Drug Interaction between Metronidazole and Warfarin

Metronidazole (Flagyl) is a nitroimidazole used as an antibiotic and antiprotozoal medication.
Warfarin is a coumarin anticoagulant used for the treatment of blood clots in cases of deep vein thrombosis or pulmonary embolism. It is also employed in the prevention of thrombosis in high risk patients like stroke, atrial fibrillation, heart attack, etc.

The concomitant use of both Metronidazole and Warfarin can lead to a major drug interaction. This is because Metronidazole (Flagyl) increases the plasma concentrations and hypoprothrombinemic effect of warfarin through the inhibition of CYP450 2C9 iso-enzyme responsible for the metabolism of S(-) enantiomer of warfarin. Significant bleeding and elevation of prothrombin time has been commonly reported.

This is considered a major drug interaction in which very close monitoring or an alternative is strongly advised.

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