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This document provides critical safety and warning information about the use of Likmez (metronidazole). Please read it carefully, and consult your healthcare provider with any questions or concerns.

• Cancer Risk: Animal studies suggest that metronidazole may cause cancer in mice and rats, though it's unclear if this risk extends to humans. Likmez should only be used when necessary, as determined by your healthcare provider, and for the prescribed duration only.

• Neurological Effects: Rarely, metronidazole can cause seizures or impair brain function, with potential for brain damage (encephalopathy) or aseptic meningitis. Symptoms include dizziness, difficulty walking or speaking, shaking, and uncontrolled movements. If any of these occur, contact your provider or seek emergency help immediately.

• Nerve Damage: Some individuals have experienced nerve damage while taking metronidazole, indicated by burning, tingling, numbness, pain, or sensitivity to temperature changes. Notify your provider if these symptoms arise.

• Blood Cell Count Issues: Metronidazole has been associated with a decrease in white blood cell counts in some cases. Inform your provider if you have a history of blood cell count issues; they may monitor your blood levels before and after treatment.

• Fungal Infections: Likmez may cause new fungal infections or exacerbate existing ones, such as yeast infections or thrush. Symptoms to watch for include white patches in the mouth, redness, soreness, pain while eating or swallowing, or vaginal symptoms like thick discharge or itching. Report these to your provider immediately.

Contraindications: Likmez (metronidazole) should not be used if:

• You have taken disulfiram within the last 2 weeks.
• You consume alcohol or products containing propylene glycol during treatment and for 3 days afterward.
• You have a history of Cockayne syndrome, due to the risk of severe liver damage.

For any contraindications or unusual symptoms, consult your healthcare provider promptly.

When taking this medication, you might experience some common side effects, which are generally mild and temporary. These include dizziness, headache, stomach upset, nausea, vomiting, loss of appetite, diarrhea, constipation, and a metallic taste in the mouth. If these symptoms persist or worsen, inform your healthcare provider. It's also possible for your urine to change to a darker color while on the medication, but this is harmless and will resolve after stopping the drug.

While many people do not experience serious side effects, it's important to be aware of them. Serious effects that require prompt medical attention include easy bruising or bleeding, stomach pain, painful urination, and changes in mental state such as confusion. If you experience severe headaches, unsteadiness, seizures, trouble speaking, numbness or tingling in the limbs, eye pain, sudden vision changes, or a stiff neck, seek immediate medical help.

In rare instances, prolonged use may lead to oral thrush or a new yeast infection, so watch for white patches in the mouth or changes in vaginal discharge. Although very rare, severe allergic reactions can occur, characterized by persistent fever, swollen lymph nodes, rash, itching, swelling, severe dizziness, or breathing difficulties. If you notice these symptoms, get emergency medical attention. Remember, it's crucial to contact your healthcare provider if you experience any unusual symptoms during treatment.