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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Tinidazole" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2020/02/20" /><meta name="citation_pmid" content="31643856" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548538/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Tinidazole" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2020/02/20" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548538/" /><meta name="description" content="Tinidazole is an orally available, broad spectrum antimicrobial agent used in the treatment of bacterial, protozoal and parasitic infections. Tinidazole is a nitroimidazole similar to metronidazole and is likely to have a similar spectrum and frequency of side effects, including a low rate of serum enzyme elevations during therapy and rare instances of clinically apparent acute liver injury." /><meta name="og:title" content="Tinidazole" /><meta name="og:type" content="book" /><meta name="og:description" content="Tinidazole is an orally available, broad spectrum antimicrobial agent used in the treatment of bacterial, protozoal and parasitic infections. Tinidazole is a nitroimidazole similar to metronidazole and is likely to have a similar spectrum and frequency of side effects, including a low rate of serum enzyme elevations during therapy and rare instances of clinically apparent acute liver injury." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548538/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Tinidazole/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548538/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548538_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548538_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Timolol/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Tinospora/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548538_"><span class="title" itemprop="name">Tinidazole</span></h1><p class="small">Last Update: <span itemprop="dateModified">February 20, 2020</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Tinidazole.OVERVIEW"><h2 id="_Tinidazole_OVERVIEW_">OVERVIEW</h2><div id="Tinidazole.Introduction"><h3>Introduction</h3><p>Tinidazole is an orally available, broad spectrum antimicrobial agent used in the treatment of bacterial, protozoal and parasitic infections. Tinidazole is a nitroimidazole similar to metronidazole and is likely to have a similar spectrum and frequency of side effects, including a low rate of serum enzyme elevations during therapy and rare instances of clinically apparent acute liver injury.</p></div><div id="Tinidazole.Background"><h3>Background</h3><p>Tinidazole (tye nid' a zole) is an oral, broad spectrum antimicrobial that has activity against bacteria as well as several parasites such as Entamoeba histolytica, Giardia duodenalis and Trichomonas vaginalis. Tinidazole is a nitroimidazole similar to metronidazole and is activated intracellularly by bacterial or parasitic enzymes to a radical anion, which damages large protein molecules and DNA. Tinidazole was approved for use in the United States in 2004 and current indications are for treatment of trichomoniasis, giardiasis, amebiasis and bacterial vaginosis. Tinidazole is available in tablets of 250 and 500 mg and the dose varies by indication, being 2 grams as a single oral dose in adults with trichomoniasis and giardiasis, and for 3 to 5 days for moderate or severe forms of amebiasis. Oral tinidazole is generally well tolerated if being used generally for only 1 to 5 days. In most comparison studies, its efficacy and spectrum of activity were found to be similar to those of metronidazole, but it was often better tolerated. Side effects can include metallic or bitter taste, fatigue, dizziness, headache, dyspepsia, nausea, and a disulfiram-like response to alcohol. Rare, but potential serious adverse events include allergic reactions, anaphylaxis and toxic megacolon.</p></div><div id="Tinidazole.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Tinidazole is typically given for a few days only, but serum enzyme elevations have been reported with its use, and serum enzyme elevations during therapy is listed as a possible adverse event in the product label. Tinidazole is also capable of causing anaphylactic and allergic reactions including urticaria, angioedema and bronchospasm, reactions which can be associated with minor serum enzyme elevations. Tinidazole, despite considerable use worldwide, has not been linked convincingly to instances of clinically apparent liver injury with jaundice.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E* (suspected but unproven rare cause of clinically apparent liver injury)</p></div><div id="Tinidazole.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The cause of rare instances of serum enzyme elevations with tinidazole therapy is unknown, but is likely to be immunologically mediated. Tinidazole is extensively metabolized in the liver largely via CYP 3A4 and can lead to significant drug-drug interactions.