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What is Zidoval?

Zidoval is a gel containing 0.75% metronidazole. Metronidazole is an antibiotic which works most effectively against anaerobic bacteria. Anaerobic bacteria do not require oxygen to live. When a woman has bacterial vaginosis (BV), anaerobic bacteria replace the lactobacilli which usually maintain a healthy vaginal environment. Metronidazole kills the anaerobic bacteria allowing the lactobacilli to take over again and restore the natural balance in the vagina.

Using Zidoval

Zidoval gel is inserted into the vagina using the disposable applicator provided, at bedtime for 5 days.

To use the applicator:

• Wash your hands before and after using Zidoval.
• Remove the cap from the tube of Zidoval.
• Screw a new applicator onto the tube.
• Gently squeeze the tube at the bottom to fill the applicator with Zidoval. The applicator is full (5gm dose) when the plunger no longer moves.
• Unscrew the applicator, and replace the tube cap.
• Holding the applicator barrel, gently insert the applicator into the vagina towards the lower back, as far as it goes without discomfort.
• Holding the applicator barrel steady, push the plunger in completely to release the gel at the top of the vagina.
• Remove the applicator and dispose of it wrapped in tissue, in a bin. Do not throw it in a toilet.
• Use a new applicator each night.
• Only use Zidoval gel once daily and complete the 5-day course.

Zidoval has a cure rate of 70%-80%, but in some women BV can be a recurrent condition requiring multiple courses of treatment. Zidoval has been shown in trials to be effective when used as a suppressive treatment. This is an off-label use, prescribed by specialists.

Cautions when using Zidoval

• Zidoval should not be used during the monthly period (menses).
• Do not use other vaginal products (tampons, creams, etc) during treatment with Zidoval vaginal gel.
• Care with use if previous blood dyscrasias.
• Avoid sexual intercourse during BV infection and whilst using treatment.
• Possible allergy or skin reaction to other ingredients. See patient leaflet for more details.
• Do not drink alcohol whilst using or for 48 hours afterwards as there is a possibility of a disulfiram reaction. Disulfiram is given to people with alcoholism, to help them to stop drinking alcohol. It causes a bad reaction when alcohol is taken. The disulfiram reaction includes nausea, vomiting, dizziness, chest, head, and abdominal pains. See also FAQs.

Zidoval and pregnancy

If BV needs to be treated during pregnancy, Zidoval can be used at any time but the manufacturers recommend caution. Dr Fox does not prescribe for pregnant women. Please consult your GP.

Zidoval and breastfeeding

Zidoval can be used with caution whilst breastfeeding. Dr Fox does not prescribe for women who are breastfeeding. Please consult your GP.

Possible side effects

As the dose of Zidoval which is absorbed is less than 2% of that from taking a metronidazole 500mg tablet, the risk of side effects is very low.

Possible mild side effects from metronidazole include:

• Nausea, vomiting, diarrhoea, loss of appetite, numbness or tingling, metallic or unpleasant taste in mouth, skin dryness, discomfort, or itch.
• Drowsiness, dizziness, and visual disorders - if affected do not drive, cycle or operate other machinery.

As with all antibiotic treatments, candida (vaginal thrush) may develop and require treatment.

Stop using Zidoval immediately and contact a doctor if any of the following occur:

• Signs of acute allergy - this includes swelling of the hands, feet, ankles, face, lips, or throat which may cause difficulty in swallowing or breathing with an itchy, lumpy, rash or nettle rash (hives/urticaria).
• Other severe skin rashes with a high temperature - possible 'Steven-Johnson Syndrome'.
• Fever, stiff neck, headache, hallucinations, confusion, difficulty using arms or legs, or speaking - possible encephalopathy.

Alternative treatments for bacterial vaginosis

There are several alternative prescription treatments for BV. Always use medication according to the regime actually prescribed for you.

Metronidazole tablets

• 400mg tablets twice a day for 5-7 days.
• 500mg tablets twice a day for 5-7 days.
• One dose of 2 grams (5 x 400mg tablets or 4 x 500mg tablets) all at once.

Clindamycin tablets

• 300mg tablets twice a day for 7 days.
• Usually reserved for pregnancy.

Clindamycin 2% vaginal cream (Dalacin)

Every night for 7 nights.

Other measures to relieve symptoms and reduce risk of getting bacterial vaginosis

• Take a shower instead of a bath.
• Use only water and a plain soap or aqueous cream to wash genital area.
• Do not use vaginal douching, vaginal washes, or vaginal deodorants.
• Do not use antiseptic, perfumed soap, bubble baths, shampoo, or shower gel in the bath.
• Do not use strong detergent to wash underwear.
• Do not smoke.

Does metronidazole in Zidoval cause cancer?

In laboratory trials, long-term use of metronidazole has caused cancers in mice and rats but not in hamsters. Despite courses of metronidazole being used in humans for many years, no link with metronidazole causing human cancer has been found. However, it is recommended that metronidazole tablets are not taken long term. The dose of Zidoval which is absorbed is extremely low and there is no evidence that there is any risk of developing cancer from using it.

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