Endar 500mg/400mg Tablet: Complete Medicine Guide
Clinical Reference Standards: CDSCO (Central Drugs Standard Control Organisation), Indian Pharmacopoeia (IP) & WHO | Last Updated: September 2026
When to Call Your Doctor IMMEDIATELY
- Blood in stool or vomit
- Severe abdominal pain or cramping
- Signs of tendon pain, swelling, or rupture
- Numbness, tingling, or burning in hands or feet
- Seizures or confusion
- Severe allergic reaction (rash, swelling, difficulty breathing)
- Yellowing of skin or eyes (jaundice)
- Decreased urine output
- Persistent diarrhoea after completing treatment
If experiencing severe symptoms, call emergency services immediately.
What is gramogyl tablet used for?
This medicine is a prescription combination of metronidazole 500 mg and norfloxacin 400 mg used to treat infectious diarrhoea, dysentery, and other susceptible bacterial and protozoal infections. It works by killing the causative organisms. It must be taken exactly as prescribed, and alcohol must be avoided completely.
- Generic Name: Metronidazole (500mg) + Norfloxacin (400mg)
- Manufacturer: Sun Pharmaceutical Industries Ltd
- Form: Allopathy
- Pregnancy Category: Consult doctor
- Prescription Required: Yes
🇮🇳 gramogyl tablet के बारे में (Hindi Summary)
उपयोग: यह दवा मेट्रोनिडाजोल 500 मिलीग्राम और नॉरफ्लोक्सासिन 400 मिलीग्राम का संयोजन है। इसका उपयोग संक्रामक दस्त, पेचिश, और कुछ जीवाणु और प्रोटोज़ोआ संक्रमणों के इलाज के लिए किया जाता है। यह दवा कीटाणुओं को मारकर काम करती है। इसे डॉक्टर के निर्देशानुसार ही लें और शराब का सेवन बिल्कुल न करें।
साइड इफेक्ट्स: इस दवा के सामान्य दुष्प्रभावों में मतली, उल्टी, पेट में असुविधा, मुँह में धातु जैसा स्वाद, सिरदर्द, चक्कर आना और भूख में कमी शामिल हैं। गंभीर दुष्प्रभावों में टेंडन टूटना, तंत्रिका क्षति, दौरे, और गंभीर एलर्जी प्रतिक्रियाएँ शामिल हो सकती हैं। कोई भी असामान्य लक्षण होने पर तुरंत डॉक्टर से संपर्क करें।
सुरक्षा सलाह: इस दवा को डॉक्टर के बताए अनुसार ही लें। बेहतर महसूस होने पर भी कोर्स पूरा करें। शराब का सेवन बिल्कुल न करें। दूध, दही, या एंटासिड के साथ इस दवा को न लें; कम से कम 2 घंटे का अंतर रखें। चक्कर आने पर वाहन न चलाएँ। गर्भवती या स्तनपान कराने वाली महिलाएँ डॉक्टर से सलाह लें।
💊 gramogyl tablet Uses & Benefits
[{"condition":"Infectious diarrhoea","description":"Used to treat diarrhoea caused by susceptible bacteria and protozoa, including mixed infections.","evidence":"Well-established"},{"condition":"Bacillary dysentery","description":"Effective against Shigella species and other invasive bacteria causing dysentery.","evidence":"Well-established"},{"condition":"Amoebic dysentery","description":"Metronidazole component targets Entamoeba histolytica, while norfloxacin covers secondary bacterial infections.","evidence":"Well-established"},{"condition":"Giardiasis","description":"Metronidazole is effective against Giardia lamblia; norfloxacin may cover concurrent bacterial overgrowth.","evidence":"Well-established"},{"condition":"Bacterial gastroenteritis","description":"Used when a specific susceptible organism is identified or suspected.","evidence":"Moderate"}]
Off-label uses: [{"condition":"Prophylaxis in colorectal surgery","description":"Sometimes used off-label for preventing postoperative infections, though not a standard regimen.","evidence":"Limited"},{"condition":"Small intestinal bacterial overgrowth (SIBO)","description":"Norfloxacin may be used off-label, but combination with metronidazole is not standard.","evidence":"Limited"}]
Primary treatment for: Infectious diarrhoea
Also treats: Bacillary dysentery, Amoebic dysentery, Giardiasis, Bacterial gastroenteritis
📋 Drug Information
| Generic Name(s) | Metronidazole (500mg) + Norfloxacin (400mg) |
| Brand Name | gramogyl tablet |
| Manufacturer | Sun Pharmaceutical Industries Ltd |
| Packaging / Form | Varies by brand (Allopathy) |
| Therapeutic Class | GASTRO INTESTINAL |
| Action Class | |
| Route of Administration | Oral |
| Storage | Store at room temperature between 15°C and 30°C (59°F to 86°F). Protect from light and moisture. Keep in the original container. |
| Shelf Life | 24 months from the date of manufacture. |
| WHO Guideline | Not established from the available information. |
| ICMR Guideline | Not established from the available information. |
👨⚕️ Doctor's Practical Tips
Evidence-based practical advice from experienced clinicians
🔍 Is This Medicine Right for Your Symptom?
