27 Apr 2018

tinidozale OR metronidazole


I am sure this has been answered elsewhere, but i cant seem to find it.Flagyl appears to be the first choice, but many appear to take tinidozale as it is easier to bear. Is flagyl actually better?I also started to wonder while writing this, would lower doses of both, taken at the same time be more effective? similar to the doxy-roxy combination idea?Or is that why one protocol already combines INH with Flagyl?


 As far as I can tell, the only differences between Flagyl and Tinidazole are:

  1. Tini has a longer half life (lasts longer in the blood stream).
  2. Flagyl is much, much cheaper as Tini is still on patent ie no generic.
  3. Two common side effects with Flagyl seem much more diminished on Tini- nausea and depression.

 I find the extra expense worth it, since I would get so nauseated by day three on flagyl that I simply couldn't take any more. I never got the "Flagyl depression."

I'm not sure the half life correlates to the active effect, since it is not the drug itself which kills the Cpn but it's metabolites in the body, and I haven't seen any data on the half-life of the metabolites (it's just assumed that they are correlated to the half-life of the drug itself). But this may be why when you stop the Tini it seems to have effect for a couple days beyond.

Both seem to be equally effective at killing CPN. So take one or the other, no reason to take both. I would take Flagyl if I could tolerate it, as it's is so cheap, but I can't. I would encourage taking only one, so the other is "in reserve" in the unlikely case you create resistance over the protocol course. 

On Wheldon/Stratton protocol for Cpn in CFS/FMS since December 2004.

[quote=CureOrBust]I am sure this has been answered elsewhere, but i cant seem to find it.[/quote]

I new I saw it somewhere before, and after a few go's at lookin for it, i found it again at:

You can find the discussion under "Choice of antibiotics" within this page.

Although, now I am wondering about the effective difference between NAC and Amoxicillin.

NAC vs Amoxi- The reality is that we don't have any hard data on NAC in terms of it's effect on EB's as it wasn't tested in the original Vanderbilt research. Interestingly, it was independently arrived at as an alternative to amoxi by two clinical experts based on it's pharmacokinetics, David Wheldon and Mike Powell. The confirmation that it is killing chlamydial EB's is derived from patient reactions: NAC is an otherwise innocuous agent which should do no more than loosen some mucous and enhance liver function (via glutathione). Family members who do not have any evidense of Cpn have taken it with no reaction, while the Cpn infected person generally hs "NAC flu" reactions. But mind you, this is all clinical observation i.e. anecdotal. One of the good reasons to raise some $ in the future would be to support restarting a Cpn lab at Vanderbilt under Dr. Stratton and get some research done about NAC.

On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra

 Just after posting the above I noticed this very related post by Sojournersister on another thread:

I was diagnosed 19 years ago at the age of 30 and consider myself both blessed and lucky because if you'd walk by me you'd never suspect I have MS.  Yes, I have my days with all the usual tingles, fatigue etc. that comes with this disease, but I live a normal life. All this about me leads me to my point regarding skeptisim and confusion new guests I'm sure have.  I decided I would start with NAC and let my body tell me if I too could have these lousy critters. What a surprise I'm having.....heavy thick eyelids, cold, tingles in places that haven't tingled for a while; actually I'm feeling more MSy in the past few weeks than I have in the past 19 years!!!! How could this be possible?  I'm the same person who can play a game of tennis or golf 18 holes like anyone else...yet NAC has reminded me of what's obviously lurking around.  I can't say enough to anyone beginning to learn about Cpn to consider trying NAC, and finding if your body speaks to you. What's the worse thing that can happen? NAC is healthy for anyone...Whether it's you or someone you love that suffers from one of the many diseasesi listed perhaps buying a bottle of this extraordinary amino acid could turn out to be the best gift ever! Thanks again Sojourner.....!



On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra

I know there is another forum topic quite active on this question, but it has appeared to go off onto another direction. Anyway, the following is almost a blog...

