosage section above.
• Monitoring Parameters: In long-term use or in patients with hepatic or renal impairment, monitor liver function tests, kidney function tests, and complete blood count.

Popular Combinations

Satranidazole is sometimes combined with ofloxacin for enhanced coverage of mixed bacterial infections.

Precautions

• General Precautions: Assess for hypersensitivity, history of blood disorders, and neurological conditions before initiating therapy.
• Specific Populations: As outlined in the special cases section above.
• Lifestyle Considerations: Avoid alcohol during therapy and up to 72 hours after discontinuation. Driving or operating machinery should be avoided if dizziness or other neurological effects occur.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Satranidazole?

A: The dosage depends on the infection. See detailed dosage information above.

Q2: Can I drink alcohol while taking Satranidazole?

A: No. Alcohol should be avoided during and for 72 hours after treatment due to the risk of a disulfiram-like reaction.

Q3: Is Satranidazole safe during pregnancy?

A: No. Satranidazole is generally contraindicated in pregnancy.

Q4: Can Satranidazole be used in children?

A: Generally not recommended for children under 18. A doctor might prescribe it in special cases where benefits clearly outweigh risks.

Q5: What are the common side effects of Satranidazole?

A: Headache, dizziness, dry mouth, weakness, and metallic taste.

Q6: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.

Q7: How does Satranidazole work?

A: It damages the DNA of susceptible anaerobic bacteria and protozoa.

Q8: Is Satranidazole effective against all types of infections?

A: No. Satranidazole is only effective against specific anaerobic bacteria and protozoa. It is not effective against viral infections.

Q9: What are the serious side effects of Satranidazole?

A: Rare but serious side effects include peripheral neuropathy, seizures, and blood disorders. Seek immediate medical attention if you experience any of these.