Educational reference. Always consult a doctor for diagnosis.
🔬 How This Medicine Works (Pharmacology)
Pharmacokinetics
How It Works
This medicine combines two agents with distinct mechanisms. Metronidazole is a nitroimidazole that enters anaerobic organisms and protozoa, where its nitro group is reduced to reactive intermediates that damage DNA, causing strand breakage and inhibiting nucleic acid synthesis, leading to cell death. Norfloxacin is a fluoroquinolone that inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription, repair, and recombination. This inhibition leads to rapid bacterial cell death. The combination provides broad coverage against anaerobic bacteria, protozoa, and many gram-negative and some gram-positive aerobic bacteria.
Mechanism Steps
💡 How to Take gramogyl tablet
Strength: Each tablet contains metronidazole 500 mg and norfloxacin 400 mg.
Dosage Information
| Adult Dosage | The usual adult dose of this medicine is one tablet taken orally twice daily, or as prescribed by your doctor. The exact dose and duration depend on the type and severity of the infection, your kidney and liver function, and your response to treatment. Dose must be individualized by a qualified clinician based on indication, age, weight, renal and hepatic function. Do not self-adjust the dose. Complete the full course even if you feel better. |
| Pediatric Dosage | Pediatric dosing is not established from available information. Consult a pediatrician. |
| Elderly Dosage | Elderly patients may be more sensitive to the effects of this medicine, especially dizziness, tendon problems, and renal impairment. Dose adjustment may be necessary based on kidney function. Use with caution and monitor closely. |
| Renal Impairment | In patients with renal impairment, dose adjustment is required. Norfloxacin is primarily excreted by the kidneys, and accumulation can occur. For creatinine clearance less than 30 mL/min, a reduced dose or extended dosing interval is recommended. Metronidazole dose may also need adjustment in severe renal failure. Consult your doctor for personalized dosing. |
| Hepatic Impairment | In patients with severe hepatic impairment, metronidazole metabolism may be reduced, leading to increased drug levels. Dose reduction may be necessary. Monitor liver function closely. Norfloxacin does not require significant adjustment in hepatic impairment. |
| Maximum Daily Dose | The maximum recommended daily dose is one tablet twice daily (metronidazole 1000 mg and norfloxacin 800 mg per day). Do not exceed the prescribed dose. |
Dosage Timeline
🍽️ Food Timing Guide
⏰ What to Do If You Miss a Dose
⚠️ Side Effects of gramogyl tablet
✅ Common Side Effects
🚨 Serious Side Effects
⚠️ Rare Side Effects
Consult your doctor if you experience any unusual symptoms.
🔬 Drug Interactions
| Drug | Severity | Effect |
|---|---|---|
| Warfarin | Major | |
| Alcohol | Major | |
| Antacids | Major | |
| Theophylline | Major | |
| Lithium | Major | |
| Cimetidine | Moderate | |
| Phenytoin | Moderate | |
| Cyclosporine | Moderate | |
| Oral contraceptives | Moderate | |
| Dairy products | Minor |
🚨 Major Interactions
- Warfarin
- Alcohol
- Antacids containing aluminum or magnesium
- Theophylline
- Lithium
⚡ Moderate Interactions
- Cimetidine
- Phenytoin
- Cyclosporine
- Oral contraceptives
🍷 Alcohol Interaction
Alcohol must be strictly avoided while taking this medicine and for at least 48 hours after the last dose. Metronidazole can cause a disulfiram-like reaction with symptoms including severe nausea, vomiting, flushing, headache, and rapid heartbeat. Norfloxacin may also increase the effects of alcohol on the central nervous system.
