Metronidazole Gel 0.75% topically for pouchitis

There was some interest in this a few years ago, then it just sort of fell off. It does seem like a reasonable approach to me. I always wondered, why not use Flagyl suppositories? They come in 500mg and 1000mg doses. Those are also for vaginal use, so I presume they are probably on the large size. Still, with a little lube, they might be easier than messing with the gel.

Jan

Hey can you get insurance coverage for "Metronidazole Vaginal Gel USP 0.75%" if you are a guy? Because I suspect that when they see that I am a male and know that I don't have a vagina, they will call shenanigans on me and I will get the ole coverage kabosh.  I suppose I can argue I am considering a sex change operation, but without getting into all that nonsense (and by the way I am not considering a sex change at this time), does anyone know if a pouchitis scrip will work and whether the product comes with an anal adaptor for the applicator?

Just ask your doc for the gel for anal use.

It is called "off label use," and is fairly common in the industry. As long as it is on your plan's formulary as a covered drug, how it is used is between you and your doctor. Drug companies are just not allowed to promote off label use to doctors to increase their profits. For that, they have to have FDA approval for that specific use. Once a drug is FDA approved, your doctor is free to prescribe it for whatever reason he chooses. It seems that the insurance companies mostly balk if it is an expensive treatment, like biologics or new brand name antibiotics.

A common example is the use of tricyclic antidepressants (like Elavil) for neuropathic pain. 

Jan

Metronidazole is pretty inexpensive, so I wouldn't waste much time worrying about coverage.

It seems possible (perhaps even likely) that the metronidazole is being absorbed systemically from the topical (enema) application. If that's the case then it's not really avoiding antibiotics, but rather consuming them in a form you find more acceptable. Similarly, oregano oil seems like it's simply an antibiotic that hasn't been studied by any drug companies or commercialized as a drug. There's nothing in the FDA approval process that makes a particular chemical more harmful. On the contrary, the process helps ferret out adverse reactions, which are largely unknown for supplements such as oregano oil.

OK, thanks for the replies.  I am going to look into oregano oil.  Is there a possibility of oregano oil by enema as well, or should it be taken orally? The flagyl gel enema seems interesting but in the past, all retention enemas that I took I had problems holding.  My Pouch is not retention enema-friendly, for whatever reason.

http://www.mayoclinic.org/dise...ts/art-20046983?pg=1

I know of several off label uses of amitriptyline, which is a tricyclic like Jan mentioned. It was prescribed by my neurologist to treat my 24/7 migraines. My psychiatrist increased the dose of it to take the place of an antidepressant I was taking. It's primary purpose is as an antidepressant. The third benefit has been my improved j-pouch function because I haven't taken a loperamide (Imodium) since I started using it. I still have chronic cuffitis and pouchitis but the number of daily BM's has decreased and their consistency is better too.

I also like the idea of using an antibiotic by inserting it directly into the j-pouch.  It's like using mesalamine suppositories (canasa) instead of taking it in pill form like many of us did for UC.

Hi guys, just an update.  The gel is still working really well for me. I find "less is more" and still am using every 2-3 nights.  Just two tsps of the Metronidazole gel per application which is probably 3 grams or so (1/2 fill of the supplied applicator).  Yes, Metronidazole is secreted in breast milk therefore there is "some" systemic absorption, but I really find no side effects from it's use in this way.  Jan, I am going to check into Flagyl supps as these would make travel and just general application easier!  Thanks for the tip! CT, I hope it works for you!  No vagina, no problem   I too have issues holding anything "liquid" but mixing the gel with just 30-40ml water in a syringe makes the entire solution thick..and seems to hold ok for me. Def. have to be lying down flat..and a pre-rinse out of the pouch prior to application really helps too.

Oregano.  I have tried using oregano tincture in an enema (oh, the things I've tried...) It was pretty irritating (for me) due to the alcohol used in tincture extraction.  I take Gaia Herbs CO2 extracted Oregano caps. Just 1 a day for maintaining but one can take 2.  Oregano can be "hard" on the liver so recommended to use 4-6 weeks tops, then take a break.  They work so well for me,  better than antibiotics.  But yes, it's all the same thing in the end. Kill the bad guys and keep that immune system in chill-out mode.

I still take no probiotics, I def. do better without them but who knows? I almost feel as though my immune system reacts to any bacteria!  Gah.

Hope everyone is doing well...