What causes severe itching after inserting metronidazole suppositories, and what should be done about it?

Generally, severe itching after inserting metronidazole suppositories may be caused by drug irritation, improper application, drug allergy, symptoms of vaginitis itself, or vulvitis. Patients can choose appropriate management methods such as general care or medication based on their specific condition. Detailed analysis is as follows:

1. Drug Irritation

The active ingredients may cause mild irritation to the vaginal mucosa, resulting in temporary itching. Discontinue the medication temporarily and observe, clean the external genitalia with warm water, wear loose cotton underwear, and avoid further irritation to the vaginal mucosa.

2. Improper Application

Rough handling or fingernail scratches during insertion may damage the vaginal mucosa, and contact of the medication with injured areas can trigger itching. Trim nails before insertion and apply the suppository gently and slowly. If mucosal injury occurs, discontinue use until healing is complete.

3. Drug Allergy

Allergic reaction to metronidazole activates the immune system, causing localized allergic responses such as itching and swelling. Immediately stop using the drug and take cetirizine hydrochloride tablets or loratadine capsules as directed by a physician. Apply calamine lotion topically for relief.

4. Symptoms of Vaginitis Itself

If the underlying condition (e.g., fungal vaginitis) is uncontrolled, inflammation may continue to irritate the vaginal mucosa, potentially worsening itching initially after medication use. Seek timely medical evaluation to adjust the treatment plan. Use clotrimazole suppositories, miconazole nitrate suppositories, or fluconazole tablets as prescribed.

5. Vulvitis

Increased vaginal discharge may irritate the skin of the external genitalia, leading to inflammatory reactions and itching, which may become more pronounced when combined with medication use. Clean the external genital area with warm water, keep it dry, and apply erythromycin ointment or mupirocin ointment as directed by a physician. Oral cefuroxime axetil tablets may also be prescribed.

When using vaginal medications, special attention should be paid to hygiene and any adverse reactions. Avoid scratching if itching occurs. If itching persists after discontinuing the medication or is accompanied by burning or pain, seek prompt medical attention to identify the cause. Avoid self-medication to prevent delays in proper diagnosis and ensure safe and effective treatment.