Drug & supplement interaction

Ephedra + Metronidazole

Metronidazole brand names: Flagyl, Protostat, Metronidazole, Nidazol, Trikacide, and others.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Ephedra has a major interaction with Metronidazole. Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.

Read the full interaction report
SeverityMajor
LikelihoodProbable
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ephedra and Metronidazole

Here is the interaction we found between these two, with the evidence behind it.

Major

QT INTERVAL-PROLONGING DRUGS

Why this applies to Metronidazole

Metronidazole falls under QT INTERVAL-PROLONGING DRUGS — the group Ephedra interacts with.

Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.
Even in healthy volunteers, EKG changes including prolonged QT interval and premature atrial contractions have been reported with ingestion of recommended doses of ephedra. Ephedra may have an additive effect with drugs that prolong the QT interval. This may increase the risk of ventricular arrhythmias.
Severity Major Likelihood Probable Evidence B

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with pairing these two. Metronidazole (Flagyl) can, in some people, stretch out a part of your heart's electrical cycle called the QT interval. Ephedra, thanks to its stimulant compounds like ephedrine, also stresses the heart and has been shown to cause EKG changes, including QT prolongation, even at usual doses. Stacking them together may add up and raise the risk of a dangerous heart rhythm problem.

The evidence here is on the theoretical side, so this isn't a certainty for everyone, but the potential outcome is serious enough that I take it seriously. On top of that, ephedra is banned in U.S. supplements for good safety reasons. My honest advice: please don't use ephedra, and let your pharmacist or doctor guide you to safer choices while you're on this antibiotic.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Jenkins DJ, Wesson V, Wolever TM, et al. Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response. BMJ 1988;297:958-60. PubMed
  2. McBride BF, Karapanos AK, Krudysz A, et al. Electrocardiographic and hemodynamic effects of a multicomponent dietary supplement containing ephedra and caffeine: a randomized controlled trial. JAMA 2004;291:216-21. PubMed
  3. Gardner SF, Franks AM, Gurley BJ, et al. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Cardiol 2003;91:1510-3, A9. PubMed
  4. Gardner, S. F., Franks, A. M., Gurley, B. J., Haller, C. A., Singh, B. K., and Mehta, J. L. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Card PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Ephedra Also Interacts With Other Medications

Ephedra has 336 major, 496 moderate known drug interactions in our database — the Metronidazole one above is one of them. If you take anything else, check it against the full list below.

Major 336 Moderate 496 No known interaction 1,998 (incl. Metronidazole)
Taking anything else?

Check Another of Your Medications Against Ephedra

Covers the 2,830 medications we’ve checked against Ephedra. Pick one to open its full report.

From our Q&A

Questions About Ephedra or Metronidazole

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Ephedra or Metronidazole, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Metronidazole

This page covers Ephedra only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Metronidazole page lists 83 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Grapefruit (major).

By severity: 7 major · 63 moderate · 13 minor.

From our pharmacist’s overview on the Metronidazole page

“Metronidazole (Flagyl) can stretch the heart's QT interval on its own, and most of the seven major-rated interactions among its 83 flagged supplement ingredients do the same thing, so I read this list with more wariness than most antibiotics earn. Grapefruit and ephedra stand out for adding to that heart-rhythm risk, while activated ch…”

Reviewed by 2 · Jul 18, 2026

Open the Metronidazole interaction page

One more smart check

Taking Ephedra as Part of a Dietary Supplement Product? Check It for Interactions

We hold 37 real supplement products containing Ephedra, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Ephedra. Your product may carry other ingredients that interact with Metronidazole too, on top of Ephedra — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Ephedra and Metronidazole Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Ephedra
Top half

#503 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Metronidazole
Top 25%

#305 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Ephedra

What is Ephedra?

Ephedra
  • Weight loss
  • Nasal and sinus congestion
  • Asthma and breathing problems
  • Boosting energy and athletic performance
  • Allergies

Ephedra (ma huang) contains powerful stimulants like ephedrine that affect the heart and nervous system. Because it has been linked to serious harms including high blood pressure, stroke, and death, it is banned for use in dietary supplements in the U.S. and many other countries. We do not recommend using ephedra-containing supplements; talk to your pharmacist or doctor about safer, approved options.

Read the full Ephedra monograph & all interactions
Medication

About Metronidazole

What Is Metronidazole Used For?

Brand names: Flagyl, Protostat, Metronidazole, Nidazol, Trikacide, MetroGel, Flagyl IV, Metronidazole Redi-Infusion, Flagyl IV RTU, Metro IV, Anabact, Metrosa, Metrotop, Noritate, Rozex Cream, Rozex Gel, Zyomet, Likmez

Metronidazole treats three main types of infections. It's used for trichomoniasis (a sexually transmitted parasitic infection), amebiasis (an intestinal or liver infection caused by a parasite), and serious anaerobic bacterial infections — infections caused by bacteria that thrive without oxygen, which can affect the abdomen, skin, bones, lungs, and other areas.

Because sexual partners can pass trichomoniasis back and forth, both partners are typically treated at the same time, even if one has no symptoms.

See full Metronidazole drug information
Keep checking

Other Drugs & Ephedra

Browse every other medication we’ve checked against Ephedra — both the ones with a known interaction and the ones without. Select any drug for the full detail.

336Major
496Moderate
0Minor
1,997No known interaction
336 Major 496 Moderate 1,997 No interaction
Major

336 interactions

Showing 60 of 336 major interactions — see all 336 on the Ephedra page.

Moderate

496 interactions

Showing 60 of 496 moderate interactions — see all 496 on the Ephedra page.

No interaction 1,997 drugs checked — show the list

We also checked Ephedra against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,997 medications checked with no known interaction — see the full Ephedra list.

See the full Ephedra interactions page
See every supplement checked against Metronidazole, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Ephedra monograph › Uses, safety, and every drug interaction in one place Metronidazole supplement interactions › Every supplement checked against Metronidazole, ranked by severity Metronidazole drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Ephedra and Metronidazole Together: Common Questions

Can you take Ephedra with Metronidazole?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Ephedra and Metronidazole interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Metronidazole and Ephedra?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.