Comprehensive medication guide to Likmez including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Insurance coverage varies; Likmez is typically Tier 3 or higher on most formularies and may require prior authorization. With approved coverage, copay ranges from $0–$80 depending on plan. Many insurers prefer generic metronidazole tablets as a lower-cost alternative.
Estimated Cash Pricing
$207–$246 retail for a 75 mL bottle (500 mg/5 mL); as low as ~$213 with a GoodRx coupon at participating pharmacies. No generic equivalent available as of 2026. Generic metronidazole tablets (same active ingredient) cost $5–$10 with GoodRx for a full course.
Medfinder Findability Score
45/100
Summarize with AI
On this page
Likmez is the brand name for metronidazole oral suspension 500 mg/5 mL — the first and only FDA-approved ready-to-use liquid formulation of metronidazole in the United States. It was approved on September 25, 2023, manufactured by Saptalis Pharmaceuticals, and marketed by Kesin Pharma. The suspension has a strawberry-peppermint flavor and does not require refrigeration.
Likmez was specifically developed to address a real clinical gap: patients who cannot take conventional metronidazole tablets due to dysphagia (difficulty swallowing), taste-related adherence barriers, or need for an FDA-approved liquid formulation rather than a compounded suspension. It belongs to the nitroimidazole class of antimicrobial drugs.
Likmez is FDA-approved to treat trichomoniasis (a sexually transmitted infection) in adults, amebiasis (intestinal and liver abscess caused by Entamoeba histolytica) in adults and pediatric patients, and serious anaerobic bacterial infections in adults. It is not a controlled substance and is available by prescription only.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Likmez works through the active ingredient metronidazole, a nitroimidazole antimicrobial. After being swallowed and absorbed, metronidazole passively diffuses into susceptible anaerobic bacteria and parasites. Inside these organisms, the low-oxygen environment causes a chemical reduction of metronidazole's nitro group, forming highly reactive nitroso free radicals.
These free radicals attack the organism's DNA — causing loss of the DNA's helical structure, strand breakage, and inhibition of DNA synthesis. Unable to maintain its genetic integrity, the organism cannot replicate and dies. This mechanism selectively kills anaerobic bacteria and certain parasites while leaving human cells and aerobic bacteria largely unaffected, because the critical activation step only occurs in low-oxygen environments.
Importantly, metronidazole also inhibits aldehyde dehydrogenase — the liver enzyme that metabolizes alcohol. This is why consuming alcohol during Likmez treatment causes a severe disulfiram-like reaction and why alcohol is contraindicated during treatment and for 3 days after the last dose.
500 mg/5 mL — oral suspension
Ready-to-use strawberry-peppermint flavored liquid suspension. Shake well before each dose. Use calibrated measuring device only. Store at room temperature; discard 10 days after opening.
Likmez has a findability score of 45 out of 100, reflecting the fact that while it is not in an official shortage, it is significantly harder to find than generic metronidazole tablets. As a niche brand-name specialty product that was only FDA-approved in September 2023, many pharmacies have not incorporated it into their standard inventory. Patients frequently need to call multiple pharmacies or ask their pharmacy to order it.
There is no active FDA or ASHP-declared shortage of Likmez as of 2026. The difficulty in finding it is primarily a distribution and stocking issue: pharmacies tend not to stock brand-name specialty products unless there is consistent demand, and the widespread availability of cheap generic metronidazole tablets reduces incentive to stock Likmez. Larger chain pharmacies (CVS, Walgreens, Rite Aid) are more likely to carry it or be able to order it within 1-2 business days.
To find Likmez in stock near you, use medfinder — a service that calls pharmacies near your location to check stock and texts you the results, saving you the time of calling multiple pharmacies yourself.
Likmez (metronidazole) is not a controlled substance and has no DEA scheduling restrictions. Any licensed prescriber in the United States can prescribe it, including via telehealth. The following provider types regularly prescribe Likmez:
Likmez can also be prescribed via telehealth appointments in all 50 states. Services like Teladoc, MDLive, Nurx, Wisp, and many insurance-provided telehealth apps can evaluate appropriate infections and prescribe Likmez electronically to your preferred pharmacy — making access faster and more convenient, especially for trichomoniasis and other STI-related indications.
