This topical cream contains metronidazole 0.75%, azelaic acid 15%, and niacinamide 4%. It is available by prescription in a 30 g pump.

This cosmetically elegant oil-in-water emulsion is designed for dermatologic preparations, incorporating a natural antioxidant and emollient to support skin health. Versatile and well-tolerated, it accommodates lipophilic drugs and acidic actives, is hypoallergenic, and dermatologist approved. With a white, shiny, low-viscosity texture for easy application, it provides a stable, reliable vehicle for advanced compounded skincare.

Metronidazole is an antibiotic. After it diffuses into a susceptible organism, it interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death [1].

Azelaic acid’s mechanisms include downregulation of the cathelicidin pathway [2], reduction of reactive oxygen species [3], antimicrobial activity against Propionibacterium acnes and Staphylococcus epidermidis, and normalization of keratinization that decreases microcomedo formation [4].

Niacinamide is also known as vitamin B3 and nicotinic acid. The existing clinical data and literature on niacinamide suggests that it is an inexpensive, safe drug with beneficial effects as an adjunct in many dermatological diseases because of its anti-inflammatory, anti-oxidant, barrier repair and protective effects. It can be used as a topical drug without any major adverse effects [5].

Rosacea is a chronic, inflammatory skin condition that often presents with facial erythema, telangiectasias, papules, and pustules, and is frequently misdiagnosed as acne in its early stages.
Accurate subtype classification, erythematotelangiectatic, papulopustular, phymatous, or ocular rosacea, is essential for targeted treatment strategies. Early recognition and patient education on trigger avoidance can significantly reduce symptom flare-ups and disease progression [6]. Patients with rosacea often report a substantial psychosocial burden; addressing both physical and emotional impacts is critical for comprehensive care.

Metronidazole has extensive clinical usage in rosacea management and is considered a reliable option for ongoing care. It is particularly useful for maintenance therapy, as it significantly prolongs disease-free intervals. In maintenance studies, only 23% of patients using metronidazole gel relapsed compared to 42% using placebo [7], and its use is recommended for long-term management to prevent relapses [8].

Azelaic acid Azelaic acid gel is a well-established first-line therapy for papulopustular rosacea, achieving reductions of 51–58% in inflammatory lesions and 44–46% improvement in erythema in pivotal clinical trials [9]. Azelaic acid is suitable for all skin types, and is generally well tolerated with only mild, transient local irritation [10]. Overall, it represents a safe, effective, and versatile treatment option supported by strong clinical evidence.

Niacinamide is included as an adjunct because of its anti-inflammatory, anti-oxidant, barrier repair and protective effects [5].

1. PRESCRIBER & PATIENT INFORMATION

Prescribing clinician’s name, licensing information, address and contact information. Patients’ full name, date of birth, shipping address and contact information.

2. COMPLETE PRESCRIPTION INFORMATION

Include: drug, dosage, and dosage form, quantity, SIG, and refills if requested.

3. PRESCRIPTION TRANSMITTAL

Fax: (940) 382-2694
Phone: 940-382-6758 | Speak to a pharmacist
Escribe ID: 0903012660 or CARIE BOYD Pharmaceuticals

•  Select Medication from the drop-down menu (bulk ingredient or powder is OK)
•  Use the words Please Compound in the SIG or Comments section followed by the compounded medication you want to prescribe.

NOTE: If you cannot find the same strength or form, that’s OK, write exactly what you want into the SIG or Comments section. In most cases we’ll be able to custom compound the prescribed medication.

Store at controlled room temperature. Protect from light and freezing. 35-Day BUD

[1] Lexicomp. (n.d.). Metronidazole: Drug information. In Lexicomp Online. Wolters Kluwer. Retrieved August 26, 2025, from https://www.online.lexi.com/
[2] Del Rosso JQ, Kircik LH. Update on the management of rosacea: a status report on the current role and new horizons with topical azelaic acid. J Drugs Dermatol. 2014 Dec;13(12):s101-7. PMID: 25607798.
[3] Gollnick H, Layton A. Azelaic acid 15% gel in the treatment of rosacea. Expert Opin Pharmacother. 2008 Oct;9(15):2699-706. doi: 10.1517/14656566.9.15.2699. PMID: 18803456.
[4] Physicians Total Care, Inc. (2004). Azelex (azelaic acid cream) 20% [Package insert]. Allergan, Inc.
[5] Bains P, Kaur M, Kaur J, Sharma S. Nicotinamide: Mechanism of action and indications in dermatology. Indian J Dermatol Venereol Leprol 2018;84:234-237
[6] Farshchian M, Daveluy S. Rosacea. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557574/
[7] Dahl MV, Katz HI, Krueger GG, Millikan LE, Odom RB, Parker F, Wolf JE Jr, Aly R, Bayles C, Reusser B, Weidner M, Coleman E, Patrignelli R, Tuley MR, Baker MO, Herndon JH Jr, Czernielewski JM. Topical metronidazole maintains remissions of rosacea. Arch Dermatol. 1998 Jun;134(6):679-83. doi: 10.1001/archderm.134.6.679. PMID: 9645635.
[8] Conde JF, Yelverton CB, Balkrishnan R, Fleischer AB Jr, Feldman SR. Managing rosacea: a review of the use of metronidazole alone and in combination with oral antibiotics. J Drugs Dermatol. 2007 May;6(5):495-8. PMID: 17679183.
[9] Thiboutot D, Thieroff-Ekerdt R, Graupe K. Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies. J Am Acad Dermatol. 2003 Jun;48(6):836-45. doi: 10.1067/mjd.2003.308. PMID: 12789172.
[10] Gupta AK, Gover MD. Azelaic acid (15% gel) in the treatment of acne rosacea. Int J Dermatol. 2007 May;46(5):533-8. doi: 10.1111/j.1365-4632.2005.02769.x. PMID: 17472690.