5-Nitroimidazoles Alcohol

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, 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. 

A disulfiram-like reaction has occurred when some patients taking oral metronidazole have drunk alcohol. There is one report of its occurrence when metronidazole was applied as a vaginal insert, and another when metronidazole was given intravenously. Some clinical studies have not confirmed the interaction, and its existence is disputed in some reports. The interaction is alleged to occur with all other 5-nitroimidazoles (e.g. tinidazole). 

The high functional group selectivity of NaB HgCN-mediated reductions is illustrated by that of the l-a-D-(2,3-di-0-acetyl-4-fonnylarabinofuranosyl)-2-nitroimidazole (222) to the corresponding [ 1 H]alcohol in 50% radiochemical yield without affecting the ancillary nitro and ester functions. In contrast, NaB H4 was found to cleave the acetate protecting... 

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