Drug/Small Molecule:
metronidazole

PharmGKB contains no dosing guidelines for this drug/small molecule. To report known genotype-based dosing guidelines, or if you are interested in developing guidelines, click here.

PharmGKB has no annotated drug labels with pharmacogenomic information for this drug/small molecule. If you know of a drug label with PGx, send us a message.

Links to Unannotated Labels

These links are to labels associated with metronidazole that have not been annotated by PharmGKB.

  1. DailyMed - DrugLabel PA166105196

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

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This is a non-comprehensive list of genetic tests with pharmacogenetics relevance, typically submitted by the manufacturer and manually curated by PharmGKB. The information listed is provided for educational purposes only and does not constitute an endorsement of any listed test or manufacturer.

A more complete listing of genetic tests is found at the Genetic Testing Registry (GTR).

PGx Test Variants Assayed Gene?
2D structure from PubChem
provided by PubChem

Overview

Generic Names
  • Methronidazole
  • Metronidazol
  • Metronidazole Benzoate
  • Metronidazole Hcl
  • Metronidazole in Plastic Container
  • Metronidazolo
Trade Names
  • Acromona
  • Anagiardil
  • Apo-Metronidazole
  • Arilin
  • Atrivyl
  • Bayer 5360
  • Bexon
  • Clont
  • Cont
  • Danizol
  • Deflamon
  • Deflamon-Wirkstoff
  • Efloran
  • Elyzol
  • Entizol
  • Eumin
  • Flagemona
  • Flagesol
  • Flagil
  • Flagyl
  • Flagyl ER
  • Flagyl I.V.
  • Flegyl
  • Fossyol
  • Giatricol
  • Gineflavir
  • Klion
  • Klont
  • Meronidal
  • Metric 21
  • Metro Cream
  • Metro I.V.
  • Metro I.V. In Plastic Container
  • Metrocream
  • Metrogel
  • Metrogel-Vaginal
  • Metrolag
  • Metrolotion
  • Metrolyl
  • Metromidol
  • Metronidaz
  • Metrotop
  • Mexibol
  • Monagyl
  • Monasin
  • Nalox
  • Neo-Tric
  • Nida
  • Nidagel
  • Noritate
  • Novonidazol
  • Orvagil
  • Protostat
  • Rathimed
  • Sanatrichom
  • Satric
  • Takimetol
  • Trichazol
  • Trichex
  • Tricho Cordes
  • Tricho-Gynaedron
  • Trichocide
  • Trichomol
  • Trichopal
  • Trichopol
  • Tricocet
  • Tricom
  • Tricowas B
  • Trikacide
  • Trikamon
  • Trikojol
  • Trikozol
  • Trimeks
  • Trivazol
  • Vagilen
  • Vagimid
  • Vertisal
  • Wagitran
  • Zadstat
Brand Mixture Names
  • Helidac (Metronidazole + Bismuth subsalicylate + tetracycline hydrochloride)

PharmGKB Accession Id:
PA450484

Description

A nitroimidazole used to treat amebiasis; vaginitis; trichomonas infections; giardiasis; anaerobic bacteria; and treponemal infections. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed).

Source: Drug Bank

Indication

For the treatment of anaerobic infections and mixed infections, surgical prophylaxis requiring anaerobic coverage, Clostridium difficile-associated diarrhea and colitis, Helicobacter pylori infection and duodenal ulcer disease, bacterial vaginosis, Giardia lamblia gastro-enteritis, amebiasis caused by Entamoeba histolytica, acne rosacea (topical treatment), and Trichomonas infections.

Source: Drug Bank

Other Vocabularies

Information pulled from DrugBank has not been reviewed by PharmGKB.

Pharmacology, Interactions, and Contraindications

Mechanism of Action

Metronidazole is a prodrug. Unionized metronidazole is selective for anaerobic bacteria due to their ability to intracellularly reduce metronidazole to its active form. This reduced metronidazole then covalently binds to DNA, disrupt its helical structure, inhibiting bacterial nucleic acid synthesis and resulting in bacterial cell death.

Source: Drug Bank

Pharmacology

Metronidazole, a synthetic antibacterial and antiprotozoal agent of the nitroimidazole class, is used against protozoa such as Trichomonas vaginalis, amebiasis, and giardiasis. Metronidazole is extremely effective against anaerobic bacterial infections and is also used to treat Crohn's disease, antibiotic-associated diarrhea, and rosacea.

Source: Drug Bank

Food Interaction

Avoid alcohol.|Take with food to reduce irritation.

Source: Drug Bank

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Hepatic metabolism by hydroxylation, oxidation, and glucuronidation.

Source: Drug Bank

Protein Binding

Less than 20% bound to plasma proteins.

