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Nuvessa

metronidazole
Used for Bacterial Vaginosis

Nuvessa (metronidazole) is a prescription vaginal antibiotic gel used to treat a vaginal infection called bacterial vaginosis (BV) in women 12 years and older. It comes as a prefilled applicator that's a single-dose treatment applied once inside the vagina, usually at bedtime. Common side effects include vaginal yeast infection, headache, and vaginal itching.

Reviewed by:
reviewerKristianne Hannemann, PharmD
reviewerDaisy Chau, PharmD
Last reviewed on March 16, 2026
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What is Nuvessa (metronidazole)?

What is Nuvessa (metronidazole) used for?

How Nuvessa (metronidazole) works

Nuvessa (metronidazole) is a nitroimidazole antibiotic. It works by damaging the DNA of certain bacteria and stopping them from growing in the vagina.

When does Nuvessa (metronidazole) start working?Time passed since treatment started:
HOURS
DAYS
Full effect
WEEKS
MONTHS

Drug facts

Common BrandsNuvessa
Drug ClassNitroimidazole antibiotic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Side effects of Nuvessa (metronidazole)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Vaginal yeast infection (6%)
  • Headache (2%)
  • Vaginal itching (2%)
  • Nausea (2%)

Less Common Side Effects

  • Diarrhea
  • Menstrual cramps

Source: DailyMed

The following Nuvessa (metronidazole) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Agitation

back pain

blindness

blurred vision

burning, numbness, tingling, or painful sensations in the hands or feet

changes in speech patterns

confusion

decreased vision

depression

dizziness

drowsiness

eye pain

fever

headache

irritability

lack of coordination

nausea

seeing or hearing things that are not there

seizures

shakiness and unsteady walk

slurred speech

stiff neck or back

trouble speaking

unsteadiness, trembling, or other problems with muscle control or coordination

unusual tiredness or weakness

vomiting

weakness in the arms, hands, legs, or feet

Less common

Black, tarry stools

blood in the urine

body aches or pain

burning while urinating

chills

clumsiness or unsteadiness

difficulty with breathing

ear congestion

fainting

feeling of pelvic pressure

frequent or painful urination

irregular heartbeat

loss of voice

nasal congestion

pinpoint red spots on the skin

runny nose

skin rash, hives, redness, itching

sneezing

stomach and back pain (severe)

unusual bleeding or bruising

vaginal irritation, discharge, or dryness not present before taking the medicine

Rare

Bleeding gums

bloating

chest pain

constipation

cough

dark urine

fast heartbeat

indigestion

loss of appetite

painful or difficult urination

pains in the stomach, side, or abdomen, possibly radiating to the back

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

yellow eyes or skin

Incidence not known

Blistering, peeling, or loosening of the skin

bloody or cloudy urine

burning while urinating

continuing diarrhea

continuing stomach pain

diarrhea

feeling of warmth

increased volume of pale, dilute urine

joint or muscle pain

loss of bladder control

red skin lesions, often with a purple center

red, irritated eyes

redness of the face, neck, arms, and occasionally, upper chest

redness of the skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness or lightheadedness

feeling of constant movement of self or surroundings

heartburn

sensation of spinning

stomach cramps

trouble sleeping

weight loss

Rare

Change in taste sensation

congestion

dry mouth

pain or tenderness around the eyes and cheekbones

tender, swollen glands in the neck

trouble with swallowing

unpleasant or sharp metallic taste

voice changes

Incidence not known

Decreased interest in sexual intercourse

inability to have or keep an erection

loss in sexual ability, desire, drive, or performance

painful sexual intercourse

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Nuvessa (metronidazole)

Pros

  • Only need to use a single dose
  • Specifically approved for women 12 years and older
  • Targets bacteria directly in the vagina

Cons

  • Should avoid alcohol during treatment at for at least 24 hours after
  • Not recommended for use while breastfeeding
  • Can cause vaginal irritation
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Pharmacist tips for Nuvessa (metronidazole)

pharmacist
  • Before using Nuvessa (metronidazole), read the Instructions for Use to better understand how to use it properly.
  • While using Nuvessa (metronidazole), don't have sex or use tampons or other vaginal products during treatment. Ask your prescriber how long you need to wait until having sex or using vaginal products after treatment.
  • If you get Nuvessa (metronidazole) in your eyes, rinse them with cool tap water right away. Contact your prescriber if irritation continues.
  • Contact your prescriber if you notice vaginal irritation while using Nuvessa (metronidazole). They might need to recommend a different treatment for you.
  • Let your prescriber know all of the medications you're taking so they can check for interactions with Nuvessa (metronidazole).
  • Don't drink alcohol during treatment with Nuvessa (metronidazole) and for at least 24 hours after. Alcohol can make you feel very sick while this medication is in your body.
  • [Nuvessa (metronidazole) can sometimes cause a vaginal yeast infection. Contact your prescriber if you notice symptoms like itching, burning, or thick discharge.
  • Pregnancy: It isn't known if Nuvessa (metronidazole) is safe to use during pregnancy. If you're pregnant or thinking of becoming pregnant, speak to your prescriber before using it.
  • Breastfeeding: Nuvessa (metronidazole) can pass into breast milk. If you're breastfeeding, talk with your prescriber about feeding options during treatment. They might recommend pumping and throwing away breast milk while using the medication and for 2 days after your last dose.
  • Store Nuvessa (metronidazole) at room temperature. Don't freeze or refrigerate it because this could damage the medication.

How to use Nuvessa (metronidazole)

  • When you're ready for your dose, tear the foil packet open and take out the prefilled applicator and plunger.
  • Keep the cap on the applicator and push the tip of the plunger into the other end. Then, pull the cap straight off.
  • You can insert the applicator into your vagina in any comfortable position. For example, you can lie on your back with your knees bent.
  • Gently insert the applicator into your vagina as far as it will comfortably go. Then pull it back slightly.
  • Hold the applicator barrel and slowly push the plunger until it stops to release the gel into your vagina.
  • Remove the empty applicator from your vagina and throw it away.
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Risks and warnings for Nuvessa (metronidazole)

Nuvessa (metronidazole) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Nervous system problems

  • Risk factors: Use of oral and IV metronidazole | History of nervous system problems

Certain nervous system problems have been reported in people who use oral or intravenous (IV) metronidazole. These problems can include seizures, brain conditions, meningitis, and nerve damage.

Tell your prescriber if you have a history of nervous system problems before using Nuvessa (metronidazole). Stop using it and contact your prescriber right away if you notice unusual nervous system symptoms like numbness or tingling in your hands or feet.

Possible risk of cancer

Animal studies have found a link between oral metronidazole and cancer. There haven’t been cancer studies with Nuvessa (metronidazole), but this form of the medication is absorbed into your body much less than the oral version. Use Nuvessa (metronidazole) exactly as prescribed. If you’re concerned about the possible cancer risk, talk with your prescriber.

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Nuvessa (metronidazole) dosage

Typical dosage for Nuvessa (metronidazole)

The typical dose is to insert 1 applicatorful into the vagina at bedtime as a one-time dose.

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Interactions between Nuvessa (metronidazole) and other drugs

Nuvessa (metronidazole) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Nuvessa (metronidazole). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Nuvessa (metronidazole) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Nuvessa (metronidazole) will not be safe for you to take.

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What are alternatives to Nuvessa (metronidazole)?

There are a number of medications that your doctor can prescribe in place of Nuvessa (metronidazole). Compare a few possible alternatives below.
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