MetroCream Side Effects: What to Expect and When to Call Your Doctor

MetroCream (metronidazole 0.75% topical cream) is generally considered safe and well tolerated. In clinical trials, the total incidence of adverse reactions was approximately 10%, and most side effects were mild and application-site related. That said, knowing what to expect — and what warrants a call to your doctor — is important for any rosacea patient starting this medication.

Common Side Effects of MetroCream (Mostly Mild)

The most common side effects of MetroCream are related to where you apply it. In controlled clinical trials, each individual event occurred in less than 3% of patients:

Burning or stinging at the application site — The most commonly reported side effect. Usually mild and improves as your skin adjusts.

Skin dryness — MetroCream can have a drying effect, especially in patients with already sensitive skin. Using a gentle, fragrance-free moisturizer after the cream dries can help.

Skin redness (erythema) — Some patients notice temporary redness after applying, separate from their rosacea.

Skin irritation — General irritation or sensitivity at the application site is possible, particularly when starting treatment.

Itching (pruritus) — Mild itching can occur, though it is uncommon and typically not severe.

Worsening of rosacea — In rare cases, some patients experience an initial worsening of rosacea symptoms. This is uncommon and typically resolves with continued use.

Tips to Minimize Common Side Effects

Always wash and dry your face before applying — wait 15 minutes after washing before applying the cream

Apply only a thin layer — using too much doesn't improve results and increases irritation risk

Avoid the eye area — accidental contact can cause tearing and irritation

Use a gentle, fragrance-free moisturizer after the cream dries to reduce dryness

If irritation is significant, your doctor may recommend applying once daily instead of twice daily

Serious Side Effects: Rare but Important to Know

Serious side effects with topical metronidazole are rare, but they do occur. The following warrant attention:

Peripheral neuropathy: Numbness, tingling, or abnormal sensations in the hands or feet. This was not observed in clinical trials for topical metronidazole, but has been reported in post-approval use. Stop using MetroCream and contact your doctor immediately if you experience any neurological symptoms.

Allergic or contact dermatitis: More than typical irritation — signs include severe redness, swelling, blistering, or rash spreading beyond the application area. Stop use and contact your doctor or seek emergency care if severe.

Eye contact: MetroCream can cause tearing and irritation if it gets into your eyes. Rinse thoroughly with water if this occurs.

When to Call Your Doctor

Any numbness, tingling, or neurological symptoms (peripheral neuropathy)

Severe skin reaction: blistering, crusting, swelling, or spreading rash

No improvement in rosacea symptoms after 3–4 weeks of consistent use

Significant worsening of rosacea symptoms rather than improvement

Any signs of allergic reaction (hives, significant swelling, difficulty breathing)

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Special Populations: Pregnancy, Breastfeeding, and Children

Systemic absorption of topical metronidazole is very low — blood levels following application are less than 1% of those seen with a single 250mg oral dose. However, caution is still appropriate. If you are pregnant, planning pregnancy, or breastfeeding, discuss MetroCream use with your provider before starting. The safety and effectiveness of MetroCream in children have not been established.

How Long Until MetroCream Works?

Most patients start to see meaningful improvement in their rosacea symptoms after 3–4 weeks of consistent daily use. Significant improvement typically occurs by weeks 8–12. If you're not seeing results by that point, talk to your dermatologist about adjusting your treatment. For more on how MetroCream works, see our guide: What is MetroCream? Uses, dosage, and what you need to know.