Source: Drug Bank

Absorption

Well absorbed (at least 80%) with peak plasma concentrations achieved in 1-3 hours following oral administration of therapeutic doses of immediate release formulation.

Source: Drug Bank

Half-Life

6-8 hours

Source: Drug Bank

Toxicity

LD50=500 mg/kg/day (orally in rat). Adverse effects include reversible peripheral neuropathy with prolonged therapy, CNS toxicity, disulfiram effect with alcohol, dark red-brown urine, metallic taste, nausea, epigastric distress, dizziness, vertigo and paresthesias associated with high doses, and neutropenia (reversible and mild).

Source: Drug Bank

Chemical Properties

Chemical Formula

C6H9N3O3

Source: Drug Bank

Isomeric SMILES

Cc1ncc(n1CCO)N(=O)=O

Source: OpenEye

Canonical SMILES

CC1=NC=C(N1CCO)[N+]([O-]

Source: Drug Bank

Average Molecular Weight

171.154

Source: Drug Bank

Monoisotopic Molecular Weight

171.064391169

Source: Drug Bank

Genes that are associated with this drug in PharmGKB's database based on (1) variant annotations, (2) literature review, (3) pathways or (4) information automatically retrieved from DrugBank, depending on the "evidence" and "source" listed below.

No related genes are available.