🔎 Check Your Other Medicines
Educational tool. Always confirm with your doctor or pharmacist.
🛡️ Safety & Warnings
🚫 Contraindications
["Known hypersensitivity to metronidazole, norfloxacin, or other fluoroquinolones","History of tendon disorders associated with fluoroquinolone use","Myasthenia gravis","Severe renal impairment (dose adjustment required, may be contraindicated)","Pregnancy (especially first trimester) and breastfeeding","Children and adolescents under 18 years (fluoroquinolones not recommended)","Alcohol consumption during treatment and for 48 hours after"]
⚠️ Warnings & Precautions
["Avoid alcohol completely during treatment and for 48 hours after the last dose.","Do not take antacids, multivitamins, or dairy products within 2 hours of this medicine.","May cause dizziness; avoid driving or operating machinery until you know how it affects you.","May cause photosensitivity; avoid excessive sun exposure and use sunscreen.","Serious tendon effects, including rupture, can occur; stop and seek medical help if you experience tendon pain or swelling.","Peripheral neuropathy may occur; report numbness or tingling to your doctor.","May cause seizures, especially in patients with epilepsy or CNS disorders.","Prolonged use may lead to superinfection or Clostridioides difficile-associated diarrhoea.","Use with caution in elderly patients and those with renal or hepatic impairment.","Inform your doctor if you are pregnant, planning pregnancy, or breastfeeding."]
🤱 Lactation Safety
Metronidazole is excreted in breast milk and may cause adverse effects in the nursing infant. Norfloxacin is also excreted in breast milk. This combination is generally not recommended during breastfeeding. If treatment is essential, breastfeeding may need to be interrupted during therapy and for 48 hours after the last dose. Consult your doctor for guidance.
💊 Overdose Management
Overdose of this medicine may cause nausea, vomiting, dizziness, and in severe cases, seizures or peripheral neuropathy. There is no specific antidote. Treatment is supportive and symptomatic. Gastric lavage may be considered if ingestion is recent. Monitor vital signs and provide supportive care. Contact a poison control center or emergency department immediately if overdose is suspected.
⏰ Missed Dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.
Additional Safety Advice
Take this medicine exactly as prescribed by your doctor. Do not skip doses or stop treatment early, even if you feel better, as this can lead to resistance. Avoid alcohol completely during treatment and for at least 48 hours after the last dose, as it can cause severe nausea, vomiting, flushing, and rapid heartbeat. Take the tablet with a full glass of water, with or without food. Do not take antacids, multivitamins, or dairy products within 2 hours before or after taking this medicine, as they can reduce absorption. Inform your doctor if you have kidney or liver problems, epilepsy, or a history of tendon problems. Avoid excessive sunlight and use sunscreen, as this medicine can make your skin more sensitive to sunlight. Do not drive or operate heavy machinery if you experience dizziness or confusion.
👴 Special Considerations for Elderly
💡 For Patients Above 65
Elderly patients are at higher risk of tendon rupture, peripheral neuropathy, and renal impairment with this medicine. Dose adjustment may be necessary based on kidney function. Use with caution and monitor closely for side effects.
🤰 Pregnancy Planning (TTC)
This combination is not recommended during pregnancy or when planning pregnancy. Norfloxacin may harm the developing fetus. If you are planning pregnancy, consult your doctor for alternative treatment options.
🏥 Post-Surgery Considerations
This medicine may be used to treat postoperative infections if susceptible organisms are involved. However, it is not routinely used for surgical prophylaxis. Consult your surgeon for specific instructions.
🦷 Dental Procedures
Inform your dentist if you are taking this medicine, as it may interact with other medications used during dental procedures. No specific precautions are typically required, but maintain good oral hygiene.
💚 Lifestyle Tips for Better Results
🏋️ Exercise Considerations
Avoid strenuous exercise while you are recovering from an infection. If you experience tendon pain, swelling, or weakness, stop exercising and consult your doctor immediately, as fluoroquinolones can increase the risk of tendon rupture.
