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Metronidazole: An overview

Melissa Johnson, PharmD
Section Editor
David C Hooper, MD
Deputy Editor
Sheila Bond, MD


Metronidazole is one of the mainstay drugs for the treatment of anaerobic infections and is the treatment of choice for most patients with mild to moderate Clostridium difficile–associated diarrhea [1,2]. It is approved by the US Food and Drug Administration for the treatment of anaerobic and protozoal infections. Metronidazole exerts its antimicrobial effects through the production of free radicals that are toxic to the microbe.

The use of metronidazole for treating specific infections is discussed separately. (See "Anaerobic bacterial infections" and "Clostridium difficile in adults: Treatment" and "Intestinal Entamoeba histolytica amebiasis" and "Extraintestinal Entamoeba histolytica amebiasis" and "Trichomoniasis".)


Metronidazole is cytotoxic to facultative anaerobic bacteria such as Helicobacter pylori and Gardnerella vaginalis, but the mechanism of this action is not well understood [3]. However, its activity against obligate anaerobes occurs through a four-step process:

Entry into the microorganism – Metronidazole is a low molecular weight compound that diffuses across the cell membranes of anaerobic and aerobic microorganisms. However, antimicrobial activity is limited to anaerobes [3].

Reductive activation by intracellular transport proteins – Metronidazole is reduced by the pyruvate:ferredoxin oxidoreductase system in obligate anaerobes, which alters its chemical structure. Pyruvate:ferredoxin oxidoreductase normally generates adenosine triphosphate (ATP) via oxidative decarboxylation of pyruvate. With metronidazole in the cellular environment, its nitro group acts as an electron sink, capturing electrons that would usually be transferred to hydrogen ions in this cycle. Reduction of metronidazole creates a concentration gradient that drives uptake of more drug and promotes formation of intermediate compounds and free radicals that are toxic to the cell [3-5].

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Literature review current through: Nov 2017. | This topic last updated: Dec 13, 2017.
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  1. Löfmark S, Edlund C, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis 2010; 50 Suppl 1:S16.
  2. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31:431.
  3. Edwards DI. Nitroimidazole drugs--action and resistance mechanisms. I. Mechanisms of action. J Antimicrob Chemother 1993; 31:9.
  4. Edwards DI. Reduction of nitroimidazoles in vitro and DNA damage. Biochem Pharmacol 1986; 35:53.
  5. Müller M. Reductive activation of nitroimidazoles in anaerobic microorganisms. Biochem Pharmacol 1986; 35:37.
  6. Tocher JH, Edwards DI. The interaction of reduced metronidazole with DNA bases and nucleosides. Int J Radiat Oncol Biol Phys 1992; 22:661.
  7. Tocher JH, Edwards DI. Evidence for the direct interaction of reduced metronidazole derivatives with DNA bases. Biochem Pharmacol 1994; 48:1089.
  8. Goldman P, Koch RL, Yeung TC, et al. Comparing the reduction of nitroimidazoles in bacteria and mammalian tissues and relating it to biological activity. Biochem Pharmacol 1986; 35:43.
  9. Stratton CW, Weeks LS, Aldridge KE. Comparison of the bactericidal activity of clindamycin and metronidazole against cefoxitin-susceptible and cefoxitin-resistant isolates of the Bacteroides fragilis group. Diagn Microbiol Infect Dis 1991; 14:377.
  10. Stratton CW, Weeks LS, Aldridge KE. Inhibitory and bactericidal activity of selected beta-lactam agents alone and in combination with beta-lactamase inhibitors compared with that of cefoxitin and metronidazole against cefoxitin-susceptible and cefoxitin-resistant isolates of the Bacteroides fragilis group. Diagn Microbiol Infect Dis 1992; 15:321.
  11. Ravdin JI, Skilogiannis J. In vitro susceptibilities of Entamoeba histolytica to azithromycin, CP-63,956, erythromycin, and metronidazole. Antimicrob Agents Chemother 1989; 33:960.
  12. Nix DE, Tyrrell R, Müller M. Pharmacodynamics of metronidazole determined by a time-kill assay for Trichomonas vaginalis. Antimicrob Agents Chemother 1995; 39:1848.
  13. Ralph ED, Kirby WM. Unique bactericidal action of metronidazole against Bacteroides fragilis and Clostridium perfringens. Antimicrob Agents Chemother 1975; 8:409.
  14. Ralph ED, Amatnieks YE. Potentially synergistic antimicrobial combinations with metronidazole against Bacteroides fragilis. Antimicrob Agents Chemother 1980; 17:379.
  15. Cuchural GJ Jr, Tally FP, Jacobus NV, et al. Antimicrobial susceptibilities of 1,292 isolates of the Bacteroides fragilis group in the United States: comparison of 1981 with 1982. Antimicrob Agents Chemother 1984; 26:145.
  16. Musial CE, Rosenblatt JE. Antimicrobial susceptibilities of anaerobic bacteria isolated at the Mayo Clinic during 1982 through 1987: comparison with results from 1977 through 1981. Mayo Clin Proc 1989; 64:392.
  17. Snydman DR, Jacobus NV, McDermott LA, et al. Multicenter study of in vitro susceptibility of the Bacteroides fragilis group, 1995 to 1996, with comparison of resistance trends from 1990 to 1996. Antimicrob Agents Chemother 1999; 43:2417.
  18. Aldridge KE, Ashcraft D, O'Brien M, Sanders CV. Bacteremia due to Bacteroides fragilis group: distribution of species, beta-lactamase production, and antimicrobial susceptibility patterns. Antimicrob Agents Chemother 2003; 47:148.
  19. Snydman DR, Jacobus NV, McDermott LA, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005-2007). Clin Infect Dis 2010; 50 Suppl 1:S26.
  20. Centers for Disease Control and Prevention (CDC). Multidrug-resistant bacteroides fragilis--Seattle, Washington, 2013. MMWR Morb Mortal Wkly Rep 2013; 62:694.
  21. van Winkelhoff AJ, Herrera Gonzales D, Winkel EG, et al. Antimicrobial resistance in the subgingival microflora in patients with adult periodontitis. A comparison between The Netherlands and Spain. J Clin Periodontol 2000; 27:79.
  22. Duerden BI. Role of the reference laboratory in susceptibility testing of anaerobes and a survey of isolates referred from laboratories in England and Wales during 1993-1994. Clin Infect Dis 1995; 20 Suppl 2:S180.
  23. Labbé AC, Bourgault AM, Vincelette J, et al. Trends in antimicrobial resistance among clinical isolates of the Bacteroides fragilis group from 1992 to 1997 in Montreal, Canada. Antimicrob Agents Chemother 1999; 43:2517.
  24. Karlowsky JA, Walkty AJ, Adam HJ, et al. Prevalence of antimicrobial resistance among clinical isolates of Bacteroides fragilis group in Canada in 2010-2011: CANWARD surveillance study. Antimicrob Agents Chemother 2012; 56:1247.
  25. Shore KP, Pottumarthy S, Morris AJ. Susceptibility of anaerobic bacteria in Auckland: 1991-1996. N Z Med J 1999; 112:424.
  26. Brazier JS, Stubbs SL, Duerden BI. Metronidazole resistance among clinical isolates belonging to the Bacteroides fragilis group: time to be concerned? J Antimicrob Chemother 1999; 44:580.
  27. Barbut F, Decré D, Burghoffer B, et al. Antimicrobial susceptibilities and serogroups of clinical strains of Clostridium difficile isolated in France in 1991 and 1997. Antimicrob Agents Chemother 1999; 43:2607.
  28. Reysset G, Haggoud A, Sebald M. Genetics of resistance of Bacteroides species to 5-nitroimidazole. Clin Infect Dis 1993; 16 Suppl 4:S401.
  29. Rasmussen BA, Bush K, Tally FP. Antimicrobial resistance in Bacteroides. Clin Infect Dis 1993; 16 Suppl 4:S390.
  30. Narikawa S, Suzuki T, Yamamoto M, Nakamura M. Lactate dehydrogenase activity as a cause of metronidazole resistance in Bacteroides fragilis NCTC 11295. J Antimicrob Chemother 1991; 28:47.
