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Aptivus and MetroGel

Determining the interaction of Aptivus and MetroGel and the possibility of their joint administration.

Check result:
Aptivus <> MetroGel
Relevance: 18.11.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

The following interaction applies only if you are receiving ritonavir capsules, ritonavir oral solution, lopinavir-ritonavir oral solution, and tipranavir capsules: Certain formulations of ritonavir, lopinavir-ritonavir, and tipranavir contain alcohol. Consumption of alcoholic beverages or products containing alcohol or propylene glycol during treatment with metroNIDAZOLE topical may occasionally trigger a reaction in some patients similar to the disulfiram reaction, which includes unpleasant effects such as flushing, throbbing in head and neck, throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and even death. Patients treated with metroNIDAZOLE topical should avoid using any products containing alcohol or propylene glycol during and for at least 3 days until after completion of therapy. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Ritonavir capsules, ritonavir oral solution, lopinavir-ritonavir oral solution, and tipranavir capsules all contain alcohol, which can produce a disulfiram-like reaction when coadministered with drugs that may be capable of inhibiting aldehyde dehydrogenase (ALDH) such as metronidazole, furazolidone, and cephalosporins with an N-methylthiotetrazole (NMTT) side chain that structurally resembles disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentrations of acetaldehyde, the accumulation of which can produce an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmia, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The interaction is well established for disulfiram. However, data for other potential ALDH inhibitors such as metronidazole and cephalosporins are limited and conflicting.

MANAGEMENT: Until further information is available, use of ritonavir capsules, ritonavir oral solution, lopinavir-ritonavir oral solution, or tipranavir capsules with metronidazole (including vaginal formulations), furazolidone, and certain cephalosporins should be avoided if possible. Given their structural similarities to metronidazole, the same precaution may be applicable to other nitroimidazoles such as benznidazole and tinidazole, although clinical data are lacking.

References
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  • "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
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  • "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  • "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc, Arlington Heights, IL.
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  • "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation, Eatontown, NJ.
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  • Kline SS, Mauro VF, Forney RB Jr, et al "Cefotetan-induced disulfiram-type reactions and hypoprothrombinemia." Antimicrob Agents Chemother 31 (1987): 1328-31
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  • "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim, Ridgefield, CT.
Aptivus

Generic Name: tipranavir

Brand name: Aptivus

Synonyms: n.a.

MetroGel

Generic Name: metronidazole topical

Brand name: MetroCream, MetroGel, MetroGel Pump, MetroLotion, Noritate, Rosadan, MetroGel-Vaginal, Nuvessa, Vandazole

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle
Disease interaction