Metronidazole interaction

An interaction has also been reported in association with metabolic acidosis in an intoxicated man 4 hours after he was given intravenous metronidazole as prophylaxis following injury. A fatality occurred in a frail 31-year old woman, which was attributed to cardiac arrhythmia caused by acetaldehyde toxicity resulting from the alcohol/metronidazole interaction, linked to autonomic distress caused by a physical assault. Alcohol is also said to taste unpleasant or to be less pleasurable while taking metronidazole. Some drug abusers apparently exploit the reaction for kicks . ... 

Assess the potential for drug interactions, particularly in patients taking regimens containing metronidazole, clarithromycin, and/or cimetidine. 

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)... 

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

Solutions of cefepime, like those of most -lactam antibiotics, should not be added to solutions of ampicillin at a concentration greater than 40 mg/mL, and should not be added to metronidazole, vancomycin, gentamicin, tobramycin, netilmicin sulfate, or aminophylline because of potential interaction. However, if concurrent therapy with cefepime is indicated, each of these antibiotics can be administered separately. P.877... 

Drugs that may interact with zalcitabine include antacids, chloramphenicol, cisplatin, dapsone, didanosine, disulfiram, ethionamide, glutethimide, gold, hydralazine, iodoquinol, isoniazid, metronidazole, nitrofurantoin, phenytoin, ribavirin, vincristine, cimetidine, metoclopramide, amphotericin, aminoglycosides, foscarnet, antiretroviral nucleoside analogs, pentamidine, and probenecid. 

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. 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

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. 

There are drug products whose interaction with PVC bags and infusion sets are so high that they must include labehng precautions for use with PVC containers. These drugs include antineoplastics such as pachtaxel, docetaxel, tacrolimus, and teniposide, and others such as ciprofloxacin, cefoperazone sodium, fluconazole, metronidazole HC1, cimetidine, and propofol [64,65]. 

Lopinavir/Ritonavir (Kaletra) [Anrirelroviral/Protease Inhibitor] Uses HIV Infxn Action Protease inhibitor Dose Adults. Tx naive 2 tab PO daily or 1 tab PO bid Tx experiencedpt 1 tab PO bid (T dose if w/ amprenavir, efavirenz, fosamprenavir, nelfinavir, nevirapine) Peds. 7-15 kg 12/3 mg/kg PO bid 15-40 kg 10/2.5 mg/kg PO bid >40 kg Adult dose w/ food Caution [C, /-] Numerous interactions Contra w/drugs dependent on CYP3A/CYP2D6 (Table VI-8) Disp Tab, soln SE Avoid disulfiram (soln has EtOH), metronidazole GI upset, asthenia, T cholesterol/triglycerides, pancreatitis protease metabolic synd Interactions T Effects Wl clarithromycin, erythromycin T effects OF amiodarone, amprenavir, azole andfungals, bepridil, cisapride, cyclosporine, CCBs, ergot alkaloids, flecainide, flurazepam, HMG-CoA reductase inhibitors, indinavir, lidocaine, meperidine, midazolam, pimozide, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, tacrolimus, terfenadine, triazolam, zolpidem 1 effects Wl barbiturates, carbamazepine, dexamethasone, didanosine, efavirenz, nevirapine, phenytoin, rifabutin, rifampin, St. John s wort 1 effects OF OCPs, warfarin EMS Use andarrhythmics and benzodiazepines... 

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