A fixed-dose combination (FDC) of a second-generation fluoroquinolone antibiotic (Norfloxacin) and a nitroimidazole antimicrobial (Tinidazole). This combination provides broad-spectrum coverage against both aerobic and anaerobic bacteria, as well as protozoa, making it highly effective in treating mixed gastrointestinal and genitourinary infections common in the Indian context. It is widely prescribed for infectious diarrhea, giardiasis, and amebiasis.
Adult: One tablet (Norfloxacin 400mg + Tinidazole 600mg) twice daily for 5-7 days. For giardiasis/amebiasis: Often prescribed as once or twice daily for 3-5 days, as per severity.
Note: Take tablet with a full glass of water, preferably 1 hour before or 2 hours after meals for optimal absorption. Do not crush or chew. Maintain adequate hydration. Avoid concomitant administration with antacids, sucralfate, or iron/zinc supplements (separate by 2-4 hours).
Norfloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription, and repair, leading to rapid bactericidal activity. Tinidazole enters microbial cells, undergoes nitro-reduction to form cytotoxic intermediates that damage DNA and inhibit nucleic acid synthesis, leading to cell death in anaerobic bacteria and protozoa.
Pregnancy: CONTRANDICATED, especially in first trimester. Tinidazole is mutagenic in bacteria and carcinogenic in rodents. Norfloxacin causes arthropathy in immature animals. Use only if potential benefit justifies extreme risk to fetus (FDA Category C).
Driving: May impair mental alertness and physical coordination. Can cause dizziness, vertigo, and visual disturbances. Patients should not drive or operate machinery until their response is known.
| Antacids (Al, Mg, Ca), Sucralfate, Iron/Zinc Salts | Markedly reduce absorption of Norfloxacin due to chelation | Major |
| Warfarin | Tinidazole may inhibit metabolism, increasing INR and bleeding risk | Major |
| Theophylline | Norfloxacin may inhibit metabolism, increasing theophylline levels and toxicity | Major |
| Cyclosporine | Norfloxacin may increase cyclosporine levels, risk of nephrotoxicity | Moderate |
| NSAIDs (e.g., Ibuprofen) | May increase risk of CNS stimulation and seizures with Norfloxacin | Moderate |
| Oral Hypoglycemics (e.g., Glyburide) | Tinidazole may potentiate effect, risk of hypoglycemia | Moderate |
| Phenobarbital, Phenytoin | May increase metabolism of Tinidazole, reducing its efficacy | Moderate |
| Alcohol | Disulfiram-like reaction with Tinidazole (flushing, nausea, vomiting, tachycardia) | Major |
Same composition (Norfloxacin (400mg) + Tinidazole (600mg)), different brands: