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Metronidazole topical Disease Interactions

There are 4 disease interactions with metronidazole topical:

Moderate

Topical Metronidazole (Includes Metronidazole topical) ↔ Alcoholism

Moderate Potential Hazard, Low plausibility

Applies to: Alcoholism

Metronidazole may be systemically absorbed when applied to the skin or mucosal membranes. A disulfiram-like reaction has been reported in patients who consume alcohol during treatment with oral metronidazole. Symptoms include nausea, vomiting, flushing, sweating, headache, abdominal cramps, and hypotension. Therapy with topical metronidazole should be administered cautiously in patients who might be prone to acute alcohol intake. Patients should be instructed to avoid alcohol-containing products during therapy and for at least 48 hours after the last dose.

References

  1. Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15
  2. Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80
  3. "Product Information. Metrogel-Vaginal (metronidazole)." Curatek Pharmaceuticals Ltd, Elk Grove Village, IL.
  4. Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3
View all 4 references
Moderate

Topical Metronidazole (Includes Metronidazole topical) ↔ Blood Dyscrasias

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts, History - Blood Dyscrasias

Metronidazole may be systemically absorbed when applied to the skin or mucosal membranes. The use of metronidazole has rarely been associated with hematologic adverse effects such as mild, transient leukopenia, thrombocytopenia, and bone marrow aplasia. The manufacturers recommend that therapy with metronidazole be administered cautiously in patients with evidence of or a history of blood dyscrasias.

References

  1. Smith JA "Neutropenia associated with metronidazole therapy." Can Med Assoc J 123 (1980): 202
  2. "Product Information. Metrogel (metronidazole)." Galderma Laboratories Inc, Fort Worth, TX.
  3. White CM, Price JJ, Hunt KM "Bone marrow aplasia associated with metronidazole." Br Med J 280 (1980): 647
Moderate

Topical Metronidazole (Includes Metronidazole topical) ↔ Liver Disease

Moderate Potential Hazard, Low plausibility

Applies to: Liver Disease

Metronidazole may be systemically absorbed when applied to the skin or mucosal membranes. Once absorbed, 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 topical metronidazole should be administered cautiously in patients with liver disease.

References

  1. Farrell G, Baird-Lambert J, Cvejic M, Buchanan N "Disposition and metabolism of metronidazole in patients with liver failure." Hepatology 4 (1984): 772-6
  2. Loft S, Dossing M, Poulsen HE, et al "Influence of dose and route of administration on disposition of metronidazole and its major metabolites." Eur J Clin Pharmacol 30 (1986): 467-73
  3. "Product Information. Metrogel-Vaginal (metronidazole)." Curatek Pharmaceuticals Ltd, Elk Grove Village, IL.
  4. Loft S, Sonne J, Dossing M, Andreasen PB "Metronidazole pharmacokinetics in patients with hepatic encephalopathy." Scand J Gastroenterol 22 (1987): 117-23
  5. Jensen JC, Gugler R "Single- and multiple-dose metronidazole kinetics." Clin Pharmacol Ther 34 (1983): 481-7
  6. Lau AH, Evans R, Chang CW, Seligsohn R "Pharmacokinetics of metronidazole in patients with alcoholic liver disease." Antimicrob Agents Chemother 31 (1987): 1662-4
View all 6 references
Moderate

Topical Metronidazole (Includes Metronidazole topical) ↔ Neurologic Toxicity

Moderate Potential Hazard, Low plausibility

Applies to: CNS Disorder, Peripheral Neuropathy

Metronidazole may be systemically absorbed when applied to the skin or mucosal membranes. The use of oral and intravenous metronidazole 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 topical metronidazole should be administered cautiously in patients with or predisposed to seizures or other nervous system abnormalities. Metronidazole therapy should be discontinued promptly if neurologic disturbances occur.

References

  1. Schentag JJ, Ziemniak JA, Greco JM, Rainstein M, Buckley RJ "Mental confusion in a patient treated with metronidazole: a concentration-related effect." Pharmacotherapy 2 (1982): 384-7
  2. Boyce EG, Cookson ET, Bond WS "Persistent metronidazole-induced peripheral neuropathy." DICP 24 (1990): 19-21
  3. "Product Information. Metrogel-Vaginal (metronidazole)." Curatek Pharmaceuticals Ltd, Elk Grove Village, IL.
  4. Stahlberg D, Barany F, Einarsson K, Ursing B, Elmquist D, Persson A "Neurophysiologic studies of patients with Crohn's disease on long-term treatment with metronidazole." Scand J Gastroenterol 26 (1991): 219-24
  5. Learned-Coughlin S "Peripheral neuropathy induced by metronidazole." Ann Pharmacother 28 (1994): 536
  6. Ahmed A, Laes DJ, Bressler EL "Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy." Neurology 45 (1995): 588-9
  7. Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ "Central nervous sytem toxicity associated with metronidazole therapy." Ann Intern Med 93 (1980): 59-60
  8. Duffy LF, Daum F, Fisher SE, et al "Peripheral neuropathy in Crohn's disease patients treated with metronidazole." Gastroenterology 88 (1985): 681-4
  9. Schreiber W, Spernal J "Metronidazole-induced psychotic disorder." Am J Psychiatry 154 (1997): 1170-1
  10. Wienbren M, Perinpanayagam RM, Camba L, Lee CA "Convulsions and encephalopathy in a patient with leukaemia after treatment with metronidazole." J Clin Pathol 38 (1985): 1076
  11. Alvarez RS, Richardson DA, Bent AE, Ostergard DR "Central nervous system toxicity related to prolonged metronidazole therapy." Am J Obstet Gynecol 145 (1983): 640-1
View all 11 references

metronidazole topical drug Interactions

There are 12 drug interactions with metronidazole topical

metronidazole topical alcohol/food Interactions

There is 1 alcohol/food interaction with metronidazole topical

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.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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