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Tongue discolouration and other toxicities: 10 case reports The Netherlands Pharmacovigilance Centre database received ten reports of tongue discolouration and other toxicities during treatment with metronidazole. Six patients had received other antibacterials or chlorhexidine mouthwash, which can also cause tongue discolouration. Nine women and one man, aged 21–60 years [exact ages not stated], received metronidazole at either 250mg or 500mg [frequencies and routes not stated]. Two patients were receiving treatment for an infection, while a further two patients had either amoebiasis or an abscess [indications for remaining patients not stated]. Five patients were receiving other antibiotics that were reported as suspect drugs; three received amoxicillin, one received amoxicillin/clavulanic acid and one received clarithromycin [details of drug administrations not stated]. Another patient was using chlorhexidine mouth wash [dosage, indication and duration of treatment to reaction onset not stated]. Tongue discolouration occurred after 1 day to 2 weeks of metronidazole in all patients. Additionally, three patients experienced either taste alteration or a metallic taste, while one patient developed pharyngitis and another patient later developed glossitis. Other suspected adverse drug reactions were reported in three patients, including malaise, palpitations, muscle weakness, urine discolouration, headache, dizziness, abnormal stools and nausea. Metronidazole therapy was withdrawn for three patients, and reduced for one patient. Four patients continued to receive metronidazole unchanged. At last follow-up, three patients were either recovering or recovered, while another three patients had not recovered; the remaining patient outcomes were not reported. Author comment: "The number of cases and latency time suggests a relationship between metronidazole and tongue discolouration, which is further supported by a mechanism due to disturbance of the mouth flora." Lareb. Metronidazole and tongue discolouration Internet Document : [4 pages], 23 803077178 Jul 2012. Available from: URL: http://www.lareb.nl/ - Netherlands

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Reactions 22 Sep 2012 No. 1420