</p></div><div id="Tinidazole.Outcome_and_Management"><h3>Outcome and Management</h3><p>The severity of the liver injury linked to tinidazole therapy has been invariably mild and self-limited, usually with transient, asymptomatic serum enzyme elevations accompanying hypersensitivity reactions. However, the use of tinidazole has been limited and it is typically given for 1 to 5 days only. In instances of allergic reactions or anaphylaxis, rechallenge should be avoided. There is no information to suggest that there is cross sensitivity to hypersensitivity reactions or hepatic injury between tinidazole and other antimicrobial agents; indeed, some patients have had severe hypersensitivity reactions to tinidazole after tolerating a course of metronidazole.</p><p>Drug Class: <a href="/books/n/livertox/Antiinfective/">Antiinfective Agents</a></p><p>Other Drugs in the Subclass, Nitroimidazoles: <a href="/books/n/livertox/Benznidazole/">Benznidazole</a>, <a href="/books/n/livertox/Metronidazole/">Metronidazole</a>, <a href="/books/n/livertox/Secnidazole/">Secnidazole</a></p></div></div><div id="Tinidazole.PRODUCT_INFORMATION"><h2 id="_Tinidazole_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Tinidazole – Generic, Tindamax®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antiinfective Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Tinidazole" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Tinidazole.CHEMICAL_FORMULA_AND_STRUCTUR"><h2 id="_Tinidazole_CHEMICAL_FORMULA_AND_STRUCTUR_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Tinidazole.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548538/table/Tinidazole.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Tinidazole.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Tinidazole.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_b_Tinidazole.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_b_Tinidazole.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_b_Tinidazole.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr><tr><td headers="hd_b_Tinidazole.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tinidazole</td><td headers="hd_b_Tinidazole.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134992666" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">19387-91-8</a>
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</td><td headers="hd_b_Tinidazole.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C8-H13-N3-O4-S</td><td headers="hd_b_Tinidazole.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134992666" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134992666" alt="image 134992666 in the ncbi pubchem database" /></a>
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</td></tr></tbody></table></div></div></div><div id="Tinidazole.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Tinidazole_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 20 February 2020</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Tinidazole.REF.zimmerman.1999">Zimmerman HJ. Amebicides. Hepatic injury from antimicrobial agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, p. 592.<div><i>(Expert review of liver injury published in 1999 mentions that metronidazole has only rarely been incriminated in causing liver injury).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF.moseley.2013">Moseley RH. Hepatotoxicity of antimicrobials and antifungal agents. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 463-82.<div><i>(Review of hepatotoxicity of antibiotics; does not discuss tinidazole).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF.wetzel.2018">Wetzel DM, Phillips MA. Chemotherapy of protozoal infections. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 987-1000.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF.rosenthal.2012">Rosenthal PJ. Antiprotozoal drugs. In, Katzung BG, Masters SB, Trevor AJ. Basic and clinical pharmacology. 12th ed. New York: McGraw Hill, 2012, pp. 915-36.<div><i>(Textbook of pharmacology and therapeutics, mentions that tinidazole has similar activity as metronidazole, but better toxicity profile and simpler dosing regimens).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF.mcewen.1983.498">McEwen J. Hypersensitivity reactions to tinidazole (Fasigyn). <span><span class="ref-journal">Med J Aust. </span>1983;<span class="ref-vol">1</span>(11):498–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6843436" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6843436</span></a>]<div>
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<i>(Report of 10 instances of hypersensitivity reactions to tinidazole from an Australian registry, all arising within 24 hours of the first dose, 9 being severe and including generalized urticaria, facial or laryngeal edema, hypotension, bronchospasm and dyspnea; no mention of ALT elevations or jaundice).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.howard.1985.513">Howard K. Tinidazole and hepatitis. <span><span class="ref-journal">Med J Aust. </span>1985;<span class="ref-vol">142</span>:513.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3990620" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3990620</span></a>]<div>
