Metronidazole Disease Interactions
There are 7 disease interactions with metronidazole:
Antibiotics (Includes Metronidazole) ↔ Colitis
Severe Potential Hazard, Low plausibility
Applies to: Colitis/Enteritis (Noninfectious)
Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to several weeks following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.
Nitroimidazoles (Includes Metronidazole) ↔ Blood Dyscrasias
Severe Potential Hazard, Low plausibility
Applies to: History - Blood Dyscrasias, Bone Marrow Depression/Low Blood Counts
The use of nitroimidazoles (e.g., metronidazole, tinidazole) has rarely been associated with hematologic adverse effects such as mild, transient leukopenia, thrombocytopenia, and bone marrow aplasia. The manufacturers recommend that therapy with nitroimidazoles be administered cautiously in patients with evidence of or a history of blood dyscrasias, and that total and differential leukocyte counts be performed before and after treatment with these drugs, particularly in patients receiving repeated courses of therapy.
Nitroimidazoles (Includes Metronidazole) ↔ Neurologic Toxicity
Severe Potential Hazard, Moderate plausibility
Applies to: CNS Disorder, Peripheral Neuropathy
The use of nitroimidazoles (e.g., metronidazole, tinidazole) has been associated with the development of nervous system toxicity including convulsive seizures and dose-related peripheral neuropathy, the latter characterized primarily by numbness or paresthesia of an extremity. Persistent peripheral neuropathy has been reported in some patients treated for prolonged periods. Other neurologic adverse effects include vertigo, incoordination, ataxia, confusion, agitation, hallucinations, and depression. Therapy with nitroimidazoles should be administered cautiously in patients with or predisposed to seizures or other nervous system abnormalities. Nitroimidazole therapy should be discontinued promptly if neurologic disturbances occur.
Metronidazole (Includes Metronidazole) ↔ Alcoholism
Moderate Potential Hazard, Moderate plausibility
Applies to: Alcoholism
Nitroimidazoles (e.g., metronidazole, tinidazole) may inhibit alcohol dehydrogenase and occasionally precipitate a disulfiram-like reaction in patients who consume alcohol while being treated. Symptoms may include nausea, vomiting, flushing, sweating, headache, abdominal cramps, and hypotension. Patients should be instructed to avoid alcohol-containing products during nitroimidazole therapy and for at least 48 to 72 hours after the last dose. Therapy with nitroimidazoles should be administered cautiously in patients who might be prone to acute alcohol intake. An alternative therapy may be appropriate.
Metronidazole (Includes Metronidazole) ↔ Dialysis
Moderate Potential Hazard, High plausibility
Applies to: hemodialysis
Metronidazole and its metabolites are moderately removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.
Metronidazole (Includes Metronidazole) ↔ Liver Disease
Moderate Potential Hazard, High plausibility
Applies to: Liver Disease
Metronidazole is extensively metabolized by the liver to both pharmacologically active and inactive compounds. The plasma clearance of metronidazole may be decreased and the half-life prolonged in patients with impaired hepatic function. Therapy with metronidazole should be administered cautiously at reduced dosages in patients with severe liver disease.
Metronidazole (Includes Metronidazole) ↔ Sodium
Moderate Potential Hazard, High plausibility
Applies to: Congestive Heart Failure, Hypertension, Fluid Retention, Hypernatremia
Flagyl I.V. RTU (brand of metronidazole ready-to-use injection) contains 14 mEq of sodium per each 500 mg dose of metronidazole. The sodium content should be considered when this product is used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.
You should also know about...
metronidazole drug Interactions
There are 170 drug interactions with metronidazole
metronidazole alcohol/food Interactions
There are 2 alcohol/food interactions with metronidazole
See also...
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
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