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When given with alcohol, metronidazole may provoke a disulfiram-like reaction in some patients. Acute psychosis or confusion have been associated with the use of metronidazole and disulfiram together.
Metronidazole is reported to impair the metabolism or excretion of several drugs including warfarin and phenytoin, lithium, ciclosporin, and fluorouracil, with the consequent potential for an increased incidence of adverse effects. Plasma concentrations of metronidazole are decreased by phenobarbital, with a consequent reduction in the effectiveness of metronidazole. Cimetidine has increased plasma concentration of metronidazole and might increase the risk of neurological adverse effects.
