Metronidazole lithium

Metronidazole Nausea/vomiting Metallic taste Refrain from using alcoholic beverages potential for disulfiram-like reaction Substrate for CYP2C9 and inhibitor of CYP2C9, 3A3/4 and 3A5-7 potential interactions may include warfarin (enhanced prothrombin time) and lithium (increased concentrations)... 

Drugs that may affect metronidazole include barbiturates and cimetidine. Drugs that may be affected by metronidazole include anticoagulants, disulfiram, ethanol, hydantoins, and lithium. 

The following drug interactions were reported for metronidazole, a chemically related nitroimidazole. Therefore, these drug interactions may occur with tinidazole. Drugs that may affect tinidazole include cholestyramine, CYP3A4 inducers and inhibitors and oxytetracycline. Drugs that may be affected by tinidazole include alcohols, anticoagulants, cyclosporine, tacrolimus, disulfiram, fluorouracil, hydantoins, and lithium. 

Metronidazole has been reported to potentiate the anticoagulant effect of coumarin-type anticoagulants. Phenytoin and phenobarbital may accelerate elimination of the drug, whereas cimetidine may decrease plasma clearance. Lithium toxicity may occur when the drug is used with metronidazole. 

Alcohol should be avoided during furazolidone and metronidazole therapy. Toxic psychosis has been seen in patients under treatment with furazolidone. Metronidazole should be used with caution when coadministering with warfarin, phenytoin, lithium, omeprazole, and phenobarbital. The coadministration of pentamidine with drugs toxic to the kidney should be avoided. 

Teicher MH, Altesman RI, Cole JO, Schatzberg AF. Possible nephrotoxic interaction of lithium and metronidazole. JAMA 1987 257(24) 3365-6. 

LITHIUM ANTIBIOTICS -METRONIDAZOLE t plasma concentrations of lithium with risk of toxicity Uncertain Monitor clinically and by measuring blood lithium levels for lithium toxicity... 

Metronidazole can lead to lithium toxicity through decreased renal clearance... 

Metronidazole (Flagyl) Increased lithium levels, lithium toxicity... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, amlodi-pine, carbamazepine, cefotaxime, ceftazidime, chloramphenicol, ciprofloxacin, cisapride, clindamycin, clonidine, codeine, cyclosporine, digoxin, diphenhydramine, disopyramide, ethosuximide, fluconazole, gentamicin, gentamicin, heparin, labetalol, levothyroxine, li-docaine, lithium, methotrexate, metronidazole, minoxidil, nafcillin, nifedipine, phenobar-bital, phenobarbital, phenytoin, phenytoin, primidone, procainamide, propranolol, quini-dine, ranitidine, salicylic acid, theophylline, tobramycin, tobramycin, valproic acid, warfarin... 

Increases in serum lithium concentration have been reported in patients receiving antibacterials (e.g., metronidazole, spectinomycin, tetracyclines, and tlcarcillinJ Regular monitoring of lithium plasma levels is advised when it is combined with cisplatin in cancer patientsJ ... 

There seems to be no reason for avoiding concurrent use, but the outcome should be well monitored. Some have recommended that a reduction in the lithium dose should be considered, especially in patients maintained at relatively high serum-lithium levels. Patients taking lithium should be aware of the symptoms of lithium toxicity and told to report them immediately should they occur. This should be reinforced when they are given metronidazole. The authors of one of the reports also recommend frequent analysis of creatinine and electrol5fte levels and urine osmolality in order to detect any renal problems in patients on this eombination. ... 

Keep in mind not all antineoplastics belong to hazard categories 4 or 5 (see Sect. 26.3.3), and the other way round some other active substances (such as ethinylestradiol, lithium carbonate, ciclosporin, coal tar, metronidazole and tacrolimus) belong to class 4 or 5. 

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