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<i>(4 year old girl with giardiasis developed peripheral and facial edema within 3 days of a single oral dose of tinidazole [bilirubin 0.5 mg/dL, AST 231 U/L, CK 1498 U/L], resolving within a few days and liver tests being normal two weeks later).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.roe.1985.72">Roe FJ. Safety of nitroimidazoles. <span><span class="ref-journal">Scand J Infect Dis Suppl. </span>1985;<span class="ref-vol">46</span>:72–81.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3865353" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3865353</span></a>]<div>
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<i>(Review of the safety of tinidazole and other nitroimidazoles mentions side effects of nausea, headaches, metallic taste, furred tongue, itching and skin rash and at least one report of transient serum enzyme elevations).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF8">Tinidazole (Tindamax) - a new anti-protozoal drug. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2004;<span class="ref-vol">46</span>(1190):70–2.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15375353" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15375353</span></a>]<div>
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<i>(Concise summary of activity, efficacy, side effects and costs of tinidazole shortly after its approval in the US, mentions that side effects were similar to metronidazole; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.fung.2005.1859">Fung HB, Doan TL. Tinidazole: a nitroimidazole antiprotozoal agent. <span><span class="ref-journal">Clin Ther. </span>2005;<span class="ref-vol">27</span>:1859–84.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16507373" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16507373</span></a>]<div>
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<i>(Thorough review of structure, mechanism of action, pharmacology, efficacy and side effects of tinidazole in protozoal disease and bacterial vaginitis; adverse events were reported in 9-11% of recipients, most commonly metallic taste and nausea; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.singbal.2005.243">Singbal SS, Rataboli PV. Anaphylaxis and hypersensitivity syndrome reactions in increasing severity following repeated exposure to tinidazole. <span><span class="ref-journal">J Postgrad Med. </span>2005;<span class="ref-vol">51</span>:243–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16333209" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16333209</span></a>]<div>
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<i>(30 year old man developed Stevens Johnson syndrome within a few days of starting tinidazole and norfloxacin, and had recurrence after starting single doses of both and another a third time when he took a half pill of tinidazole alone, having previously tolerated metronidazole; no mention of liver involvement or ALT levels).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.livengood.2007.302">Livengood CH 3rd, Ferris DG, Wiesenfeld HC, Hillier SL, Soper DE, Nyirjesy P, Marrazzo J, et al. Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. <span><span class="ref-journal">Obstet Gynecol. </span>2007;<span class="ref-vol">110</span>(2 Pt 1):302–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17666604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17666604</span></a>]<div>
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<i>(Among 235 women with bacterial vaginosis treated with tinidazole [1 g daily for 5 days or 2 g daily for 2 days] or placebo, cure rates were higher with tinidazole [36% and 27%] versus placebo [5%]; side effects included dysgeusia [26% and 40% vs 5%] and nausea and dizziness; tinidazole had "no clinically significant effect" on liver function tests).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
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<i>(Among 300 cases of drug induced liver disease in the US between 2004 and 2008, more than 100 agents were implicated and the most commonly implicated class of agents was antibiotics, but no case was attributed to tinidazole or metronidazole).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.escobedo.2008.199">Escobedo AA, Alvarez G, González ME, Almirall P, Cañete R, Cimerman S, Ruiz A, et al. The treatment of giardiasis in children: single-dose tinidazole compared with 3 days of nitazoxanide. <span><span class="ref-journal">Ann Trop Med Parasitol. </span>2008;<span class="ref-vol">102</span>:199–207.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18348774" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18348774</span></a>]<div>
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<i>(Among 166 children with giardiasis who were treated with tinidazole [3 g single dose] or nitazoxanide [twice daily for 3 days], cure rates were 90% vs 78% and there were only mild, transient side effects; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
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<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, but none were attributed to tinidazole or metronidazole).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF15">Drugs for parasitic infections. 2nd ed. New Rochelle, NY: Medical Letter, Inc., 2010.<div><i>(Thorough description of drugs for parasitic infections in adults and children as well as a table of their major side effects; tinidazole, like metronidazole, is considered a first line agent for treatment of amebiasis, giardiasis and trichomonas infections; side effects are listed as occasional [metallic taste, GI symptoms, rash] and rare [weakness]).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF.pasupuleti.2014.e2733">Pasupuleti V, Escobedo AA, Deshpande A, Thota P, Roman Y, Hernandez AV. Efficacy of 5-nitroimidazoles for the treatment of giardiasis: a systematic review of randomized controlled trials. <span><span class="ref-journal">PLoS Negl Trop Dis. </span>2014;<span class="ref-vol">8</span>:e2733. </span> [<a href="/pmc/articles/PMC3953020/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3953020</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24625554" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24625554</span></a>]<div>
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<i>(Systematic review of 30 randomized controlled trials in 3930 patients comparing nitroimidazoles to placebo in giardiasis; mentions that harmful outcomes were uncommon and side effects reported more commonly than with placebo included only metallic taste and headache; no mention of ALT levels or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.blumenthal.2015">Blumenthal KG, Youngster I, Rabideau DJ, Parker RA, Manning KS, Walensky RP, Nelson SB. Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics. J Allergy Clin Immunol 2015; 136: 1288-94. e1. [<a href="/pmc/articles/PMC4640981/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4640981</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25981739" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25981739</span></a>]<div><i>(Among 824 patients receiving outpatient parenteral antibiotic therapy who had concurrent white blood cell and differential counts, eosinophilia [>500 cells/uL] was found in 25%, being most common with vancomycin [30%], the penicillins [28%], carbapenems [28%], cephalosporins [22%], fluoroquinolones [21%], and less common with metronidazole [15%] and there was no association of eosinophilia with liver test abnormalities).</i></div></div></li><li><div class="bk_ref" id="Tinidazole.REF18">Drugs for Helicobacter pylori infection. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2017;<span class="ref-vol">59</span>(1525):113–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28699931" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28699931</span></a>]<div>
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<i>(Concise review of the efficacy, safety and costs of drugs for H. pylori infection lists preferred regimens, usually include metronidazole [500 mg twice daily for 10-14 days] or tinidazole at the same dosage, whose adverse effects can include metallic taste, reactions to alcohol, seizures and neuropathy).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.pandey.2018.196">Pandey S, Gupta GK, Wanjari SJ, Nijhawan S. Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: A randomized control trial. <span><span class="ref-journal">Indian J Gastroenterol. </span>2018;<span class="ref-vol">37</span>:196–201.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29948994" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29948994</span></a>]<div>
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<i>(Among 150 patients with amebic liver abscess treated with metronidazole [14 days] or tinidazole [5 days], time to response was better with tinidazole but ultimate response rates were similar, although metronidazole was associated with a higher rate of adverse events including nausea, vomiting and metallic taste resulting in early discontinuation in 10%; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.shamberg.2018.674">Shamberg L, Vaziri H. Hepatotoxicity of Inflammatory Bowel Disease Medications. <span><span class="ref-journal">J Clin Gastroenterol. </span>2018;<span class="ref-vol">52</span>:674–84.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30036242" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30036242</span></a>]<div>
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<i>(Review of the hepatotoxicity of drugs used for inflammatory bowel disease mentions that metronidazole has been reported to cause liver injury, but it is rare and does not justify prospective monitoring during therapy).</i>
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</div></div></li><li><div class="bk_ref" id="Tinidazole.REF.ataee.2020.9634196">Ataee P, Karimi A, Eftekhari K. Hepatic failure following metronidazole in children with Cockayne syndrome. <span><span class="ref-journal">Case Rep Pediatr. </span>2020;<span class="ref-vol">2020</span>:9634196. </span> [<a href="/pmc/articles/PMC7008298/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7008298</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32082677" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32082677</span></a>]<div>
