Metronidazole 1% | Niacinamide 3%

Topical cream/gel — apply to affected facial skin: Cleanse the skin gently with a mild, non-irritating cleanser and pat dry before application. Apply a thin, even layer to the affected area(s) once or twice daily as prescribed. Avoid contact with eyes, lips, and mucous membranes — rinse thoroughly with water if contact occurs. Wash hands before and after application. Allow the preparation to absorb before applying moisturizer or sunscreen. Do not apply under occlusion unless specifically directed by the prescriber.

Application frequency and treatment duration are determined by the prescriber based on condition severity and patient response.

• Typical regimen: Once or twice daily application to affected areas; most clinical data for metronidazole 1% gel used once-daily application.
• Clinical improvement in rosacea and acne typically becomes evident at 4–8 weeks; full benefit may require 12 weeks or longer of consistent use.
• Long-term maintenance therapy may be appropriate; duration is prescriber-determined.

• Metronidazole 1%: Topically, the primary mechanism is inhibition of reactive oxygen species (ROS) production by neutrophils — a central driver of rosacea pathophysiology. Metronidazole also reduces Demodex folliculorum colonization and exhibits direct anti-inflammatory effects independent of its antimicrobial properties, reducing erythema, papules, and pustules. It does not significantly suppress gram-positive flora at topical concentrations, reducing the risk of dysbiosis compared to topical antibiotics.
• Niacinamide 3%: Acts as a precursor to NAD⁺ and NADP⁺ within keratinocytes, maintaining redox balance. Inhibits poly(ADP-ribose) polymerase-1 (PARP-1), reducing NF-κB–mediated transcription of pro-inflammatory cytokines (IL-8, TNF-α, IL-1β). Reduces sebocyte lipid synthesis (sebostatic effect), inhibits transfer of melanosomes from melanocytes to keratinocytes (skin-lightening effect), and increases ceramide and free fatty acid production, strengthening the stratum corneum barrier and reducing transepidermal water loss.

Clinical indications addressed: Papulopustular rosacea (primary indication for metronidazole 1%), erythematotelangiectatic rosacea (niacinamide's anti-inflammatory and barrier-strengthening effects complement), acne vulgaris, perioral dermatitis, and seborrheic dermatitis. The combination targets multiple rosacea and acne pathways simultaneously.

Prescriber monitoring:

• Assess clinical response at 4–8 weeks (papule/pustule count, erythema severity)
• Evaluate for contact dermatitis or application-site irritation — niacinamide is generally very well tolerated; metronidazole may cause mild initial stinging
• Consider periodic medication review for long-term maintenance users
• Advise patients on daily photoprotection (sunscreen SPF ≥30) — rosacea skin is inherently UV-sensitive and both active ingredients offer modest but not sufficient sun protection independently

Contraindications:

• Hypersensitivity to metronidazole, nitroimidazoles, or niacinamide
• Avoid contact with eyes and mucous membranes

Warnings & Precautions:

• Topical metronidazole has negligible systemic absorption at 1%; however, caution is advised in patients with a history of blood dyscrasia or seizure disorder (relevant primarily to oral/IV routes)
• Niacinamide 3% does not cause the vasodilatory flushing seen with oral niacin — it is generally safe and non-irritating
• Avoid use on broken or excoriated skin until healing occurs

Drug Interactions:

• Systemic metronidazole interaction risks (warfarin potentiation, disulfiram-like reaction with alcohol) are not considered relevant at topical concentrations, but prescribers should be aware for patients also on oral metronidazole

Common Side Effects: Mild and transient application-site stinging, burning, or dryness (metronidazole); flushing or mild erythema at higher niacinamide concentrations (not seen at 3%); contact dermatitis (rare).

Store at room temperature (15–25°C), away from direct sunlight and heat. Do not freeze. Keep the container tightly closed. Topical preparations may separate if stored improperly — check the appearance before each use. Observe the beyond-use date assigned by Genesis Compounding. Keep out of reach of children.

What conditions is this topical combination used for?

This preparation addresses inflammatory skin conditions such as rosacea (particularly papulopustular and erythematotelangiectatic subtypes), acne vulgaris, perioral dermatitis, and seborrheic dermatitis by combining metronidazole's anti-inflammatory and antimicrobial properties with niacinamide's multi-pathway skin benefits.

How long before I see improvement?

Initial reduction in redness and pustules may be visible at 4–6 weeks with consistent twice-daily use. Maximum benefit typically requires 12 weeks. Maintenance therapy may be required to prevent recurrence.

Will niacinamide cause the flushing I hear about with niacin?

No. Niacinamide (nicotinamide) does not cause the vasodilatory flushing associated with niacin (nicotinic acid). Topical niacinamide 3% is generally well-tolerated with a low irritation profile.

Can I wear makeup over this?

Allow the preparation to absorb fully before applying cosmetics. Many patients tolerate mineral makeup over this preparation; discuss preferences with your prescriber or pharmacist.

Is this a compounded medication?

Yes. This combination is not commercially available as a single product. Genesis Compounding prepares it as a prescription-only, patient-specific 503A formulation under prescriber direction. It has not been evaluated by the FDA for safety or efficacy as a compounded combination.