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INTERACTIONS: Alcohol should be avoided because metronidazole and alcohol together can cause nausea, vomiting, cramps, flushing and headache.

Metronidazole may increase the effects of blood thinning warfarin (Coumadin) and increase the risk of bleeding probably by reducing the breakdown of warfarin.

Cimetidine (Tagamet) increases blood levels of metronidazole while cholestyramine reduces blood levels of metronidazole by reducing its absorption.

Metronidazole should not be combined with amprenavir for treating human immunodeficiency disease (HIV) because amprenavir contains propylene glycol. Metronidazole blocks the breakdown of propylene glycol in the liver leading to accumulation of propylene glycol in the blood. The accumulation of propylene glycol can cause convulsions, increased heart rate and lead to kidney failure.

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Metronidazole increases the blood levels of carbamazepine, lithium and cyclosporine if unknown mechanisms. Severe reactions may occur if these medicines are taken with metronidazole.

PREGNANCY: Metronidazole is not used in early pregnancy because of potential adverse effects on the fetus.

Breast-feeding: Metronidazole is excreted in breast milk. Nursing mothers, because of potential adverse effects on the newborn, should not use metronidazole.

SIDE EFFECTS: Metronidazole is an antibiotic of value and is generally well tolerated with appropriate use. Side effects include nausea, headaches, loss of appetite, metallic taste, and rarely a rash. Serious side effects of metronidazole are rare. Serious side effects of seizures and damage of nerves resulting in numbness and tingling of the extremities (peripheral neuropathy). Metronidazole should be discontinued if these symptoms appear.

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