Drug Interactions

Drug Description
metronidazole Increased risk of side effects (oral solution) (source: Drug Bank)
metronidazole Increased risk of side effects (oral solution) (source: Drug Bank)
metronidazole Metronidazole increases the effect/toxicity of busulfan (source: Drug Bank)
metronidazole Metronidazole increases the effect/toxicity of busulfan (source: Drug Bank)
metronidazole Metronidazole increases the effect of carbamazepine (source: Drug Bank)
metronidazole Metronidazole increases the effect of carbamazepine (source: Drug Bank)
metronidazole Possible acute psychosis and confusion (source: Drug Bank)
metronidazole Possible acute psychosis and confusion (source: Drug Bank)
metronidazole Risk of 5-FU toxicity when associated with metronidazole (source: Drug Bank)
metronidazole Risk of 5-FU toxicity when associated with metronidazole (source: Drug Bank)
metronidazole Metronidazole increases the effect and toxicity of lithium (source: Drug Bank)
metronidazole Metronidazole increases the effect and toxicity of lithium (source: Drug Bank)
acenocoumarol Metronidazole increases the anticoagulant effect (source: Drug Bank)
acenocoumarol Metronidazole may increase the anticoagulant effect of acenocoumarol. (source: Drug Bank)
amobarbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
amobarbital The barbiturate, amobarbital, decreases the effect of metronidazole. (source: Drug Bank)
amprenavir Increased risk of side effects (oral solution) (source: Drug Bank)
amprenavir Increased risk of side effects (oral solution) (source: Drug Bank)
anisindione Metronidazole may increase the anticoagulant effect of anisindione. (source: Drug Bank)
aprobarbital The barbiturate, aprobarbital, decreases the effect of metronidazole. (source: Drug Bank)
busulfan Metronidazole increases the effect/toxicity of busulfan (source: Drug Bank)
busulfan Metronidazole increases the effect/toxicity of busulfan (source: Drug Bank)
butabarbital The barbiturate, butabarbital, decreases the effect of metronidazole. (source: Drug Bank)
butalbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
butalbital The barbiturate, butalbital, decreases the effect of metronidazole. (source: Drug Bank)
butethal The barbiturate, butethal, decreases the effect of metronidazole. (source: Drug Bank)
carbamazepine Metronidazole increases the effect of carbamazepine (source: Drug Bank)
carbamazepine Metronidazole increases the effect of carbamazepine (source: Drug Bank)
dicumarol Metronidazole increases the anticoagulant effect (source: Drug Bank)
dicumarol Metronidazole may increase the anticoagulant effect of dicumarol. (source: Drug Bank)
disulfiram Possible acute psychosis and confusion (source: Drug Bank)
disulfiram Possible acute psychosis and confusion (source: Drug Bank)
fluorouracil Risk of 5-FU toxicity when associated with metronidazole (source: Drug Bank)
fluorouracil Risk of 5-FU toxicity when associated with metronidazole (source: Drug Bank)
heptabarbital The barbiturate, heptabarbital, decreases the effect of metronidazole. (source: Drug Bank)
hexobarbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
hexobarbital The barbiturate, hexobarbital, decreases the effect of metronidazole. (source: Drug Bank)
lithium Metronidazole increases the effect and toxicity of lithium (source: Drug Bank)
lithium Metronidazole increases the effect and toxicity of lithium (source: Drug Bank)
methohexital The barbiturate, methohexital, decreases the effect of metronidazole. (source: Drug Bank)
methylphenobarbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
methylphenobarbital The barbiturate, methylphenobarbital, decreases the effect of metronidazole. (source: Drug Bank)
pentobarbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
pentobarbital The barbiturate, pentobarbital, decreases the effect of metronidazole. (source: Drug Bank)
phenobarbital The barbiturate decreases the effect of metronidazole (source: Drug Bank)
phenobarbital The barbiturate, phenobarbital, decreases the effect of metronidazole. (source: Drug Bank)
primidone The barbiturate decreases the effect of metronidazole (source: Drug Bank)
primidone The barbiturate, primidone, decreases the effect of metronidazole. (source: Drug Bank)
quinidine The barbiturate, quinidine barbiturate, decreases the effect of metronidazole. (source: Drug Bank)
secobarbital The barbiturate, secobarbital, decreases the effect of metronidazole. (source: Drug Bank)
tacrolimus Metronidazole increases the levels/toxicity of tacrolimus (source: Drug Bank)
tacrolimus Metronidazole increases the levels/toxicity of tacrolimus (source: Drug Bank)
talbutal The barbiturate, talbutal, decreases the effect of metronidazole. (source: Drug Bank)
warfarin Metronidazole increases the anticoagulant effect (source: Drug Bank)
warfarin Metronidazole may increase the anticoagulant effect of warfarin by decreasing its metabolism. (source: Drug Bank)
metronidazole The barbiturate decreases the effect of metronidazole (source: Drug Bank)
metronidazole The barbiturate, phenobarbital, decreases the effect of metronidazole. (source: Drug Bank)
metronidazole The barbiturate decreases the effect of metronidazole (source: Drug Bank)
metronidazole The barbiturate, primidone, decreases the effect of metronidazole. (source: Drug Bank)
metronidazole Metronidazole, a CYP3A4 inhibitor, may decrease the metabolism and clearance of Tamsulosin, a CYP3A4 substrate. Monitor for changes in therapeutic/adverse effects of Tamsulosin if Metronidazole is initiated, discontinued, or dose changed. (source: Drug Bank)
metronidazole Metronidazole, a CYP3A4 inhibitor, may decrease the metabolism and clearance of Tamsulosin, a CYP3A4 substrate. Monitor for changes in therapeutic/adverse effects of Tamsulosin if Metronidazole is initiated, discontinued, or dose changed. (source: Drug Bank)
metronidazole Metronidazole may decrease the metabolism and clearance of Tolterodine. Adjust Tolterodine dose and monitor for efficacy and toxicity. (source: Drug Bank)
metronidazole Metronidazole may decrease the metabolism and clearance of Tolterodine. Adjust Tolterodine dose and monitor for efficacy and toxicity. (source: Drug Bank)
metronidazole Metronidazole may increase Tramadol toxicity by decreasing Tramadol metabolism and clearance. (source: Drug Bank)
metronidazole The CYP3A4 inhibitor, Metronidazole, may increase Trazodone efficacy/toxicity by decreasing Trazodone metabolism and clearance. Monitor for changes in Trazodone efficacy/toxicity if Metronidazole is initiated, discontinued or dose changed. (source: Drug Bank)
metronidazole The CYP3A4 inhibitor, Metronidazole, may increase Trazodone efficacy/toxicity by decreasing Trazodone metabolism and clearance. Monitor for changes in Trazodone efficacy/toxicity if Metronidazole is initiated, discontinued or dose changed. (source: Drug Bank)
metronidazole Metronidazole may increase the serum concentration of warfarin by decreasing its metabolism. Consider alternate therapy or a dose reduction in warfarin. Monitor for changes in prothrombin time and therapeutic and adverse effects of warfarin if metronidazole is initiated, discontinued or dose changed. (source: Drug Bank)

Publications related to metronidazole: 2

No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Warfarin interactions with substances listed in drug information compendia and in the FDA-approved label for warfarin sodium. Clinical pharmacology and therapeutics. 2009. Anthony M, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Clinical impact of CYP2C19 polymorphism on the action of proton pump inhibitors: a review of a special problem. International journal of clinical pharmacology and therapeutics. 2006. Klotz U. PubMed

LinkOuts

Web Resource:
Wikipedia
National Drug Code Directory:
0299-3835-45
DrugBank:
DB00916
ChEBI:
6909
KEGG Drug:
D00409
PubChem Compound:
4173
PubChem Substance:
46508911
7847475
Drugs Product Database (DPD):
649074
ChemSpider:
4029
Therapeutic Targets Database:
DAP000534

Clinical Trials

These are trials that mention metronidazole and are related to either pharmacogenetics or pharmacogenomics.

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Sources for PharmGKB drug information: DrugBank, Open Eye Scientific Software.