Metronidazole with Cyclosporine Interaction Details
Brand Names Associated with Metronidazole
- Flagyl®
- Flagyl® 375
- Flagyl® ER
- Metronidazole
Brand Names Associated with Cyclosporine
- Cyclosporine
- Gengraf®
- Neoral®
- Sandimmune® Capsules
- Sandimmune® Oral Solution
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 04, 2024
Interaction Effect
An increased risk of cycloSPORINE toxicity (nephrotoxicity, cholestasis, paresthesias)
Interaction Summary
In a case report, the combined use of metronidazole 1500 mg daily and cimetidine 800 mg daily resulted in a greater than two-fold increase in cycloSPORINE levels (from 400 to 800 mcM/L). When cimetidine was discontinued, levels declined to about 600 mcM/L. It was not until metronidazole was discontinued that cycloSPORINE levels returned to baseline. Another case report described a patient who experienced a 97% increase in his cycloSPORINE blood level when metronidazole 1200 mg daily was administered for one week .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor circulating cycloSPORINE levels and adjust cycloSPORINE dosage as necessary; usual therapeutic trough levels range from 50 mcg/L to 150 mcg/L. Also monitor patients for increased signs of cycloSPORINE toxicity (nephrotoxicity, cholestasis, overimmunosuppression).
Mechanism Of Interaction
Inhibition by metronidazole of cytochrome P450 3A4-mediate cycloSPORINE metabolism
Literature Reports
A) A 50-year-old male with a cadaveric renal allograft was stabilized on cycloSPORINE 125 mg twice daily with a trough cycloSPORINE concentration between 130 mcg/L and 150 mcg/L. Following a three-day history of vomiting and diarrhea, a stool culture isolated Campylobacter coli for which he was treated with metronidazole 400 mg three times daily for one week. His illness resolved over three days, but the cycloSPORINE level increased to 264 mcg/L and his serum creatinine increased from 0.17 mmol/L to 0.19 mmol/L. Following the discontinuation of metronidazole, cycloSPORINE levels decreased to 120 mcg/L and renal function returned to baseline .
Metronidazole Overview
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Metronidazole capsules and tablets are used to treat infections of the reproductive system, gastrointestinal (GI) tract, skin, heart, bone, joint, lung, blood, nervous system, and other areas of the body. Metronidazole capsules and tablets are also used to treat sexually transmitted diseases (STDs). Metronidazole extended-release (long-acting) tablets are used to treat bacterial vaginosis (an infection caused by too much of certain types of harmful bacteria in the vagina) in women. Metronidazole is in a class of medications called nitroimidazole antimicrobials. It works by stopping the growth of bacteria.
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Antibiotics will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
Cyclosporine Overview
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Cyclosporine and cyclosporine (modified) are used with other medications to prevent transplant rejection (attack of the transplanted organ by the immune system of the person who received the organ) in people who have received kidney, liver, and heart transplants. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments. Cyclosporine and cyclosporine (modified) are in a class of medications called immunosuppressants. They work by decreasing the activity of the immune system.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.