Comprehensive medication guide to Metronidazole including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$15 copay for generic metronidazole; typically Tier 1 on most commercial, Medicare Part D, and Medicaid plans. High-deductible plan patients not yet at deductible may pay retail until deductible is met — in this case a GoodRx coupon is usually cheaper.
Estimated Cash Pricing
$22–$28 retail for a 14-tablet (500 mg) course without insurance; as low as $3.93–$9 with a free GoodRx or SingleCare coupon. Walmart's $4 generic program has historically included metronidazole.
Medfinder Findability Score
88/100
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Metronidazole is a nitroimidazole antimicrobial agent first FDA-approved in 1963. Known by the brand name Flagyl, it is one of the most widely prescribed antibiotics in the world. It is available as an affordable generic and is used to treat a broad range of bacterial and protozoal (parasitic) infections.
Metronidazole treats infections of the reproductive system (bacterial vaginosis, trichomoniasis, pelvic inflammatory disease), gastrointestinal tract (C. diff, amebiasis, giardiasis, H. pylori), skin and soft tissue, bone, joints, lungs, blood, and central nervous system. Topical forms (Metrogel, Metrocream, Metrolotion) are also used for rosacea.
Metronidazole comes in oral tablets (250 mg, 500 mg), extended-release tablets (750 mg, Flagyl ER), capsules (375 mg), intravenous solution, topical gel/cream/lotion, and vaginal gel formulations. It is not a controlled substance and can be prescribed by any licensed healthcare provider.
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Metronidazole is a prodrug — it is inactive until it enters the target organism. Once inside an anaerobic bacterium or parasite, the drug's nitro group is reduced by intracellular electron transport proteins (ferredoxin and pyruvate-ferredoxin oxidoreductase), creating highly reactive intermediates that attack and break the organism's DNA strands. With its DNA irreparably damaged, the organism dies.
This activation mechanism is specific to anaerobic and microaerophilic organisms — bacteria and parasites that live in low-oxygen environments. Aerobic bacteria and human cells cannot activate metronidazole in the same way, which is why the drug is selectively toxic to its targets while largely sparing the body's own cells.
Beyond its antimicrobial action, metronidazole also has anti-inflammatory properties — it inhibits NF-κB activation and reduces production of pro-inflammatory cytokines. This explains its effectiveness in topical form for rosacea and potential benefit in Crohn's disease and periodontal disease.
250 mg — tablet
Less commonly prescribed; used for some pediatric dosing and specific infection protocols
500 mg — tablet
Most common oral form; first-line for BV (500 mg BID x 7 days) and standard dosing for anaerobic infections
375 mg — capsule
Available as branded Flagyl capsule; less commonly prescribed than tablets
750 mg — extended-release tablet
Flagyl ER; once-daily dosing for bacterial vaginosis; not stocked at all pharmacies
500 mg/100 mL — IV solution
Used for serious inpatient anaerobic infections, PID, surgical prophylaxis; bioequivalent to oral
0.75% / 1% — topical gel
Metrogel for rosacea; applied once or twice daily to affected facial areas
0.75% — vaginal gel
Metrogel-Vaginal for BV; one applicatorful intravaginally once daily for 5 days
1.3% — vaginal gel
Nuvessa; single-dose vaginal gel for BV
Generic oral metronidazole tablets (500 mg) are one of the most widely available prescription medications in the United States, earning a findability score of 88/100. The vast majority of retail pharmacies — chain stores, grocery pharmacies, independent pharmacies — stock the 500 mg generic tablet routinely. It is not subject to any active national FDA shortage as of 2026.
However, specific forms can be harder to locate: the extended-release 750 mg tablet (Flagyl ER) is not stocked at every pharmacy; the oral suspension requires a compounding pharmacy or special order; and topical forms (Metrogel, Metrocream, vaginal gel) vary in availability. IV metronidazole has experienced manufacturing-related national shortages in the past and remains at some risk.
If you can't find metronidazole at your pharmacy, medfinder calls pharmacies near you to check which ones have it in stock and texts you the results — eliminating the need to call pharmacy after pharmacy yourself.
Metronidazole is not a controlled substance and carries no DEA scheduling restrictions. Any licensed prescriber with authority to write antibiotic prescriptions can prescribe it without special certification or DEA registration requirements beyond standard prescribing privileges.
Primary care physicians (family medicine, internal medicine, pediatrics)
OB/GYNs (especially for BV, trichomoniasis, and PID)
Urgent care physicians and emergency medicine providers
Nurse practitioners (NPs) and physician assistants (PAs)
Gastroenterologists (for C. diff, giardiasis, H. pylori, IBD)
Dentists (for dental abscesses and periodontal infections)
Infectious disease specialists
Metronidazole is widely available via telehealth for common indications like bacterial vaginosis and trichomoniasis. Platforms including Wisp, Nurx, Plushcare, and Teladoc routinely prescribe it. A telehealth visit for BV or trichomoniasis typically takes 10–15 minutes and results in an electronic prescription sent to the patient's preferred pharmacy.
