Drug interactions
Metronidazole + Sirolimus
Severity: Moderate
Metronidazole and Sirolimus: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Case reports and the known behavior of related nitroimidazoles suggest metronidazole may raise sirolimus blood concentrations. Higher exposure can cause immunosuppressant toxicity such as hyperlipidemia, cytopenias and impaired wound healing.
What this interaction means in plain words
Metronidazole and Sirolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Metronidazole belongs to Anti Parasitic; Sirolimus belongs to Miscellaneous.
Why it happens
Possible inhibition of CYP3A4-mediated sirolimus metabolism; the mechanism is not firmly established.
What to do
Monitor sirolimus trough concentrations when starting or stopping metronidazole and adjust the sirolimus dose accordingly.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Metronidazole
- Ethanol + Metronidazole Contraindicated
- Metronidazole + Pimozide Contraindicated
- Amiodarone + Metronidazole Major
- Disulfiram + Metronidazole Major
- Ergotamine + Metronidazole Major
- Lomitapide + Metronidazole Major
Other interactions of Sirolimus
- Adenovirus types 4 and 7 live + Sirolimus Contraindicated
- Bcg vaccine live + Sirolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Sirolimus Contraindicated
- Ketoconazole + Sirolimus Contraindicated
- Levoketoconazole + Sirolimus Contraindicated
- Measles mumps and rubella vaccine live + Sirolimus Contraindicated
Frequently asked questions
Can I take Metronidazole with Sirolimus?
MediHelp rates the interaction as moderate. Metronidazole and Sirolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Case reports and the known behavior of related nitroimidazoles suggest metronidazole may raise sirolimus blood concentrations. Higher exposure can cause immunosuppressant toxicity such as hyperlipidemia, cytopenias and impaired wound healing.
How serious is the interaction between Metronidazole and Sirolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sirolimus trough concentrations when starting or stopping metronidazole and adjust the sirolimus dose accordingly.
What other medicines interact with Metronidazole?
MediHelp also lists interactions of Metronidazole with, for example, Ethanol, Pimozide, Amiodarone. The full list is on the Metronidazole page.
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