I recently looked up info on Flagyl (as i had some reactions on the 3rd day of a pulse. which would be a modified pulse, starting with a single 800mg first dose, followed by 400mg every 8hrs)

Anyways, as in the following (and many other pages) I read of flagyl causing neuropathy while under high doses. eg: [quote]Overdose: Symptoms: Single oral doses of metronidazole, up to 12 g have been reported in accidental overdoses. Symptoms were limited to vomiting, ataxia and slight disorientation. Neurotoxic effects, including seizures and peripheral neuropathy have been reported after 5 to 7 days of oral doses of 6 to 10.4 g every other day.[/quote] at

Now, Im no doctor, however, I would hazard a guess that having MS makes my myelin a little more sensitive to neurotoxic effects, and therefore i may possibly experience these side effects at much lower flagyl doses. So i will be tryng to get a tini script from my doctor for my next pulse. I dont even know if tini is in this country (Australia)

Those 12 grams of Flagyl side effects sound surprisingly mild. Hell, I have pretty much those symptoms without Flagyl ;) If I had any hope whatsoever that you could take out a lot of Cpn with a very large dose of Flagyl that would probably be worth trying. But based upon the way it and Cpn works I would guess it would probably just kill a few and make you feel a little worse than normal.

- Paul 

Single oral doses of flagyl up to 15 g have been used, and not even for suicidal purposes! Flagyl was an experimental radiosensitizer used in conjunction with radiation in terminal cancer patients in the mid 1970s. These doses were not used every day; it was every other day or sparser. The paper reporting the 15 g dose reported a max of 55 g total intake over three weeks, which is not that much in terms of average per day.

Some patients (not sure how many) had no issues except nausea/vomiting, but Annals Intern Med 88.3.361, 1978, reports two cases of severe seizures in patients taking respectively 6 and 3 g /m^2 every other day. One of the patients also had liver problems. Surface area by the Mosteller formula is [(height cm * weight kg) / 3600] ^ (0.5).

There are some hitches with translating this research to anti-infective therapy:

1. Even in the absence of a personal seizure history, people with brain diseases like CFS and MS might have quite lower seizure threshholds than normals or cancer patients (I dont know for sure). Thus there might be greater sensitivity to seizures caused by flagyl. Herxheimer reaction could also potentially magnify the problem (or create problems in other organs). I apparantly had a mild complex partial seizure myself early in my illness (before I was on any treatment). Seizures can potentially be lethal.

2. These very large flagyl doses might be somewhat carcinogenic. It depends on whether the mutagenicity for human cells is concentration-dependent or time-dependent. The experimenters probably didnt care about this since their patients already had cancers (mostly or all terminal cancers, I think). Theres no point worrying about cancer when you already have a severe case of it.

One group (Placidi) used radiolabelled metronidazole in mice. They found that it (or a metabolite) built up in the cerebellum and hippocampus and remained there with a long half-life. The group reporting the seizure problem in high-dosing patients thinks that this progressive buildup in the brain may be why the seizures only occured after the fifth or so 48-hourly dose (at 3 or 6 g /m^2).

Apparantly, at the accepted doses of metronidazole (up to 2 g a day), this buildup in the brain comes to equilibrium at a concentration low enough that most patients dont experience neruological side effects.

 Some of the early work looking at flagyl reported a differential clearance of it from neural tissues, especially the brain, compared to other tissues. in other words it cleared much more slowly from neural tissues, and thus toxic build up could occur there with high doses, hence seizure potential from high doses. Now I have to find the paper on my hard disk!

Let's see if this link works:


On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra

I did a search for tini (after I realized the correct spelling) in australia, and found a few links.

Pfizers australian product sheet on it has the following:[quote]Do not take Fasigyn if you have any disease of the brain, spinal cord or nerves.[/quote](Fasigyn is their trade name)

um... MS i think would be something like that. But its gotta be better than flagyl.

The quote is from

Hmm.  I wondered about this myself when reading my Metronidazole information sheet which also says to consult your doctor if :

  • you have a disease of the central nervous system (other than a brain abcess)

Now here's a thought.  What if the pharmaceutical company added this after seeing, during trials say, that MS sufferers for example had an MS like relapse while taking these drugs.  It's a real shame they didn't think for a minute "hang on this is affecting people with MS is there a link here"?  Die off of CPn is thought to cause such a reaction and hence a misinterpretation as a "bad" reaction to the drug could well have been a "good" sign that the drug was in fact killing off an unwanted bacteria?  Sorry if this is slightly off topic.

Does anybody know why these cautionary notes are in the product information leaflets as it very nearly put me off?

On Wheldon Protocol for MS since Feb 2006, West Sussex, U.K.

Part of it is the finding that high dose or long term use increases risk of peripheral neuropathy. Another is that brain tissue clears the metronidazole slower than other tissue, so a borderline toxicicity from it in other tissues can become toxic to brain tissue over the longer time it takes to clear it.

But do remember that these cautions are also for liability reasons, and are oriented from the "worst case" scenario, not from the appropriateness of medical use. Then if there's a problem, the legal department can say, "We warned them, they just didn't heed."

On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra