Abstract
Introduction: Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; nevertheless, it interacts with a wide variety of other medications. Some interactions with other medicines diminish its effectiveness, while others increase it.
 Aims: The study aims to detect and evaluate metronidazole interactions with other medicines at King Abdulaziz Specialist Hospital.
 Methodology: This retrospective study encompasses the review of 360 computerized prescriptions inside the outpatient clinic at King Abdulaziz Specialist Hospital in Saudi Arabia between March and September 2020 to detect and evaluate interactions among metronidazole and different medications.
 Results: Metronidazole interactions are mostly major or moderate. Metronidazole had the most common interactions with domperidone (15.83 %), famotidine (13.89 %), and ciprofloxacin (11.67 %). Metronidazole contains a nitroimidazole ring, which suppresses the metabolism in the liver of numerous medications, including those that may be metabolized by the CYP3A4 and/or CYP450 2C9 isoenzymes. The combination of metronidazole with phenytoin or phenobarbital can cause metronidazole elimination to be accelerated and phenytoin clearance to be reduced. Metronidazole may improve warfarin's anticoagulant effects, leading to a longer prothrombin time and a higher risk of bleeding. Concurrent use of metronidazole with alfuzosin, escitalopram, and ondansetron may raise the risks of QT-interval prolongation and arrhythmias.
 Conclusion: Most metronidazole drug interactions can be avoided by following excellent clinical care and clinical pharmacology concepts, such as avoiding complex treatment regimens, educating patients. and identifying patient risk factors. Furthermore, before prescribing and dispensing medicines, physicians and pharmacists should utilize drug-drug interactions checkers such as Micromedex and Lexicomp or a book such as Stockley's Drug Interactions.
Highlights
Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis
58% of the prescriptions were for females, while 42% were for males with metronidazole drug interactions (Fig. 1)
The common interactions were metronidazole with domperidone (15.83%), famotidine (13.89%), and ciprofloxacin (11.67%)
Summary
Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; it interacts with a wide variety of other medications. Metronidazole (2-(2-methyl-5-nitro-1H-imidazole1-yl) ethanol) is a mainstay medication for the treatment of anaerobic infections and the treatment of choice for the majority of patients with Clostridium difficile-related diarrhea [1,2]. Metronidazole is available in 375 mg capsules, 250 mg and 500 mg tablets, oral suspension, vaginal gel, and skin cream. Metronidazole's mode of action against obligate anaerobes is a four-step process that includes entrance into the organism, reductive activation through intracellular transport proteins, interactions with intracellular targets, and breakdown of cytotoxic-intermediate metabolites. Metronidazole is toxic to facultatively anaerobic bacteria such as Gardnerella vaginalis and Helicobacter pylori. Metronidazole has two distinguishing features: it reaches high blood concentrations after oral administration and has good tissue penetration [3,4]
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