Personalized Veterinary Administration Support
Oral suspensionOralNon sterile Rx only

Metronidazole Oral Suspension, Custom Strength

Oral Suspension Vehicle

A metronidazole oral suspension compounded to each prescriber's order, in the concentration, flavor, and salt form a patient or animal will accept.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

  • USP <795> compliant
  • USP <800> hazardous drug lab
  • PCCA member

Clinical Advantages

  • Custom strength available
  • Weight based dosing
  • Flavored for palatability
  • Alternative to swallowing pills
  • Alcohol free

How It Works

What is Metronidazole Oral Suspension?

Metronidazole Oral Suspension is a compounded liquid form of metronidazole, a nitroimidazole antimicrobial. Mixwell prepares it by prescription in the concentration and flavor the prescriber specifies, using either metronidazole base or the benzoate ester.

How it works

  1. Metronidazole enters anaerobic organisms, where it is reduced into reactive intermediates that disrupt the organism's DNA [2].
  2. The drug is a small, moderately lipophilic weak base, which supports nearly complete absorption after an oral dose [2].
  3. Metronidazole benzoate is an ester of the same drug. It is less bitter, and hydrolysis in the gut releases metronidazole [2].
  4. The two forms are dosed on different bases. In cats, 20 mg/kg of the benzoate delivered about 12.4 mg/kg of metronidazole base [2].

When prescribers choose it

  • Veterinarians dosing puppies, kittens, and small or exotic animals by weight
  • Veterinarians who need a flavor an animal will accept
  • Prescribers whose patients need a concentration the approved suspension does not offer
  • Prescribers whose patients react to an excipient or flavor in a commercial product

Clinical Details

What does the evidence show?
  • The FDA approved Likmez (metronidazole) oral suspension, 500 mg/5 mL, in 2023. It is indicated for trichomoniasis, amebiasis, and anaerobic bacterial infections, and its labeling reserves use to those indications [1].
  • The CDC 2021 STI treatment guidelines recommend metronidazole 500 mg orally twice daily for 7 days for bacterial vaginosis and for trichomoniasis in women, and include metronidazole in every recommended regimen for pelvic inflammatory disease [3].
  • Sekis and colleagues (2009, Journal of Feline Medicine and Surgery) gave cats 20 mg/kg of metronidazole benzoate orally, equal to 12.4 mg/kg of metronidazole base, and measured plasma concentrations by HPLC alongside a genotoxicity assessment [2].
  • The ENOVAT guidelines for canine acute diarrhoea (Jessen and colleagues, 2024, The Veterinary Journal) advise against routine antimicrobial use in acute diarrhoea, drawing on a systematic review and meta analysis of the available trials [4].
  • The ACVIM endorsed consensus statement on chronic inflammatory enteropathy in dogs (2026, Journal of Veterinary Internal Medicine) reports that in dogs that failed dietary trials, metronidazole at 10 to 15 mg/kg every 12 hours for 21 days might produce a short term partial or complete response, at moderate quality of evidence [5].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Why it is compounded

An FDA approved oral suspension exists for human patients, in a single strength and flavor [1]. No FDA approved metronidazole product exists for dogs or cats, so veterinarians rely on human products or compounded preparations. A kitten dosed from a 100 mg/mL suspension needs a volume too small to measure reliably.

Dosage forms and strengths

  • Concentration set by the prescriber for the patient's weight
  • Flavors selected for the species or the patient
  • Metronidazole base or the benzoate ester, specified by the prescriber
  • Dye free and alcohol free versions on request

Prescriptions should state which form is intended and how the dose was calculated, because the benzoate ester delivers roughly 62% of its weight as metronidazole base [2]. Dosing, monitoring, and duration are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds this suspension in Chino, California under USP 795 standards for non sterile preparations [6]. Prescribers may specify metronidazole base or the benzoate ester, and our pharmacist confirms the form and the dose basis before compounding. Batch records document each preparation, and finished suspensions ship across California.

Safety information

Metronidazole labeling carries a boxed warning. The drug has been shown to be carcinogenic in mice and rats, unnecessary use should be avoided, and treatment is reserved for the labeled indications [1].

It is contraindicated in patients with Cockayne syndrome, where severe irreversible hepatotoxicity and acute liver failure with fatal outcomes have been reported [1]. Patients should stop the drug and report neurological symptoms immediately, and psychotic reactions have occurred in patients using disulfiram concurrently [1].

In cats, genotoxicity after a single dose has been studied, and the benzoate ester adds a benzoate load that prescribers weigh for that species [2]. Patient selection, dosing, monitoring, and duration are the prescriber's responsibility.

References
  1. Likmez (metronidazole) oral suspension, 500 mg/5 mL. Prescribing information. DailyMed, U.S. National Library of Medicine. DailyMed label
  2. Sekis I, Ramstead K, Rishniw M, et al. Single dose pharmacokinetics and genotoxicity of metronidazole in cats. J Feline Med Surg. 2009;11(2):60 to 68. doi:10.1016/j.jfms.2008.06.011
  3. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1 to 187. CDC STI treatment guidelines
  4. Jessen LR, Werner M, Singleton D, et al. European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) guidelines for antimicrobial use in canine acute diarrhoea. Vet J. 2024;307:106208. doi:10.1016/j.tvjl.2024.106208
  5. ACVIM endorsed consensus statement and systematic review on guidelines for the diagnosis and treatment of chronic inflammatory enteropathy in dogs. J Vet Intern Med. 2026;40(1):aalaf017.
  6. United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

  • APIs and strengths
  • Base or vehicle
  • Quantity
  • Directions for use
  • Refills
  • Allergies or dye free needs
Call (909) 378-7301 Fax (909) 378-7071

Related Solutions

Gabapentin Oral Suspension, Custom Strength and Xylitol Free OptionsFlavored Pharmaceutical Oral Liquid Itraconazole Oral Suspension, Custom ConcentrationORAL SUSPENSION Mebendazole 100 mg/mL Oral SuspensionAnhydrous SuspendIt® Commonly prescribed for Personalized Veterinary Administration Support Commonly prescribed for Difficulty Swallowing / Dysphagia Support

Compounded in Chino, CA. Delivered across California.

  • Chino
  • Chino Hills
  • Ontario
  • Pomona
  • Diamond Bar
  • Rancho Cucamonga
  • Eastvale
Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

Call pharmacist Send Rx

Want to learn more about Metronidazole Oral Suspension, Custom Strength

Are you a healthcare provider or patient in Chino, Chino Hills, Ontario, Eastvale, Rancho Cucamonga, or Upland? Mixwell Pharmacy provides specialized pharmaceutical support throughout San Bernardino, Los Angeles, and Orange Counties. Contact our Chino laboratory to learn how we facilitate customized Metronidazole Oral Suspension, Custom Strengthfor practitioners across Southern California.

(909) 378-7301

Serving Los Angeles County, Orange County, San Bernardino County, Riverside County, Ventura County, and the Inland Empire