No. Metronidazole is not a controlled substance and is not scheduled by the DEA. It does not have addiction potential or significant abuse liability. Any licensed prescriber with authority to write antibiotic prescriptions can prescribe metronidazole — including primary care physicians, OB/GYNs, nurse practitioners, physician assistants, dentists, urgent care providers, and telehealth platforms.
Because it is not controlled, prescriptions for metronidazole can be called in, faxed, or e-prescribed without the special handling required for DEA-scheduled medications. Refills are permitted without restriction (though refills are rarely needed given that most courses are 7–14 days). Prescriptions can be transferred between pharmacies normally.
Metallic or bitter taste in the mouth (most frequently reported)
Nausea (especially with large single doses)
Diarrhea
Headache
Dizziness
Abdominal pain or cramping
Dark or reddish-brown urine (harmless — from drug metabolites)
Vaginal yeast infection (in approximately 10% of women)
Seizures or convulsions (rare; call 911 immediately)
Encephalopathy (confusion, hallucinations, visual changes — stop medication immediately)
Peripheral neuropathy (numbness, tingling in hands or feet — report promptly)
Aseptic meningitis (severe headache, neck stiffness, fever)
Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis (rare; severe blistering skin reaction)
DRESS reaction (multiorgan allergic reaction — fever, rash, organ involvement)
Disulfiram-like reaction with alcohol (nausea, vomiting, flushing, rapid heartbeat — avoid alcohol during treatment and 3 days after)
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Tinidazole (Tindamax)
Same nitroimidazole class; longer half-life (~13h vs 8h); often single-dose convenience; fewer GI side effects; effective for BV, trichomoniasis, giardiasis, amebiasis
Secnidazole (Solosec)
Newest nitroimidazole; FDA-approved 2017; single-dose 2g oral granule packet for BV and trichomoniasis; convenient compliance advantage
Clindamycin (Cleocin)
Lincosamide antibiotic; effective against anaerobic bacteria; oral or vaginal for BV; preferred CDC alternative for metronidazole-allergic patients; higher C. diff risk
Fidaxomicin (Dificid)
Macrocyclic antibiotic; now preferred for C. diff infections over metronidazole due to better efficacy and lower recurrence rates
Prefer Metronidazole? We can find it.
Alcohol / propylene glycol
majorCauses disulfiram-like reaction: nausea, vomiting, flushing, rapid heartbeat. Avoid alcohol during treatment and 3 days after last dose.
Disulfiram (Antabuse)
majorAbsolutely contraindicated within 2 weeks of metronidazole use. Can cause psychotic reactions and severe CNS effects.
Warfarin (Coumadin)
majorMetronidazole inhibits CYP2C9 metabolism of warfarin, significantly increasing INR and bleeding risk. Monitor INR closely; warfarin dose reduction often needed.
Lithium
majorMetronidazole may increase lithium blood levels, risking toxicity (tremor, confusion, seizures). Monitor lithium levels.
Busulfan
majorMetronidazole increases busulfan plasma levels, potentially causing severe toxicity in cancer patients.
Phenytoin / Phenobarbital
moderateThese anticonvulsants increase metronidazole metabolism (potentially reducing efficacy); metronidazole may also raise phenytoin levels. Monitor both.
Cimetidine (Tagamet)
moderateSlows metronidazole metabolism, potentially increasing blood levels and side effect risk.
QT-prolonging drugs (certain antidepressants, antipsychotics)
moderateAdditive QT prolongation risk; may increase risk of torsades de pointes arrhythmia.
Metronidazole has been a cornerstone of antimicrobial therapy for over 60 years. Its unique mechanism of action — exploiting the anaerobic metabolism of target organisms to generate DNA-damaging intermediates — makes it one of the most selectively effective antibiotics available. It treats an exceptionally broad range of bacterial and parasitic infections, is available in multiple forms for oral, IV, and topical use, and is extremely affordable as a generic.
The most important rules for patients: take metronidazole with food to reduce nausea, absolutely avoid alcohol during treatment and for 3 days after, and complete the full prescribed course. Neurological side effects — while rare — are serious and should be reported immediately. For the conditions it treats, metronidazole remains highly effective with cure rates of 80-95%.
If you have a metronidazole prescription and are having trouble finding it in stock at your pharmacy, medfinder can help. Enter your medication and location, and medfinder will contact pharmacies near you to check availability and text you the results — no hold music, no repeated phone calls.
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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
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