🥗 Diet Recommendations
💼 Impact on Daily Work & Life
This medicine may cause dizziness, confusion, or seizures in rare cases. Avoid driving or operating heavy machinery until you know how it affects you. You may need to take time off work if you have severe diarrhoea or are feeling unwell. Complete the full course before returning to normal activities.
🛑 When to Stop This Medicine
Do not stop taking this medicine without consulting your doctor, even if you feel better. Stopping early can lead to recurrence of infection and antibiotic resistance. However, if you experience serious side effects such as tendon pain, severe allergic reaction, or seizures, stop the medicine immediately and seek medical help.
📅 Long-Term Use Effects
Long-term use of this medicine is not recommended and may lead to antibiotic resistance, superinfections, and rare but serious effects such as peripheral neuropathy, tendon damage, and blood dyscrasias. Prolonged use should be avoided unless specifically directed by a doctor. Regular monitoring of renal and hepatic function may be required if extended therapy is necessary.
🌿 Non-Medicine Approaches
These can complement medicine but do not replace prescribed treatment.
Essential for managing dehydration from diarrhoea, regardless of cause.
Evidence: Well-establishedMay help restore gut flora and reduce duration of diarrhoea, but should be taken at least 2 hours apart from antibiotics.
Evidence: ModerateRecommended in children with diarrhoea to reduce severity and duration.
Evidence: Well-established💉 Vaccination Considerations
💉 If You're Getting Vaccinated
This medicine may reduce the efficacy of live bacterial vaccines such as typhoid vaccine. Avoid taking live vaccines during treatment and for several days after. Consult your doctor for specific timing.
📦 Storage Guide
✅ DO
Store at room temperature (15-30°C)
❌ DON'T
Do not refrigerate unless specified
✅ DO
Keep in original container
❌ DON'T
Do not transfer to unmarked containers
✅ DO
Keep away from direct sunlight
❌ DON'T
Do not store in bathroom cabinet
✈️ Traveling with This Medicine
When traveling, carry this medicine in its original packaging with a copy of your prescription. Store it at room temperature, away from direct sunlight and moisture. If crossing time zones, adjust dosing times gradually to maintain even intervals. Do not pack it in checked luggage; keep it in your carry-on. Check local customs regulations regarding prescription medicines before travel.
💰 Cost Analysis & Savings
👥 Real Patient Stories
Educational, anonymized scenarios. Individual results may vary.
💬 Questions Patients Often Ask
A: You may start feeling better within 1-2 days, but it is important to complete the full course as prescribed, usually 3-7 days.
A: Yes, you can take it with food to reduce stomach upset. However, avoid dairy products and antacids within 2 hours of the dose.
A: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
A: No, alcohol must be strictly avoided during treatment and for 48 hours after the last dose, as it can cause a severe reaction with metronidazole.
A: This combination is generally not recommended during pregnancy, especially norfloxacin. Consult your doctor if you are pregnant or planning to become pregnant.
🤔 Common Patient Concerns
🔄 Substitutes for gramogyl tablet
View AllAlternative brands with exact same active ingredient:
-
vigyl n 500mg/400mg tabletVision Medilink ₹43.13 42.5% CHEAPER
-
kumagyl n 500mg/400mg tabletKumayun Drugs Pvt Ltd ₹57.00 24% CHEAPER
-
endar 500mg/400mg tabletMagnachem Pharmaceuticals Pvt Ltd ₹65.63 12.5% CHEAPER
Medical Note: Always consult your doctor before switching medications.
🛑 Myths vs. Facts
- Myth: This medicine can cure any type of diarrhoea.
Fact: This medicine is only effective against specific susceptible bacteria and protozoa. It is not effective for viral diarrhoea or diarrhoea caused by non-infectious conditions. - Myth: You can stop taking this medicine once you feel better.
Fact: You must complete the full prescribed course to prevent recurrence and resistance, even if symptoms improve. - Myth: It is safe to drink alcohol while taking this medicine.
Fact: Alcohol must be strictly avoided as it can cause a severe disulfiram-like reaction with metronidazole. - Myth: This medicine can be taken with milk or antacids.
Fact: Dairy products and antacids reduce the absorption of norfloxacin. They should be taken at least 2 hours apart.
🔄 Alternative Options
Generic Alternatives
- Metronidazole 500 mg + Norfloxacin 400 mg tablet (various manufacturers)
Brand Alternatives
- Endar 500mg/400mg tablet