Imagine this: you've just started to give metronidazole to your dog, as prescribed by your veterinarian for a digestive issue. You breathe a sigh of relief, thinking the hardest part is over. But what if your canine friend starts showing unusual symptoms? Could it be a side effect or something more serious like metronidazole toxicosis? This article will discuss metronidazole toxicity in dogs so that you can better understand what may be happening if you notice your dog having neurological signs.

What is metronidazole toxicity in dogs?

Metronidazole is a nitroimidazole antibiotic commonly used in veterinary medicine. It is often prescribed for treating bacterial and parasitic infections, which are typically associated with conditions like diarrhea, inflammatory bowel disease, and hepatic encephalopathy. While it is an effective medication, it is not without risks—one of which is metronidazole toxicity.

Toxicosis from Metronidazole can manifest in two primary ways:

  1. Gastrointestinal signs (GI): These may include severe vomiting, diarrhea, or loss of appetite, which can be detrimental to your dog's overall health.
  2. Central Nervous System signs (CNS): More concerning are the neurological symptoms like central vestibular and cerebellar dysfunction. These are most commonly reported in dogs and cats and require immediate medical intervention.

In rare cases, metronidazole toxicosis can also lead to liver toxicity, affecting the function of the liver.

How does metronidazole toxicosis develop in dogs?

Toxicosis occurs when the normal dose of metronidazole is exceeded or if the medication is given for an extended period. The body's ability to metabolize and eliminate the drug becomes overwhelmed, leading to an accumulation of toxic levels in the bloodstream.

Interestingly, the risk of toxicosis tends to be higher with long-term or chronic use rather than just a single, large dose. This means that if your dog has been on this medication for a while—even at a lower dose—it's important to stay alert for signs of toxicosis.

Once administered, metronidazole is quickly absorbed, usually within a few hours. It's metabolized by the liver and can stay in your dog's system for up to 12 hours. The medication also has the ability to cross the blood-brain barrier, which is why symptoms affecting the nervous system are common.

Another aspect to consider is bioavailability, which varies from 50-100% in dogs. This means that the same dose might have different effects in different dogs, making accurate dosing and vigilant monitoring your best defenses against metronidazole toxicosis.

Symptoms of metronidazole toxicity in dogs

The signs of metronidazole toxicity in dogs will vary depending on the severity and duration of exposure. In most cases, symptoms start to appear within a few hours or days of starting treatment.

If your dog is experiencing GI signs, they may include:

  • Severe vomiting
  • Loss of appetite
  • Drooling and hypersalivation

On the other hand, if your dog is experiencing CNS signs, they may exhibit:

  • Seizures
  • Wide-based stance
  • Head tilting and circling
  • Nystagmus (rapid eye movement at rest)
  • Loss of coordination (ataxia)

Also remember that every dog is unique and different, and their response to metronidazole may vary. Be sure to pay close attention if you notice any changes in their behavior or physical well-being.

How metronidazole toxicosis diagnosed?

If you suspect your dog may be experiencing metronidazole toxicity, it's essential to see your veterinarian right away.

A tentative diagnosis can often be made based on your dog's clinical signs and a history of metronidazole use. However, if your veterinarian needs more confirmation, they may recommend blood tests to check for liver enzymes or perform more detailed neurological exams.

To rule out other potential causes of the symptoms, additional testing such as imaging studies (MRI or CT scans) may also be necessary.

Treatment and management of metronidazole toxicity in dogs

The treatment for metronidazole toxicosis primarily focuses on supportive care and symptom management. In most cases, it is essential to discontinue the medication immediately.

If an accidental overdose has occurred within an hour or so, your veterinarian will likely recommend inducing vomiting. They may also recommend a dose of activated charcoal to help absorb any remaining metronidazole in the gastrointestinal tract.

For more severe cases, your dog may need hospitalization for intravenous fluids and medications to control vomiting and seizures.

Most cases of toxicity caused by metronidazole are reversible when the medication is stopped, indicating temporary effects on the central nervous system for the majority of patients. However, it's important to note that not all patients will fully recover even with the appropriate treatment.


While metronidazole is an effective medication commonly used in veterinary medicine, it's essential to be aware of the potential risks associated with it. Toxicity can develop with either high doses or at normal doses but for longer periods of time. Symptoms of toxicity include vomiting, loss of appetite, or excessive drooling, seizures, a wide-based stance, head tilting, rapid eye movement at rest (nystagmus), or a loss of coordination (ataxia). If you suspect your dog may be experiencing metronidazole toxicity, seek veterinary care immediately. With proper treatment and management, most cases of toxicosis are reversible, but every dog is different and may have varying responses to the medication.