Skip to main content

Drug Interactions between Metryl and tipranavir

This report displays the potential drug interactions for the following 2 drugs:

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

metroNIDAZOLE tipranavir

Applies to: Metryl (metronidazole) and tipranavir

GENERALLY AVOID: Ritonavir capsules, ritonavir oral solution, lopinavir-ritonavir oral solution, and tipranavir capsules all contain alcohol, which may produce a disulfiram-like reaction when coadministered with drugs that can inhibit aldehyde dehydrogenase (ALDH) such as nitroimidazoles (e.g., metronidazole, tinidazole), nitrofurans (e.g., furazolidone, nifurtimox), and cephalosporins with an N-methylthiotetrazole (NMTT) side chain that structurally resembles 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. The interaction is well established for disulfiram. However, data for other potential ALDH inhibitors such as metronidazole and cephalosporins are limited and conflicting.

MANAGEMENT: Until further information is available, use of ritonavir capsules, ritonavir oral solution, lopinavir-ritonavir oral solution, or tipranavir capsules with nitroimidazoles (including vaginal formulations), nitrofurans, and certain cephalosporins should be avoided if possible.

References

  1. Uri JV, Parks DB "Disulfiram-like reaction to certain cephalosporins." Ther Drug Monit 5 (1983): 219-24
  2. Kline SS, Mauro VF, Forney RB Jr, et al. "Cefotetan-induced disulfiram-type reactions and hypoprothrombinemia." Antimicrob Agents Chemother 31 (1987): 1328-31
  3. Portier H, Chalopin JM, Freysz M, Tanter Y "Interaction between cephalosporins and alcohol." Lancet 08/02/80 (1980): 263
  4. Shimada J, Hayashi Y, Nakamura K "Cefmetazole: clinical evaluation of efficacy and safety in Japan." Drugs Exp Clin Res 11 (1985): 181-94
  5. Freundt KJ, Kitson TM "Inactivation of aldehyde dehydrogenase by a putative metabolite of cefamandole." Infection 14 (1986): 44-7
  6. Freundt KJ, Schreiner E, Christmann-Kleiss U "Cefamandole: a competitive inhibitor of aldehyde dehydrogenase." Infection 13 (1985): 91
  7. McMahon FG "Disulfiram-like reaction to a cephalosporin." JAMA 243 (1980): 2397
  8. Reeves DS, Davies AJ "Antabuse effect with cephalosporins." Lancet 2 (1980): 540
  9. Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15
  10. Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3
  11. Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80
  12. Neu HC, Prince AS "Interaction between moxalactam and alcohol." Lancet June (1980): 1422
  13. Brown KR, Guglielmo BJ, Pons VG, Jacobs RA "Theophylline elixir, moxalactam, and a disulfiram reaction." Ann Intern Med 97 (1982): 621-2
  14. Umeda S, Arai T "Disulfiram-like reaction to moxalactam after celiac plexus alcohol block." Anesth Analg 64 (1985): 377
  15. "Product Information. Flagyl (metronidazole)." Searle PROD (2001):
  16. Jones RO "Death following the ingestion of alcohol in an antabuse treated patient." Can Med Assoc J 60 (1949): 609-12
  17. van Ieperen L "Sudden death during disulfiram-ethanol reaction." S Afr Med J 66 (1984): 165
  18. Buening MK, et al. "Disulfiram-like reaction to beta-lactams." JAMA 245 (1981): 2047
  19. Foster TS, Raehl CL, Wilson HD "Disulfiram-like reaction associated with a parenteral cephalosporin." Am J Hosp Pharm 37 (1980): 858-9
  20. Elenbaas RM "Drug therapy reviews: management of the disulfiram-alcohol reaction." Am J Hosp Pharm 34 (1977): 827-31
  21. "Product Information. MetroGel-Vaginal (metroNIDAZOLE topical)." Curatek Pharmaceuticals Ltd (2022):
  22. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical PROD (2001):
  23. Cina SJ, Russell RA, Conradi SE "Sudden death due to metronidazole/ethanol interaction." Am J Forensic Med Pathol 17 (1996): 343-6
  24. "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation PROD (2001):
  25. Williams CS, Woodcock KR "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother 34 (2000): 255-7
  26. "Product Information. Kaletra (lopinavir-ritonavir)." Abbott Pharmaceutical PROD (2001):
  27. Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP "Lack of disulfiram-like reaction with metronidazole and ethanol." Ann Pharmacother 36 (2002): 971-4
  28. Krulewitch CJ "An unexpected adverse drug effect." J Midwifery Womens Health 48 (2003): 67-8
  29. McMahon FG, Ryan JR, Jain AK, LaCorte W, Ginzler F "Absence of disulfiram-type reactions to single and multiple doses of cefonicid: a placebo-controlled study." J Antimicrob Chemother 20 (1987): 913-8
  30. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc (2004):
  31. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim (2005):
View all 31 references

Switch to consumer interaction data

Drug and food interactions

Major

metroNIDAZOLE food

Applies to: Metryl (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

  1. Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15
  2. Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3
  3. Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80
  4. "Product Information. Flagyl (metronidazole)." Searle PROD (2001):
  5. Edwards DL, Fink PC, Van Dyke PO "Disulfiram-like reaction associated with intravenous trimethoprim-sulfamethoxazole and metronidazole." Clin Pharm 5 (1986): 999-1000
  6. Williams CS, Woodcock KR "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother 34 (2000): 255-7
  7. Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP "Lack of disulfiram-like reaction with metronidazole and ethanol." Ann Pharmacother 36 (2002): 971-4
  8. Krulewitch CJ "An unexpected adverse drug effect." J Midwifery Womens Health 48 (2003): 67-8
  9. "Product Information. Benznidazole (benznidazole)." Everett Laboratories Inc (2017):
View all 9 references

Switch to consumer interaction data

Moderate

tipranavir food

Applies to: tipranavir

ADJUST DOSING INTERVAL: Food does not appear to substantially alter the pharmacokinetics of tipranavir. When tipranavir capsules or oral solution was coadministered with ritonavir capsules at steady-state, no clinically significant changes in tipranavir peak plasma concentration (Cmax) and systemic exposure (AUC) were observed under fed conditions (500 to 682 kcal, 23% to 25% calories from fat) relative to fasted conditions. The effect of food on tipranavir exposure during coadministration with ritonavir tablets has not been evaluated. High-fat foods may enhance the gastrointestinal absorption of tipranavir. In a multiple-dose study, administration of tipranavir capsules with a high-fat meal (868 kcal, 53% from fat, 31% from carbohydrates) increased the oral bioavailability of tipranavir by 31% compared to administration with toast and skimmed milk, but did not significantly affect tipranavir Cmax. Thus, tipranavir may be safely taken with standard or high-fat meals.

MANAGEMENT: Tipranavir coadministered with low-dose ritonavir should be taken with food to improve the gastrointestinal tolerability of ritonavir. According to the product labeling, tipranavir coadministered with ritonavir capsules or solution can be taken with or without meals, whereas tipranavir coadministered with ritonavir tablets must be taken with meals.

References

  1. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim (2005):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  4. Cerner Multum, Inc. "Australian Product Information." O 0
View all 4 references

Switch to consumer interaction data

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

Report options

Loading...
QR code containing a link to this page

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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

Medical Disclaimer