Drug Interactions between metronidazole and nitazoxanide
This report displays the potential drug interactions for the following 2 drugs:
- metronidazole
- nitazoxanide
Interactions between your drugs
No interactions were found between metronidazole and nitazoxanide. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.
metronidazole
A total of 349 drugs are known to interact with metronidazole.
- Metronidazole is in the following drug classes: amebicides, miscellaneous antibiotics.
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Metronidazole is used to treat the following conditions:
- Amebiasis
- Aspiration Pneumonia
- Bacteremia
- Bacterial Infection
- Bacterial Vaginosis
- Balantidium coli
- Bone infection
- Clostridioides difficile Infection
- Crohn's Disease, Active (off-label)
- Crohn's Disease, Maintenance (off-label)
- Deep Neck Infection
- Dental Abscess
- Dientamoeba fragilis
- Diverticulitis
- Dracunculiasis
- Endocarditis
- Gastrointestinal Perforation (off-label)
- Giardiasis
- Helicobacter Pylori Infection
- Intraabdominal Infection
- Joint Infection
- Lemierre's Syndrome
- Meningitis
- Nongonococcal Urethritis
- Pelvic Inflammatory Disease
- Peritonitis
- Pneumonia
- Pouchitis
- Pseudomembranous Colitis
- Skin and Structure Infection
- Skin or Soft Tissue Infection
- STD Prophylaxis
- Surgical Prophylaxis
- Trichomoniasis
nitazoxanide
A total of 26 drugs are known to interact with nitazoxanide.
- Nitazoxanide is in the drug class amebicides.
- Nitazoxanide is used to treat the following conditions:
Drug and food interactions
metroNIDAZOLE food
Applies to: metronidazole
CONTRAINDICATED: Use of alcohol or products containing alcohol during nitroimidazole therapy may result in a disulfiram-like reaction in some patients. There have been a few case reports involving metronidazole, although data overall are not convincing. The presumed mechanism is inhibition of aldehyde dehydrogenase (ALDH) by metronidazole in a manner similar to disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentrations of acetaldehyde, the accumulation of which can produce an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmia, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. However, some investigators have questioned the disulfiram-like properties of metronidazole. One study found neither elevations in blood acetaldehyde nor objective or subjective signs of a disulfiram-like reaction to ethanol in six subjects treated with metronidazole (200 mg three times a day for 5 days) compared to six subjects who received placebo.
MANAGEMENT: Because clear evidence is lacking concerning the safety of ethanol use during nitroimidazole therapy, patients should be apprised of the potential for interaction. Consumption of alcoholic beverages and products containing propylene glycol is specifically contraindicated during and for at least 3 days after completion of metronidazole and benznidazole therapy according to their product labeling.
References
- Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15
- Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3
- Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80
- "Product Information. Flagyl (metronidazole)." Searle PROD (2001):
- Edwards DL, Fink PC, Van Dyke PO "Disulfiram-like reaction associated with intravenous trimethoprim-sulfamethoxazole and metronidazole." Clin Pharm 5 (1986): 999-1000
- Williams CS, Woodcock KR "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother 34 (2000): 255-7
- Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP "Lack of disulfiram-like reaction with metronidazole and ethanol." Ann Pharmacother 36 (2002): 971-4
- Krulewitch CJ "An unexpected adverse drug effect." J Midwifery Womens Health 48 (2003): 67-8
- "Product Information. Benznidazole (benznidazole)." Everett Laboratories Inc (2017):
nitazoxanide food
Applies to: nitazoxanide
ADJUST DOSING INTERVAL: Food enhances the bioavailability of the pharmacologically active metabolite tizoxanide (desacetyl-nitazoxamide) from nitazoxanide administration. According to the product labeling, administration of nitazoxanide tablets with food increases the area under the plasma concentration-time curve (AUC) of tizoxanide and tizoxanide glucuronide in plasma by almost 2-fold and the peak plasma concentration (Cmax) by almost 50%. Administration of nitazoxanide oral suspension with food increases the AUC of tizoxanide and tizoxandie glucuronide by about 45% to 50% and the Cmax by less than 10%.
MANAGEMENT: Nitazoxanide tablets and oral suspension were administered with food in clinical trials and are recommended to be administered with food to ensure maximal drug levels in plasma.
References
- "Product Information. Alinia (nitazoxanide)." Romark Laboratories L.C. (2002):
Therapeutic duplication warnings
Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.
Amebicides
Therapeutic duplication
The recommended maximum number of medicines in the 'amebicides' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'amebicides' category:
- metronidazole
- nitazoxanide
Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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