Topical Antibiotic/Antiprotozoal — Rosacea Pregnancy: US label: Pregnancy Category B. There has been no experience to date with the use of metronidazole 0.75% topical gel in pregnant patients. Metronidazole crosses the placental barrier and enters the fetal circulation rapidly; because oral metronidazole has been shown to be a carcinogen in some rodents, this drug should be used during pregnancy only if clearly needed. (UK oral SPC: there is inadequate evidence of safety in pregnancy; should not be given during pregnancy or lactation unless the physician considers it essential.)

Metronidazole Topical

Brand names: Rozex, Metrogel, Metrosa

Used in: Sepsis Acute Appendicitis

Topical metronidazole is an antimicrobial and anti-inflammatory preparation applied to the face for the inflammatory papules and pustules of rosacea.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Apply and rub in a thin film of metronidazole 0.75% topical gel to the entire affected area twice daily, morning and evening, after washing

Route: Topical (cutaneous)

Frequency: Twice daily (morning and evening)

SOURCE / ROUTE FLAG: the UK SPC fetched into this bundle is Metronidazole 200 mg Film-Coated TABLETS (oral route, systemic anaerobic/protozoal infections) — that posology does NOT apply to this topical monograph and has deliberately not been used. The dose above is taken verbatim from the US label for metronidazole 0.75% topical gel; the UK SPC for the topical product (gel/cream) still needs to be sourced and the strength, frequency and licensed indication (e.g. rosacea) verified. Areas to be treated should be cleansed before application; patients may use cosmetics after application. Paediatric: safety and effectiveness of the topical gel in paediatric patients have not been established; no per-kg dose is stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

History of hypersensitivity to metronidazole, to parabens, or to other ingredients of the formulation
(Oral metronidazole SPC, for reference only) known hypersensitivity to nitroimidazoles, metronidazole or any excipient

Side effects

Burning at the application site
Skin irritation and dryness
Transient redness
Metallic taste
Tingling or numbness of extremities; nausea

Interactions

Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, prolonging prothrombin time; the effect of topical metronidazole on prothrombin time is not known

Clinical monograph

How it works

In rosacea its benefit is attributed mainly to anti-inflammatory and antioxidant effects on the skin rather than to a classical antibacterial mechanism.

Prescribing in practice

For external use only; avoid contact with the eyes and apply only to affected areas of the face.
Advise avoidance of excessive sunlight, as some patients report photosensitivity.
Apply a thin film to the affected skin once or twice daily as directed, and expect a gradual response over weeks.

Monitoring

Monitoring is clinical, assessing improvement in inflammatory rosacea lesions and any local irritation or dryness.

Counselling the patient

Apply a thin layer to the affected areas as directed and keep it away from the eyes.
Improvement is gradual, so continue the treatment course even if results are slow.
Avoid known rosacea triggers and protect your face from strong sun.

Evidence & guidelines

Topical metronidazole is an established first-line option for papulopustular rosacea and is recommended within NICE clinical guidance.

Reference: BAD Rosacea Guidelines 2017; ATTRACT Trial (Taieb et al. Br J Dermatol 2015); NICE CKS Rosacea; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways