Metronidazole Alcohol

METRONIDAZOLE ALCOHOL Disulfiram-like reaction Metronidazole inhibits aldehyde dehydrogenase Avoid co-ingestion... 

Chlorpropamide, tolbutamide, tolazamide, acetohexamide, metronidazole Alcohol Disulfiram-like reaction... 

Not understood. In the disulfiram reaction, the accumulation of acetaldehyde appears to be responsible for most of the symptoms (see Alcohol + E)isulfiram , p.61). Some workers have reported an increase in acetaldehyde levels due to the metronidazole/alcohol interaction, but others have... 

When metronidazole is prescribed, the nurse warns the patient to avoid the use of alcoholic beverages because a severe reaction may occur. 

Metronidazole is contraindicated in patients with known hypersensitivity. Metronidazole is contraindicated during the first trimester of pregnancy (Category B). Metronidazole is given during the second and third trimesters of pregnancy. Metronidazole is used cautiously in patients with blood dyscrasias, seizure disorders, and severe hepatic impairment. The patient must avoid alcohol while taking metronidazole... 

Educate patients on specific adverse drug effects, particularly with metronidazole (avoidance of alcohol) and bismuth (change in stool color). 

Counsel women taking metronidazole regarding potential for nausea, vomiting, and abdominal pain. Counsel patients to avoid alcohol or alcohol-containing substances during therapy with metronidazole owing to the risk of disulfuram-like reactions. 

Counsel women taking metronidazole to avoid drinking alcohol or using alcohol-containing substances during therapy. 

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)... 

Patients taking metronidazole should be instructed to avoid alcohol ingestion during therapy and for 1 to 2 days after completion of therapy because of a possible disulfiram-like effect. 

Flagyl tablets contain metronidazole. All patients taking metronidazole are advised to avoid alcohol as the combination of alcohol and metronidazole may lead to a disulfiram-like reaction. 

Concomitant intake of alcohol and metronidazole is potentially dangerous, leading to a disulfiram-like type reaction characterised by intense vasodilatation, throbbing headache, tachycardia and sweating which can lead to death. 

Metronidazole is an antiprotozoal agent that, if taken concomitantly with alcohol, may result in a disulfiram-like reaction characterised by intense vasodilation, headache, tachycardia, sweating and vomiting. 

Q52 A patient v/ho is taking metronidazole tablets should be advised to take tablets v/ith or after food and to avoid alcoholic drink. When alcohol is consumed v/ith metronidazole, the patient may present v/ith acute psychoses or confusion. 

Metronidazole and alcohol interact resulting in a disulfiram-type reaction, which may present with acute psychoses and confusion leading to lethal consequences. Patients are therefore strongly advised not to consume alcohol during treatment with metronidazole and to take tablets with or after food. 

Drugs that may affect barbiturates include alcohol, charcoal, chloramphenicol, MAO inhibitors, rifampin, and valproic acid. Drugs that may be affected by barbiturates include acetaminophen, anticoagulants, beta blockers, carbamazepine, chloramphenicol, clonazepam, oral contraceptives, corticosteroids, digitoxin, doxorubicin, doxycycline, felodipine, fenoprofen, griseofulvin, hydantoins, methoxyflurane, metronidazole, narcotics, phenmetrazine, phenylbutazone, quinidine, theophylline, and verapamil. 

Severe myocardial disease or coronary occlusion psychoses hypersensitivity to disulfiram or to other thiuram derivatives used in pesticides and rubber vulcanization patients receiving or who have recently received metronidazole, paraldehyde, alcohol, or alcohol-containing preparations. 

Drugs that may interact with disulfiram include alcohol, benzodiazepines, caffeine, chlorzoxazone, cocaine, hydantoins, isoniazid, metronidazole, theophylline, tricyclic antidepressants, and warfarin. 

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. 

Oral bioavailability is almost 100%. Metronidazole is protein bound for less than 20% and is widely distributed, including the CNS. It is metabolized in the liver with an elimination half-life of 8 hours. Common adverse effects include nausea, headache and taste disturbances. With alcohol a severe disulfiram-like reaction, with flushing, sweating and abdominal cramps will occur. 

Answer Metronidazole shares the abihty of disulfi-ram to block the metabolism of alcohol and cause an accumulation of acetaldehyde. The student s symptoms are consistent with an accumulation of this agent. 

Displacement of GABA from its receptors by ciprofloxacin results in increased levels of the neu-roexcitatory transmitter and acute CNS toxicity. The neuroexcitation can range from irritability, confusion, and agitation to seizures and toxic psychosis. Ciprofloxacin has no interaction with alcohol. A disulfiramlike reaction (flushing, nausea, vomiting, and profuse sweating) is associated with alcohol and metronidazole. Avoid alcohol and metronidazole coadministration. 

Metronidazole, a nitroimidazole, is effective only against anaerobic bacteria since its mechanism of action involves the generation of toxic metabolites in a milieu of low redox potential. It is well absorbed when administered orally and, apart from disulfiram reactions when co-administered with alcohol, is well tolerated. It is indicated in infections in which anaerobes have a major role, such as intestinal or biliary tract sepsis, and is the first-line agent for C. of/ffic/Ze-associated colitis. 

Oxidation of acetaldehyde is inhibited by disulfiram, a drug that has been used to deter drinking by alcohol-dependent patients undergoing treatment. When ethanol is consumed in the presence of disulfiram, acetaldehyde accumulates and causes an unpleasant reaction of facial flushing, nausea, vomiting, dizziness, and headache. Several other drugs (eg, metronidazole, cefotetan, trimethoprim) inhibit ALDH and can cause a disulfiram-like reaction if combined with ethanol. 

Fosamprenavir PI2 1400 mg bid or 700 mg bid with ritonavir 100 bid or 1400 mg daily with ritonavir 100-200 mg daily. Adjust dose in hepatic insufficiency Separate dosing from antacids by 2 h. Avoid concurrent high-fat meals Diarrhea, nausea, vomiting, hypertriglyceridemia, rash, headache, perioral paresthesias, t liver enzymes See footnote 4 for contraindicated medications. Do not administer with lopinavir/ritonavir or in severe hepatic insufficiency. Also avoid cimetidine, disulfiram, metronidazole, vitamin E, ritonavir oral solution, and alcohol when using the oral solution... 

Adverse effects include nausea, diarrhea, stomatitis, and peripheral neuropathy with prolonged use. Metronidazole has a disulfiram-like effect, and patients should be instructed to avoid alcohol. Although teratogenic in some animals, metronidazole has not been associated with this effect in humans. Other properties of metronidazole are discussed in Chapter 52. 

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