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Metronidazole

Also indexed as: Flagyl®, MetroCream®, MetroGel®, MetroLotion®, Noritate®, Protostat®

Combination drug: Helidac®

Metronidazole is an antibiotic used to treat a variety of bacterial and parasitic infections, such as amebiasis, trichomoniasis, and giardiasis. It is also used as a component of multidrug antibiotic combinations to heal stomach and duodenal ulcers caused by Helicobacter pylori infections. Metronidazole is available alone and in a combination product.

Interactions with Dietary Supplements

Saccharomyces boulardii
The yeast Saccharomyces boulardii may help restore microbial balance in the intestines and prevent pseudomembranous colitis (PMC), an intestinal disorder caused by infection with Clostridium difficile. Even when Clostridium difficile is successfully treated with antibiotics, symptoms recur in about 20% of cases. Saccharomyces boulardii has been shown in controlled trials to reduce recurrences when given as an adjunct to antibiotic therapy.1 2 3

Interactions with Herbs

Milk thistle  (Silybum marianum)
Milk thistle has been reported to protect the liver from harm caused by some prescription drugs.4 While milk thistle has not yet been studied directly for protecting people against the known potentially liver-damaging actions of metronidazole, it is often used for this purpose.

Interactions with Foods and Other Compounds

Food
Metronidazole should be taken with food to avoid stomach upset.

Alcohol
Alcohol may interact with metronidazole, causing facial flushing, headache, light-headedness, nausea, breathlessness, and other symptoms.5 Vinegar typically contains small amounts of alcohol and should be avoided during metronidazole therapy. People should read all product labels carefully for alcohol content and should avoid alcohol-containing products during metronidazole therapy.

Summary of Interactions for Metronidazole

Depletion or interference None known
Adverse interaction None known
Side effect reduction/prevention Saccharomyces boulardii (for Clostridium difficile only)
Supportive interaction Saccharomyces boulardii (for Clostridium difficile only)
Reduced drug absorption/bioavailability None known
Other (see text) Milk thistle

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Surawicz CM, McFarland LV. Pseudomembranous colitis: causes and cures. Digestion 1999;60:91–100 [review].

2. Eddy JT, Stamatakis MK, Makela EH. Saccharomyces boulardii for the treatment of Clostridium difficile-associated colitis. Ann Pharmacother 1997;31:919–21.

3. McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994;271:1913–8 [published erratum appears in JAMA 1994;272:518].

4. Morazzoni P, Bombardelli E. Silybum marianum (Carduus marianus). Fitoterapia 1995;66:3–42 [review].

5. Threlkeld DS, ed. Systemic Anti-Infectives, Metronidazole. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Nov 1992, 353a–3e.