Black Cohosh and MetroGel

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.

The following interaction applies only to tincture (liquid) preparations of black cohosh: Tincture (liquid) preparations of black cohosh may contain large amounts of 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.

GENERALLY AVOID: Due to a potentially high alcohol content, tincture formulations of black cohosh may theoretically 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 more information is available, the use of black cohosh tinctures 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.

Black Cohosh

Generic Name: black cohosh

Brand name:

Synonyms: n.a.

What is Black Cohosh?

MetroGel

Generic Name: metronidazole topical

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

Synonyms: n.a.

What is MetroGel?