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<i>(Two cases: 2 and 5 years old boys with type B [infant onset] Cockayne syndrome developed jaundice, vomiting and agitation 2 and 3 days after starting oral metronidazole for minor infection [bilirubin 13.7 and 16.0 mg/dL, ALT 2815 and 2248 U/L, Alk P 1265 and 1654 U/L, INR 5.1 and 4.6], one dying within 2 days of admission and the second recovering but with persistent jaundice and serum enzyme elevations one month later; whether similar reactions occur with tinidazole is uncertain).</i>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548538/?report=reader">PubReader</a></li><li><a href="/books/NBK548538/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548538" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548538" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. 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[Updated 2020 Feb 20].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK548538/pdf/Bookshelf_NBK548538.pdf">PDF version of this page</a> (104K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/29/31/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download LiverTox data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Overviews</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/intro/">Introduction</a></li><li><a href="/books/n/livertox/ClinicalCourse/">Clinical Course</a></li><li><a href="/books/n/livertox/ClinicalOutcome/">Clinical Outcomes</a></li><li><a href="/books/n/livertox/ImmuneFeatures/">Immune Features</a></li><li><a href="/books/n/livertox/Phenotypes_intro/">Phenotypes</a></li><li><a href="/books/n/livertox/Causality/">Causality</a></li><li><a href="/books/n/livertox/DrugCategory/">Likelihood Scale</a></li><li><a href="/books/n/livertox/Severity/">Severity Grading</a></li><li><a href="/books/n/livertox/CaseReport/">Writing a Case Report</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Support Links</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/">LiverTox Homepage</a></li><li><a href="/books/n/livertox/masterlistintro/">Master List of LiverTox Drugs [with Metadata]</a></li><li><a href="/books/n/livertox/drugliverinjury/">LiverTox Drugs by Drug Class</a></li><li><a href="/books/n/livertox/aboutus/">About LiverTox</a></li><li><a href="/books/n/livertox/editorsandreviewers/">Editors and Review Committee</a></li><li><a href="/books/n/livertox/alert/">Meetings and News</a></li><li><a href="/books/n/livertox/abbreviation/">Abbreviations Used</a></li><li><a href="/books/n/livertox/glossary/">Glossary</a></li><li><a href="/books/n/livertox/resource/">Information Resources</a></li><li><a href="/books/n/livertox/disclaimer/">User/Medical Advice Disclaimer</a></li><li><a href="/books/n/livertox/Contactus/">Contact Us</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>
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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=(Tinidazole/AE)+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Tinidazole: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Tinidazole" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Tinidazole: from ClinicalTrials.gov</a>
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Epub 2021 Jul 29.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643547" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Secnidazole.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Secnidazole.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643406" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Benznidazole.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Benznidazole.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/15482233" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Tinidazole: from protozoa to Helicobacter pylori--the past, present and future of a nitroimidazole with peculiarities.</a><span class="source">[Expert Rev Anti Infect Ther. 2...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Tinidazole: from protozoa to Helicobacter pylori--the past, present and future of a nitroimidazole with peculiarities.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Manes G, Balzano A. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Expert Rev Anti Infect Ther. 2004 Oct; 2(5):695-705. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/16507373" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Tinidazole: a nitroimidazole antiprotozoal agent.</a><span class="source">[Clin Ther. 2005]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Tinidazole: a nitroimidazole antiprotozoal agent.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Fung HB, Doan TL. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Clin Ther. 2005 Dec; 27(12):1859-84. </em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=31643856" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=31643856" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1ffa68b6b5afc7b65ed">Tinidazole - LiverTox</a><div class="ralinkpop offscreen_noflow">Tinidazole - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1feb15b832ebc16ba70">Timolol - LiverTox</a><div class="ralinkpop offscreen_noflow">Timolol - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1fdab82281a8043b35c">Tildrakizumab - LiverTox</a><div class="ralinkpop offscreen_noflow">Tildrakizumab - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1fcab82281a8043ac5d">Tigecycline - LiverTox</a><div class="ralinkpop offscreen_noflow">Tigecycline - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1fbab82281a8043a45e">Ticlopidine - LiverTox</a><div class="ralinkpop offscreen_noflow">Ticlopidine - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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