  31. Results of a multicentre European survey in 1991 of metronidazole resistance in Helicobacter pylori. European Study Group on Antibiotic Susceptibility of Helicobacter pylori. Eur J Clin Microbiol Infect Dis 1992; 11:777.
  32. Adamek RJ, Suerbaum S, Pfaffenbach B, Opferkuch W. Primary and acquired Helicobacter pylori resistance to clarithromycin, metronidazole, and amoxicillin--influence on treatment outcome. Am J Gastroenterol 1998; 93:386.
  33. Mégraud F, Lehn N, Lind T, et al. Antimicrobial susceptibility testing of Helicobacter pylori in a large multicenter trial: the MACH 2 study. Antimicrob Agents Chemother 1999; 43:2747.
  34. Lacey SL, Moss SF, Taylor GW. Metronidazole uptake by sensitive and resistant isolates of Helicobacter pylori. J Antimicrob Chemother 1993; 32:393.
  35. Moore RA, Beckthold B, Bryan LE. Metronidazole uptake in Helicobacter pylori. Can J Microbiol 1995; 41:746.
  36. van Zwet AA, Thijs JC, Schievink-de Vries W, et al. In vitro studies on stability and development of metronidazole resistance in Helicobacter pylori. Antimicrob Agents Chemother 1994; 38:360.
  37. Tankovic J, Lamarque D, Delchier JC, et al. Frequent association between alteration of the rdxA gene and metronidazole resistance in French and North African isolates of Helicobacter pylori. Antimicrob Agents Chemother 2000; 44:608.
  38. Logan RP, Gummett PA, Misiewicz JJ, et al. One week eradication regimen for Helicobacter pylori. Lancet 1991; 338:1249.
  39. Owen RJ, Bell GD, Desai M, et al. Biotype and molecular fingerprints of metronidazole-resistant strains of Helicobacter pylori from antral gastric mucosa. J Med Microbiol 1993; 38:6.
  40. Wong WM, Gu Q, Wang WH, et al. Effects of primary metronidazole and clarithromycin resistance to Helicobacter pylori on omeprazole, metronidazole, and clarithromycin triple-therapy regimen in a region with high rates of metronidazole resistance. Clin Infect Dis 2003; 37:882.
  41. Dore MP, Leandro G, Realdi G, et al. Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy: a meta-analytical approach. Dig Dis Sci 2000; 45:68.
  42. Krajden S, Lossick JG, Wilk E, et al. Persistent Trichomonas vaginalis infection due to a metronidazole-resistant strain. CMAJ 1986; 134:1373.
  43. Müller M, Meingassner JG, Miller WA, Ledger WJ. Three metronidazole-resistant strains of Trichomonas vaginalis from the United States. Am J Obstet Gynecol 1980; 138:808.
  44. Dombrowski MP, Sokol RJ, Brown WJ, Bronsteen RA. Intravenous therapy of metronidazole-resistant Trichomonas vaginalis. Obstet Gynecol 1987; 69:524.
  45. Kulda J. Trichomonads, hydrogenosomes and drug resistance. Int J Parasitol 1999; 29:199.
  46. Edwards DI. Nitroimidazole drugs--action and resistance mechanisms. II. Mechanisms of resistance. J Antimicrob Chemother 1993; 31:201.
  47. Quon DV, d'Oliveira CE, Johnson PJ. Reduced transcription of the ferredoxin gene in metronidazole-resistant Trichomonas vaginalis. Proc Natl Acad Sci U S A 1992; 89:4402.
  48. Nguyen MH, Yu VL, Morris AJ, et al. Antimicrobial resistance and clinical outcome of Bacteroides bacteremia: findings of a multicenter prospective observational trial. Clin Infect Dis 2000; 30:870.
  49. Baron EJ, Ropers G, Summanen P, Courcol RJ. Bactericidal activity of selected antimicrobial agents against Bilophila wadsworthia and Bacteroides gracilis. Clin Infect Dis 1993; 16 Suppl 4:S339.
  50. Pankuch GA, Jacobs MR, Appelbaum PC. Susceptibilities of 428 gram-positive and -negative anaerobic bacteria to Bay y3118 compared with their susceptibilities to ciprofloxacin, clindamycin, metronidazole, piperacillin, piperacillin-tazobactam, and cefoxitin. Antimicrob Agents Chemother 1993; 37:1649.
  51. Sheikh W, Pitkin DH, Nadler H. Antibacterial activity of meropenem and selected comparative agents against anaerobic bacteria at seven North American centers. Clin Infect Dis 1993; 16 Suppl 4:S361.
  52. Alexander CJ, Citron DM, Brazier JS, Goldstein EJ. Identification and antimicrobial resistance patterns of clinical isolates of Clostridium clostridioforme, Clostridium innocuum, and Clostridium ramosum compared with those of clinical isolates of Clostridium perfringens. J Clin Microbiol 1995; 33:3209.
  53. Brazier JS, Levett PN, Stannard AJ, et al. Antibiotic susceptibility of clinical isolates of clostridia. J Antimicrob Chemother 1985; 15:181.
  54. Goldstein EJ, Citron DM, Cherubin CE, Hillier SL. Comparative susceptibility of the Bacteroides fragilis group species and other anaerobic bacteria to meropenem, imipenem, piperacillin, cefoxitin, ampicillin/sulbactam, clindamycin and metronidazole. J Antimicrob Chemother 1993; 31:363.
  55. Jones BM, Geary I, Lee ME, Duerden BI. Comparison of the in vitro activities of fenticonazole, other imidazoles, metronidazole, and tetracycline against organisms associated with bacterial vaginosis and skin infections. Antimicrob Agents Chemother 1989; 33:970.
  56. Spiegel CA. Susceptibility of Mobiluncus species to 23 antimicrobial agents and 15 other compounds. Antimicrob Agents Chemother 1987; 31:249.
  57. Bannatyne RM, Jackowski J, Cheung R, Biers K. Susceptibility of Gardnerella vaginalis to metronidazole, its bioactive metabolites, and tinidazole. Am J Clin Pathol 1987; 87:640.
  58. Easmon CS, Ison CA, Kaye CM, et al. Pharmacokinetics of metronidazole and its principal metabolites and their activity against Gardnerella vaginalis. Br J Vener Dis 1982; 58:246.
  59. Lau AH, Lam NP, Piscitelli SC, et al. Clinical pharmacokinetics of metronidazole and other nitroimidazole anti-infectives. Clin Pharmacokinet 1992; 23:328.
  60. Jokipii AM, Myllylä VV, Hokkanen E, Jokipii L. Penetration of the blood brain barrier by metronidazole and tinidazole. J Antimicrob Chemother 1977; 3:239.
  61. Warner JF, Perkins RL, Cordero L. Metronidazole therapy of anaerobic bacteremia, meningitis, and brain abscess. Arch Intern Med 1979; 139:167.
  62. Karjagin J, Pähkla R, Karki T, Starkopf J. Distribution of metronidazole in muscle tissue of patients with septic shock and its efficacy against Bacteroides fragilis in vitro. J Antimicrob Chemother 2005; 55:341.
  63. Karjagin J, Pähkla R, Starkopf J. Perioperative penetration of metronidazole into muscle tissue: a microdialysis study. Eur J Clin Pharmacol 2004; 59:809.
  64. Nielsen ML, Justesen T. Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile. Scand J Gastroenterol 1977; 12:1003.
  65. Jensen JC, Gugler R. Single- and multiple-dose metronidazole kinetics. Clin Pharmacol Ther 1983; 34:481.
  66. Kreeft JH, Ogilvie RI, Dufresne LR. Metronidazole kinetics in dialysis patients. Surgery 1983; 93:149.
  67. Lau AH, Chang CW, Sabatini S. Hemodialysis clearance of metronidazole and its metabolites. Antimicrob Agents Chemother 1986; 29:235.
  68. Roux AF, Moirot E, Delhotal B, et al. Metronidazole kinetics in patients with acute renal failure on dialysis: a cumulative study. Clin Pharmacol Ther 1984; 36:363.
  69. Somogyi A, Kong C, Sabto J, et al. Disposition and removal of metronidazole in patients undergoing haemodialysis. Eur J Clin Pharmacol 1983; 25:683.
  70. Guay DR, Meatherall RC, Baxter H, et al. Pharmacokinetics of metronidazole in patients undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother 1984; 25:306.
  71. Farrell G, Baird-Lambert J, Cvejic M, Buchanan N. Disposition and metabolism of metronidazole in patients with liver failure. Hepatology 1984; 4:722.
  72. Farrell G, Buchanan N, Baird-Lambert J. Impaired elimination of metronidazole in decompensated chronic liver disease. Br Med J (Clin Res Ed) 1984; 288:1009.
  73. Daneshmend TK, Roberts CJ. Impaired elimination of metronidazole in decompensated chronic liver disease. Br Med J (Clin Res Ed) 1984; 288:405.
  74. Plaisance KI, Quintiliani R, Nightingale CH. The pharmacokinetics of metronidazole and its metabolites in critically ill patients. J Antimicrob Chemother 1988; 21:195.
  75. Lau AH, Evans R, Chang CW, Seligsohn R. Pharmacokinetics of metronidazole in patients with alcoholic liver disease. Antimicrob Agents Chemother 1987; 31:1662.
  76. Upadhyaya P, Bhatnagar V, Basu N. Pharmacokinetics of intravenous metronidazole in neonates. J Pediatr Surg 1988; 23:263.
  77. Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ. Central nervous system toxicity associated with metronidazole therapy. Ann Intern Med 1980; 93:59.
  78. Lamp KC, Freeman CD, Klutman NE, Lacy MK. Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet 1999; 36:353.
  79. Urtasun RC, Rabin HR, Partington J. Human pharmacokinetics and toxicity of high-dose metronidazole administered orally and intravenously. Surgery 1983; 93:145.
  80. Saginur R, Hawley CR, Bartlett JG. Colitis associated with metronidazole therapy. J Infect Dis 1980; 141:772.
  81. Frytak S, Moertel CH, Childs DS. Neurologic toxicity associated with high-dose metronidazole therapy. Ann Intern Med 1978; 88:361.
  82. Halloran TJ. Convulsions associated with high cumulative doses of metronidazole. Drug Intell Clin Pharm 1982; 16:409.
  83. Farmakiotis D, Zeluff B. IMAGES IN CLINICAL MEDICINE. Metronidazole-Associated Encephalopathy. N Engl J Med 2016; 374:1465.
  84. Kim E, Na DG, Kim EY, et al. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 2007; 28:1652.
  85. Carroll MW, Jeon D, Mountz JM, et al. Efficacy and safety of metronidazole for pulmonary multidrug-resistant tuberculosis. Antimicrob Agents Chemother 2013; 57:3903.
  86. Knowles S, Choudhury T, Shear NH. Metronidazole hypersensitivity. Ann Pharmacother 1994; 28:325.
  87. Cina SJ, Russell RA, Conradi SE. Sudden death due to metronidazole/ethanol interaction. Am J Forensic Med Pathol 1996; 17:343.
  88. Williams CS, Woodcock KR. Do ethanol and metronidazole interact to produce a disulfiram-like reaction? Ann Pharmacother 2000; 34:255.
  89. Alexander I. 'Alcohol-antabuse' syndrome in patients receiving metronidazole during gynaecological treatment. Br J Clin Pract 1985; 39:292.
  90. Plosker GL. Possible interaction between ethanol and vaginally administered metronidazole. Clin Pharm 1987; 6:189, 192.
  91. Visapää JP, Tillonen JS, Kaihovaara PS, Salaspuro MP. Lack of disulfiram-like reaction with metronidazole and ethanol. Ann Pharmacother 2002; 36:971.
  92. Tillonen J, Väkeväinen S, Salaspuro V, et al. Metronidazole increases intracolonic but not peripheral blood acetaldehyde in chronic ethanol-treated rats. Alcohol Clin Exp Res 2000; 24:570.
  93. McKendrick MW, Geddes AM. Neutropenia associated with metronidazole. Br Med J 1979; 2:795.
  94. Smith JA. Neutropenia associated with metronidazole therapy. Can Med Assoc J 1980; 123:202.
  95. Celifarco A, Warschauer C, Burakoff R. Metronidazole-induced pancreatitis. Am J Gastroenterol 1989; 84:958.
  96. Sanford KA, Mayle JE, Dean HA, Greenbaum DS. Metronidazole-associated pancreatitis. Ann Intern Med 1988; 109:756.
  97. Altın C, Kanyılmaz S, Baysal S, Özin B. QT interval prolongation due to metronidazole administration. Anadolu Kardiyol Derg 2011; 11:468.
  98. Cohen O, Saar N, Swartzon M, et al. First report of metronidazole-induced QT interval prolongation. Int J Antimicrob Agents 2008; 31:180.
  99. Poluzzi E, Raschi E, Motola D, et al. Antimicrobials and the risk of torsades de pointes: the contribution from data mining of the US FDA Adverse Event Reporting System. Drug Saf 2010; 33:303.
  100. Powell SJ. The cardiotoxicity of systemic amebicides. A comparative electrocardiographic study. Am J Trop Med Hyg 1967; 16:447.
  101. Teicher MH, Altesman RI, Cole JO, Schatzberg AF. Possible nephrotoxic interaction of lithium and metronidazole. JAMA 1987; 257:3365.
  102. Lassen E. Effects of acute and short-time antibiotic treatment on renal lithium elimination and serum lithium levels in the rat. Acta Pharmacol Toxicol (Copenh) 1985; 56:273.
  103. Blyden GT, Scavone JM, Greenblatt DJ. Metronidazole impairs clearance of phenytoin but not of alprazolam or lorazepam. J Clin Pharmacol 1988; 28:240.
  104. O'Reilly RA. The stereoselective interaction of warfarin and metronidazole in man. N Engl J Med 1976; 295:354.
  105. Patterson BD. Possible interaction between metronidazole and carbamazepine. Ann Pharmacother 1994; 28:1303.
  106. Kounas SP, Letsas KP, Sideris A, et al. QT interval prolongation and torsades de pointes due to a coadministration of metronidazole and amiodarone. Pacing Clin Electrophysiol 2005; 28:472.
  107. Panduranga P, Al-Mukhaini M, Rajarao MP. Multi-factorial causes of torsade de pointes in a hospitalised surgical patient. Sultan Qaboos Univ Med J 2013; 13:152.
  108. Zylber-Katz E, Rubinger D, Berlatzky Y. Cyclosporine interactions with metronidazole and cimetidine. Drug Intell Clin Pharm 1988; 22:504.
  109. Herzig K, Johnson DW. Marked elevation of blood cyclosporin and tacrolimus levels due to concurrent metronidazole therapy. Nephrol Dial Transplant 1999; 14:521.
  110. Page RL 2nd, Klem PM, Rogers C. Potential elevation of tacrolimus trough concentrations with concomitant metronidazole therapy. Ann Pharmacother 2005; 39:1109.
  111. Early CR, Park JM, Dorsch MP, et al. Effect of metronidazole use on tacrolimus concentrations in transplant patients treated for Clostridium difficile. Transpl Infect Dis 2016; 18:714.
  112. Nilsson C, Aschan J, Hentschke P, et al. The effect of metronidazole on busulfan pharmacokinetics in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 31:429.
  113. Eradiri O, Jamali F, Thomson AB. Interaction of metronidazole with phenobarbital, cimetidine, prednisone, and sulfasalazine in Crohn's disease. Biopharm Drug Dispos 1988; 9:219.
  114. Mead PB, Gibson M, Schentag JJ, Ziemniak JA. Possible alteration of metronidazole metabolism by phenobarbital. N Engl J Med 1982; 306:1490.
  115. Loft S, Døssing M, Sonne J, et al. Lack of effect of cimetidine on the pharmacokinetics and metabolism of a single oral dose of metronidazole. Eur J Clin Pharmacol 1988; 35:65.
  116. Rajnarayana K, Reddy MS, Vidyasagar J, Krishna DR. Study on the influence of silymarin pretreatment on metabolism and disposition of metronidazole. Arzneimittelforschung 2004; 54:109.
  117. Loft S, Sonne J, Døssing M, Andreasen PB. Metronidazole pharmacokinetics in patients with hepatic encephalopathy. Scand J Gastroenterol 1987; 22:117.