No. Likmez (metronidazole) is not a controlled substance and has no DEA schedule classification. It is a standard prescription-only antibiotic that can be prescribed by any licensed healthcare provider, including primary care physicians, nurse practitioners, physician assistants, OBGYNs, and specialists.
Because Likmez is not controlled, it can be prescribed via telehealth in all 50 states without special DEA requirements. Prescriptions can be transmitted electronically to any pharmacy. There are no refill restrictions beyond the standard antibiotic prescribing rules — however, because Likmez is used to treat specific infections with defined treatment courses, refills are rarely needed and should only be prescribed based on clinical indication.
The following side effects are common and typically mild, improving as treatment progresses or resolving after the course is complete:
Stop taking Likmez and seek immediate medical attention for these serious side effects:
Know what you need? Skip the search.
Metronidazole tablets (generic)
Same active ingredient as Likmez; clinically equivalent for patients who can swallow tablets. Much less expensive ($5–$10 per course) and universally available. Preferred when liquid form is not medically necessary.
Flagyl (metronidazole brand tablet)
Brand-name metronidazole tablet by Pfizer. Same indications and mechanism as Likmez. Available in 250 mg and 500 mg tablets and as Flagyl ER (750 mg extended-release). More expensive than generic tablets but cheaper than Likmez.
Tinidazole (Tindamax)
Related nitroimidazole antibiotic effective for trichomoniasis and amebiasis. For trichomoniasis, can be given as a single 2g dose. Fewer GI side effects reported in some studies. Available as tablets only; not approved for anaerobic bacterial infections.
Clindamycin
Alternative for anaerobic bacterial infections when metronidazole is contraindicated (e.g., alcohol dependency, Cockayne syndrome). Available in oral capsule and liquid forms (75 mg/5 mL), as well as IV. Different spectrum of coverage.
Prefer Likmez? We can find it.
Alcohol / propylene glycol
majorContraindicated. Causes severe disulfiram-like reaction (nausea, vomiting, flushing, tachycardia). Avoid all sources of alcohol during treatment and for 3 days after last dose.
Disulfiram (Antabuse)
majorAbsolutely contraindicated if used within the past 2 weeks. Combination has caused severe psychotic reactions including confusion and hallucinations in alcoholic patients.
Warfarin (Coumadin)
majorMetronidazole significantly increases warfarin's anticoagulant effect by inhibiting CYP2C9. Monitor INR closely; warfarin dose reduction often needed.
Lithium (Lithobid)
moderateMetronidazole can increase lithium blood levels, raising risk of lithium toxicity (tremor, confusion, diarrhea). Monitor lithium levels during and after treatment.
Phenytoin (Dilantin)
moderateMetronidazole inhibits phenytoin metabolism, raising phenytoin levels and risk of toxicity (dizziness, ataxia, nystagmus). Monitor phenytoin levels.
Lopinavir/ritonavir oral solution
majorContains propylene glycol — causes disulfiram-like reaction. Use lopinavir/ritonavir tablet form (not oral solution) during Likmez treatment.
Live bacterial vaccines (typhoid)
moderateLikmez may reduce effectiveness of live bacterial vaccines. Avoid administering live bacterial vaccines during treatment.
Likmez represents a meaningful advance in antibiotic formulation — the first FDA-approved ready-to-use liquid metronidazole fills a real gap for patients with dysphagia, pediatric patients needing amebiasis treatment, and those who have struggled with tablet adherence. Its room-temperature storage, pleasant flavoring, and FDA-approved status make it preferable to compounded alternatives.
The key challenges in 2026 are availability and cost. At $207–$246 per bottle with no generic equivalent, Likmez is significantly more expensive than generic metronidazole tablets. And because it's a relatively new specialty product, not all pharmacies stock it. Patients should be prepared to search across multiple pharmacies or ask a pharmacy to order it within 1-2 days.
If you're struggling to find Likmez, medfinder is a service that calls pharmacies near you to check which ones have Likmez in stock and texts you the results — eliminating the frustrating cycle of hold times and dead ends. Whether you're a patient or a prescriber trying to help a patient access this medication, medfinder is designed to make the process faster and less stressful.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini