Metronidazole is a nitroimidazole used to treat trichomoniasis, amebiasis, inflammatory lesions of rosacea, and bacterial infections, as well as prevent postoperative infections.

Brand Names
Flagyl, Flagystatin, Metrocream, Metrogel, Metrolotion, Nidagel, Noritate, Nuvessa, Pylera, Rosadan, Vandazole
Generic Name
DrugBank Accession Number

Metronidazole is a commonly used antibiotic, belonging to the nitroimidazole class of antibiotics.14 It is frequently used to treat gastrointestinal infections as well as trichomoniasis and giardiasis, and amebiasis which are parasitic infections.4 Metronidazole has been used as an antibiotic for several decades15, with added antiparasitic properties that set it apart from many other antibacterial drugs, allowing it to treat a wide variety of infections. It is available in capsule form, tablet form, and topical form, and suppository preparations for the treatment of various infections.

Small Molecule
Average: 171.154
Monoisotopic: 171.064391169
Chemical Formula
  • 1-(2-hydroxy-1-ethyl)-2-methyl-5-nitroimidazole
  • 1-(2-hydroxyethyl)-2-methyl-5-nitroimidazole
  • 1-(β-ethylol)-2-methyl-5-nitro-3-azapyrrole
  • 1-(β-hydroxyethyl)-2-methyl-5-nitroimidazole
  • 1-(β-oxyethyl)-2-methyl-5-nitroimidazole
  • 2-methyl-1-(2-hydroxyethyl)-5-nitroimidazole
  • 2-methyl-3-(2-hydroxyethyl)-4-nitroimidazole
  • 2-methyl-5-nitroimidazole-1-ethanol
  • Metronidazol
  • Métronidazole
  • Metronidazole
  • Metronidazolum
External IDs
  • Bayer 5360
  • BAYER-5360
  • NSC-50364
  • NSC-69587
  • RP 8823
  • RP-8823



Metronidazole is indicated for the treatment of confirmed trichomoniasis caused by Trichomonas vaginalis (except for in the first trimester of pregnancy) and the patient's sexual partners, bacterial vaginosis16, certain types of amebiasis, and various anaerobic infections.11 The above anaerobic infections may occur on the skin and skin structures, the abdomen, the heart, reproductive organs, central nervous system, and the respiratory system. Some may also be present in the bloodstream in cases of septicemia. Common infections treated by metronidazole are Bacteroides species infections, Clostridium infections, and Fusobacterium infections, as well as Peptococcus and Peptostreptococcus infections.14

It is also used off-label in the treatment of Crohn's disease and rosacea, as a prophylactic agent after surgery5, and in the treatment of Helicobacter pylori infection.7 It has also been studied in the prevention of preterm births and to treat periodontal disease.1,12

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Associated Conditions
Contraindications & Blackbox Warnings
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Metronidazole treats amebiasis, trichomoniasis, and giardiasis, exerting both antibacterial and antiprotozoal activities.16 Metronidazole is an effective treatment for some anaerobic bacterial infections.11 Metronidazole has shown antibacterial activity against the majority of obligate anaerobes, however, during in vitro studies, it does not demonstrate significant action against facultative anaerobes or obligate aerobes.14 The nitro group reduction of metronidazole by anaerobic organisms is likely responsible for the drug's antimicrobial cytotoxic effects, causing DNA strand damage to microbes.5,7

A note on convulsions and neuropathy and carcinogenesis

It is important to be aware of the risk of peripheral neuropathy and convulsions associated with metronidazole, especially at higher doses. If convulsions or numbness of an extremity occur, discontinue the drug immediately.14 Metronidazole has been found to be carcinogenic in mice and rats. The relevance to this effect in humans is unknown. It is advisable to only administer metronidazole when clinically necessary and only for its approved indications.17

Mechanism of action

The exact mechanism of action of metronidazole has not been fully established, however, it is possible that an intermediate in the reduction of metronidazole which is only made by anaerobic bacteria and protozoa, binds deoxyribonucleic acid and electron-transport proteins of organisms, blocking nucleic acid synthesis.14 After administration, metronidazole enters cells by passive diffusion. Following this, ferredoxin or flavodoxin reduce its nitro group to nitro radicals. The redox potential of the electron transport portions of anaerobic or microaerophilic microorganisms renders metronidazole selective to these organisms, which cause nitro group reduction, leading to the production of toxic metabolites. These include N-(2-hydroxyethyl) oxamic acid and acetamide, which may damage DNA of replicating organisms.5

AOxygen-insensitive NADPH nitroreductase
Helicobacter pylori (strain ATCC 700392 / 26695)
UAnaerobic bacterial DNA
UProtozoal DNA

After the intravenous infusion of a 1.5g dose, peak concentration was reached within 1 hour and was peak level of 30-40 mg/L.16 When a multiple-dose regimen of 500mg three times a day administered intravenously, steady-state concentrations were achieved within about 3 days and peak concentration was measured at 26 mg/L.16 When administered orally in the tablet form, metronidazole is absorbed entirely absorbed, showing a bioavailability of greater than 90%.7 One resource indicates that Cmax after a single oral dose of 500mg metronidazole ranges from 8 to 13 mg/L, with a Tmax of 25 minutes to 4 hours. The AUC following a single 500mg oral dose of metronidazole was 122 ± 10.3 mg/L • h.7

A note on the absorption of topical preparations

Insignificant percutaneous absorption of metronidazole occurs after the application of 1% metronidazole cream topically. Healthy volunteers applied one 100 mg dose of 14C-labelled metronidazole 2% cream to unbroken skin. After 12 hours, metronidazole was not detected in the plasma. Approximately 0.1% to 1% of the administered metronidazole was measured in the urine and feces.16

Volume of distribution

Metronidazole is widely distributed throughout the body5 and various body fluids. They include the bile, saliva, breastmilk, cerebrospinal fluid, and the placenta.16 Steady-state volume distribution of metronidazole in adults ranges from 0.51 to 1.1 L/kg. It attains 60 to 100% of plasma concentrations in various tissues, such as the central nervous system, however, is not measured in high concentrations in the placental tissue.7

Protein binding

Metronidazole is less than 20% bound to plasma proteins.7,16


Metronidazole undergoes hepatic metabolism via hydroxylation, oxidation, and glucuronidation. The metabolism of metronidazole yields 5 metabolites. The hydroxy metabolite, 1-(2-hydroxy-ethyl)-2-hydroxy methyl-5-nitroimidazole, is considered the major active metabolite.7,13 Unchanged metronidazole is found in the plasma along with small amounts of its 2- hydroxymethyl metabolite. Several metabolites of metronidazole are found in the urine. They are primarily a product of side-chain oxidation in addition to glucuronide conjugation. Only 20% of the dose found in the urine is accounted for by unchanged metronidazole.16 The two main oxidative metabolites of metronidazole are hydroxy and acetic acid metabolites.6,9

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Route of elimination

Metronidazole and metabolites are 60 to 80% eliminated in the urine, and 6-15% excreted in the feces.7,14


The elimination half-life of metronidazole is 7.3 ± 1.0 after a single 500mg IV dose in healthy subjects.16 Another resource indicates that the elimination half-life for metronidazole ranges from 6 to 10 hours.7


Dose adjustments may be required in patients with hepatic impairment, as clearance is impaired in these patients.16 The clearance of metronidazole in the kidneys is estimated at 10 mL/min/1.73 m2.14 The total clearance from serum is about 2.1 to 6.4 L/h/kg.7

Adverse Effects
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LD50 information

The oral LD50 of metronidazole in rats is 5000 mg/kg 16

Overdose information

Adverse effects that may be exaggerated with an overdose include peripheral neuropathy, central nervous system toxicity, seizures, disulfiram-like effect (if combined with alcohol) dark urine, a metallic taste in the mouth, nausea, epigastric discomfort, and vertigo, in addition to neutropenia.10,16 There is no specific antidote for metronidazole overdose. Symptomatic and supportive treatment should be employed in addition to the administration of activated charcoal to remove the unabsorbed drug from the gastrointestinal tract. In addition to the above measures, contact the local poison control center for updated information on the management of a metronidazole overdose.16

Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
AbataceptThe metabolism of Metronidazole can be increased when combined with Abatacept.
AbemaciclibThe metabolism of Abemaciclib can be decreased when combined with Metronidazole.
AcalabrutinibThe metabolism of Acalabrutinib can be decreased when combined with Metronidazole.
AcenocoumarolThe serum concentration of Acenocoumarol can be increased when it is combined with Metronidazole.
AcetaminophenThe metabolism of Metronidazole can be decreased when combined with Acetaminophen.
AcetazolamideThe therapeutic efficacy of Acetazolamide can be decreased when used in combination with Metronidazole.
AcetohexamideThe metabolism of Acetohexamide can be decreased when combined with Metronidazole.
Acetylsalicylic acidThe metabolism of Acetylsalicylic acid can be decreased when combined with Metronidazole.
AcrivastineThe risk or severity of QTc prolongation can be increased when Metronidazole is combined with Acrivastine.
AdalimumabThe metabolism of Metronidazole can be increased when combined with Adalimumab.
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Food Interactions
  • Avoid alcohol. Unpleasant symptoms such as nausea, vomiting, and abdominal distress may occur with alcohol.
  • Take with or without food. The extended release formulation should, however, be taken without food.


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Product Ingredients
IngredientUNIICASInChI Key
Metronidazole hydrochloride76JC1633UF69198-10-3FPTPAIQTXYFGJC-UHFFFAOYSA-N
Product Images
International/Other Brands
Anabact (Cambridge Healthcare Supplies) / Arilin / Clont / Deflamon / Efloran / Elyzol / Entizol / Fossyol / Klion / Klont / Metrolyl / Metrotop / Nalox / Nidagel / Novonidazol / Orvagil / Protostat / Takimetol / Trichazole / Trichex / Trichopol / Tricowas B / Trikacide / Trikozol / Vagilen / Vagimid / Vertisal / Zadstat
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
FlagylCapsule375 mg/1OralPhysicians Total Care, Inc.1995-05-032000-09-19US flag
FlagylCapsule375 mg/1OralPfizer Laboratories Div Pfizer Inc1995-05-03Not applicableUS flag
FlagylCream10 %VaginalSanofi Aventis1970-12-31Not applicableCanada flag
FlagylCapsule500 mgOralOdan Laboratories Ltd1979-12-31Not applicableCanada flag
FlagylTablet, film coated500 mg/1OralPfizer Laboratories Div Pfizer Inc1963-07-182021-10-31US flag
FlagylTablet, film coated500 mg/1OralRedPharm Drug1963-07-18Not applicableUS flag
FlagylTablet, film coated250 mg/1OralPfizer Laboratories Div Pfizer Inc1963-07-182019-02-28US flag
Flagyl 500 500mgSuppository500 mg / supVaginalAventis Pharma Ltd.1960-12-312003-07-22Canada flag
Flagyl ERTablet, film coated, extended release750 mg/1OralG.D. Searle LLC Division of Pfizer Inc1997-11-262014-10-31US flag
Florazole ERTablet, extended release750 mgOralFerring Pharmaceuticals2002-10-102012-09-30Canada flag
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Apo-metronidazoleCapsule500 mgOralApotex CorporationNot applicableNot applicableCanada flag
Apo-metronidazoleCapsule500 mgOralApotex Corporation2003-11-27Not applicableCanada flag
Apo-metronidazoleTablet250 mgOralApotex CorporationNot applicableNot applicableCanada flag
Auro-metronidazoleCapsule500 mgOralAuro Pharma Inc2018-04-03Not applicableCanada flag
Mar-metronidazoleCapsule500 mgOralMarcan Pharmaceuticals IncNot applicableNot applicableCanada flag
MetronidazoleTablet500 mg/1OralSt Marys Medical Park Pharmacy2013-01-102018-11-30US flag
MetronidazoleTablet250 mg/1OralUDL Laboratories, Inc.2011-10-062014-02-28US flag
MetronidazoleInjection, solution500 mg/100mLIntravenousWest Ward Pharmaceutical2009-08-04Not applicableUS flag
MetronidazoleTablet500 mg/1OralWatson Laboratories, Inc.2011-08-222011-09-30US flag
MetronidazoleTablet500 mg/1OralBluePoint Laboratories2014-03-132015-12-31US flag
Over the Counter Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
เมโตรจิล เจลGel1 %w/wTopicalห้างหุ้นส่วนจำกัด จีไอเอส ฟาร์มา2014-06-172019-10-21Thailand flag
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
AMEBICOL®Metronidazole (300 mg) + Nifuroxazide (200 mg)Capsule, coatedOralBIOQUIMICO PHARMAS.A.2017-05-22Not applicableColombia flag
BIOGYNOL® OVULOSMetronidazole (750 mg) + Miconazole nitrate (200 mg)InsertVaginalBIOCHEM FARMACEUTICA DE COLOMBIAS.A.2016-07-08Not applicableColombia flag
Bismuth Subsalicylate/Metronidazole/Tetracycline HydrochlorideMetronidazole (250 mg/1) + Bismuth subsalicylate (262.4 mg/1) + Tetracycline hydrochloride (500 mg/1)KitOralAilex Pharmaceuticals, Llc2018-11-30Not applicableUS flag
CANDAZOL® OVULOSMetronidazole (500 mg) + Clotrimazole (100 mg)CapsuleVaginalPRODUCTORA DE CAPSULAS DE GELATINA S.A.. PROCAPS S.A.2006-11-10Not applicableColombia flag
DIARSET NX® M CAPSULASMetronidazole (600 mg) + Nifuroxazide (200 mg)Capsule, coatedOralCOLOMPACK S.A.2014-01-10Not applicableColombia flag
EXAGYN VAJINAL TABLET, 7 ADETMetronidazole (750 mg) + Lidocaine hydrochloride (100 mg) + Miconazole nitrate (200 mg)TabletVaginalHELBA İLAÇ İÇ VE DIŞ SAN. TİC. LTD. ŞTİ.2020-08-14Not applicableTurkey flag
FEMDUO®Metronidazole (500 mg) + Clotrimazole (100 mg)InsertVaginalPROCAPS S.A.2016-05-24Not applicableColombia flag
FlagystatinMetronidazole (500 mg) + Nystatin (100000 unit)SuppositoryVaginalSanofi Aventis1979-12-31Not applicableCanada flag
FlagystatinMetronidazole (500 mg / sup) + Nystatin (100000 unit / sup)SuppositoryVaginalAventis Pharma Ltd.1972-12-312004-07-30Canada flag
FlagystatinMetronidazole (500 mg / 4.5 g) + Nystatin (100000 unit / 4.5 g)CreamVaginalSanofi Aventis1976-12-312017-08-24Canada flag
Unapproved/Other Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
171083 Ivermectin 1% / Metronidazole 1% / Niacinamide 4%Metronidazole (1 g/100g) + Ivermectin (1 g/100g) + Nicotinamide (4 g/100g)GelTopicalSincerus Florida, LLC2020-07-02Not applicableUS flag
Brimonidine Tartrate 0.25% / Ivermectin 1% / Metronidazole 1% / Niacinamide 4%Metronidazole (1 g/100g) + Brimonidine tartrate (0.25 g/100g) + Ivermectin (1 g/100g) + Nicotinamide (4 g/100g)GelTopicalSincerus Florida, LLC2019-05-16Not applicableUS flag
Ivermectin 1% / Metronidazole 1%Metronidazole (1 g/100g) + Ivermectin (1 g/100g)GelTopicalSincerus Florida, LLC2019-05-01Not applicableUS flag
Ivermectin 1% / Metronidazole 1% / Niacinamide 4%Metronidazole (1 g/100g) + Ivermectin (1 g/100g) + Nicotinamide (4 g/100g)GelTopicalSincerus Florida, LLC2019-05-01Not applicableUS flag
MetronidazoleMetronidazole (500 mg/100mL)Injection, solutionIntravenousBaxter Healthcare Corporation2017-10-052019-10-31US flag
Metronidazole 1% / Mupirocin 2%Metronidazole (1 g/100g) + Mupirocin (2 g/100g)OintmentTopicalSincerus Florida, LLC2019-05-15Not applicableUS flag
Metronidazole 1% / Mupirocin 2%Metronidazole (1 g/100g) + Mupirocin (2 g/100g)OintmentTopicalSincerus Florida, LLC2019-05-15Not applicableUS flag
Metronidazole 1% / Mupirocin 2% /Metronidazole (1 g/100g) + Mupirocin (2 g/100g)OintmentTopicalSincerus Florida, LLC2019-05-14Not applicableUS flag
Metronidazole 1% / Niacinamide 4%Metronidazole (1 g/100g) + Nicotinamide (4 g/100g)GelTopicalSincerus Florida, LLC2019-05-16Not applicableUS flag
POLGYL %0,5 IV PERFUZYON SOL 100 ML SETLIMetronidazole (0.5 %)SolutionIntravenousPOLİFARMA İLAÇ SAN. VE TİC. A.Ş.2020-08-14Not applicableTurkey flag


ATC Codes
A02BD11 — Pantoprazole, amoxicillin, clarithromycin and metronidazoleD06BX01 — MetronidazoleA02BD03 — Lansoprazole, amoxicillin and metronidazoleJ01XD01 — MetronidazoleJ01RA04 — Spiramycin and metronidazoleA02BD01 — Omeprazole, amoxicillin and metronidazoleA02BD15 — Vonoprazan, amoxicillin and metronidazoleJ01RA03 — Cefuroxime and metronidazoleA01AB17 — MetronidazoleG01AF20 — Combinations of imidazole derivativesJ01RA10 — Ciprofloxacin and metronidazoleA02BD02 — Lansoprazole, tetracycline and metronidazoleA02BD13 — Rabeprazole, amoxicillin and metronidazoleG01AF01 — MetronidazoleP01AB51 — Metronidazole, combinationsA02BD08 — Bismuth subcitrate, tetracycline and metronidazoleP01AB01 — Metronidazole
Drug Categories
Chemical TaxonomyProvided by Classyfire
This compound belongs to the class of organic compounds known as nitroimidazoles. These are compounds containing an imidazole ring which bears a nitro group.
Organic compounds
Super Class
Organoheterocyclic compounds
Sub Class
Direct Parent
Alternative Parents
Nitroaromatic compounds / 1,2,5-trisubstituted imidazoles / N-substituted imidazoles / Heteroaromatic compounds / Propargyl-type 1,3-dipolar organic compounds / Organic oxoazanium compounds / Azacyclic compounds / Alkanolamines / Primary alcohols / Organopnictogen compounds
show 3 more
1,2,5-trisubstituted-imidazole / Alcohol / Alkanolamine / Allyl-type 1,3-dipolar organic compound / Aromatic heteromonocyclic compound / Azacycle / C-nitro compound / Heteroaromatic compound / Hydrocarbon derivative / N-substituted imidazole
show 15 more
Molecular Framework
Aromatic heteromonocyclic compounds
External Descriptors
C-nitro compound, imidazoles, primary alcohol (CHEBI:6909)
Affected organisms
  • Bacteria and protozoa
  • Helicobacter pylori
  • Peptoclostridium difficile

Chemical Identifiers

CAS number
InChI Key


Synthesis Reference
General References
  1. Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, Jones G, Poston L: A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BJOG. 2006 Jan;113(1):65-74. [Article]
  2. Williams CS, Woodcock KR: Do ethanol and metronidazole interact to produce a disulfiram-like reaction? Ann Pharmacother. 2000 Feb;34(2):255-7. [Article]
  3. Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP: Lack of disulfiram-like reaction with metronidazole and ethanol. Ann Pharmacother. 2002 Jun;36(6):971-4. [Article]
  4. Dingsdag SA, Hunter N: Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms. J Antimicrob Chemother. 2018 Feb 1;73(2):265-279. doi: 10.1093/jac/dkx351. [Article]
  5. Hernandez Ceruelos A, Romero-Quezada LC, Ruvalcaba Ledezma JC, Lopez Contreras L: Therapeutic uses of metronidazole and its side effects: an update. Eur Rev Med Pharmacol Sci. 2019 Jan;23(1):397-401. doi: 10.26355/eurrev_201901_16788. [Article]
  6. Sprandel KA, Schriever CA, Pendland SL, Quinn JP, Gotfried MH, Hackett S, Graham MB, Danziger LH, Rodvold KA: Pharmacokinetics and pharmacodynamics of intravenous levofloxacin at 750 milligrams and various doses of metronidazole in healthy adult subjects. Antimicrob Agents Chemother. 2004 Dec;48(12):4597-605. doi: 10.1128/AAC.48.12.4597-4605.2004. [Article]
  7. Lamp KC, Freeman CD, Klutman NE, Lacy MK: Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet. 1999 May;36(5):353-73. doi: 10.2165/00003088-199936050-00004. [Article]
  8. Morales-Leon F, von Plessing-Rossel C, Villa-Zapata L, Fernandez-Rocca P, Sanhueza-Sanhueza C, Bello-Toledo H, Mella-Montecinos S: [Pharmacokinetics/pharmacodinamic (PK/PD) evaluation of a short course of oral administration of metronidazole for the management of infections caused by Bacteroides fragilis]. Rev Chilena Infectol. 2015 Apr;32(2):135-41. doi: 10.4067/S0716-10182015000300001. [Article]
  9. Lau AH, Lam NP, Piscitelli SC, Wilkes L, Danziger LH: Clinical pharmacokinetics of metronidazole and other nitroimidazole anti-infectives. Clin Pharmacokinet. 1992 Nov;23(5):328-64. doi: 10.2165/00003088-199223050-00002. [Article]
  10. Kapoor K, Chandra M, Nag D, Paliwal JK, Gupta RC, Saxena RC: Evaluation of metronidazole toxicity: a prospective study. Int J Clin Pharmacol Res. 1999;19(3):83-8. [Article]
  11. Lofmark S, Edlund C, Nord CE: Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis. 2010 Jan 1;50 Suppl 1:S16-23. doi: 10.1086/647939. [Article]
  12. Loesche WJ, Schmidt E, Smith BA, Morrison EC, Caffesse R, Hujoel PP: Effects of metronidazole on periodontal treatment needs. J Periodontol. 1991 Apr;62(4):247-57. doi: 10.1902/jop.1991.62.4.247. [Article]
  13. Pearce RE, Cohen-Wolkowiez M, Sampson MR, Kearns GL: The role of human cytochrome P450 enzymes in the formation of 2-hydroxymetronidazole: CYP2A6 is the high affinity (low Km) catalyst. Drug Metab Dispos. 2013 Sep;41(9):1686-94. doi: 10.1124/dmd.113.052548. Epub 2013 Jun 27. [Article]
  14. Flagyl (Metronidazole) FDA Label [Link]
  15. FDA approvals, Metronidazole [Link]
  16. Canadian monograph, Flagyl [Link]
  17. Flagyl [Link]
  18. DailyMed: Flagyl (metronidazole) oral tablets [Link]
Human Metabolome Database
KEGG Compound
PubChem Compound
PubChem Substance
Therapeutic Targets Database
PDBe Ligand
RxList Drug Page Drug Page
PDB Entries
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Clinical Trials

Clinical Trials
4Active Not RecruitingBasic ScienceRabies Human1
4Active Not RecruitingPreventionSurgery, Colorectal1
4Active Not RecruitingTreatmentBlastocystis Hominis Infections1
4Active Not RecruitingTreatmentChronic Periodontitis (Disorder)2
4Active Not RecruitingTreatmentExacerbation of Ulcerative Colitis / Granulomatous Colitis / Ulcerative Colitis, Active Severe1
4Active Not RecruitingTreatmentGastrointestinal Ulcer Haemorrhage / Helicobacter Pylori Infection1
4CompletedPreventionInfection Prophylaxis in Colo Rectal Surgery1
4CompletedPreventionPostoperative Wound Infection1
4CompletedSupportive CareAmoxicillin / Metronidazole / Ofloxacin / Periodontitis / Root Planing1
4CompletedSupportive CareGeneralized Aggressive Periodontitis / Periodontitis, Aggressive1


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Dosage Forms
SuspensionOral5 g
SuspensionOral8.04 g
Tablet, film coatedOral
Capsule, coatedOral400 mg
Injection, solution5 mg/1ml
Capsule; kit; tabletOral
Capsule, liquid filledVaginal
Injection, solutionParenteral500 MG/100ML
SuppositoryVaginal500 mg
CapsuleOral375 mg/1
CreamVaginal10 %
TabletOral; Vaginal500 MG
SuppositoryVaginal500 mg / sup
SolutionIntravenous5 mg
Tablet, extended releaseOral750 mg
Tablet, coatedOral
GelVaginal0.75 g
Capsule, coatedOral
Tablet, film coated
CreamTopical.75 %
SuspensionOral4.02 g
GelTopical10 mg/1g
GelVaginal7.5 mg/1g
GelTopical1 %
LotionTopical0.75 %
SuspensionOral4 g
Capsule, liquid filledOral250 mg
SolutionIntravenous500 mg
Injection, solutionIntravenous
TabletVaginal500 mg
SolutionIntravenous500 g
SolutionParenteral5 MG/ML
SolutionParenteral500 MG/100ML
SolutionIntravenous1.5 g
SolutionParenteral500 mg
SolutionParenteral5 mg
Tablet, film coatedOral500 mg
TabletOral500 mg
Tablet, coatedOral500 mg
CreamTopical10 mg/1g
CreamTopical7.5 mg/1g
GelTopical7.5 mg/1g
GelVaginal13 mg/1g
Injection, solutionIntravenous500 mg/100mL
LotionTopical7.5 mg/1mL
LotionTopical7.5 mg/1g
PowderNot applicable1 g/1g
SolutionIntravenous500 mg/100mL
TabletOral250 mg/1
TabletOral500 mg/1
Tablet, coatedOral250 mg/1
Tablet, coatedOral500 1/1
Tablet, film coatedOral500 mg/1
Tablet, film coated, extended releaseOral750 mg/1
Tablet; tablet, film coatedOral
Injection, solutionIntravenous5 mg/1ml
SolutionIntravenous5 mg / mL
Tablet, film coatedOral250 mg/1
Tablet, film coatedOral250 MG
Injection, solutionParenteral5 MG/ML
Injection, solutionIntravenous; Parenteral0.5 G/100ML
Injection, solutionIntravenous; Parenteral500 MG/100ML
Injection, solution
Injection, solutionParenteral0.5 G/100ML
TabletOral250 mg
Capsule, liquid filledOral
Tablet, film coatedOral
GelTopical0.75 g
Capsule, liquid filledOral500 mg
InsertVaginal500 mg
CapsuleVaginal500 mg
GelVaginal0.75 % w/w
CreamTopical1 % w/w
CreamTopical10 mg/60g
GelTopical65 mg/5g
GelVaginal65 mg/5g
InjectionParenteral500 mg
CapsuleOral500 mg
KitTopical7.5 mg/1g
CreamTopical0.75 %
EmulsionTopical0.75 %
GelTopical0.75 %
CapsuleOral250 MG
Capsule200 mg
Capsule250 mg
Tablet200 mg
Tablet400 mg
Tablet250 mg
Solution5 mg/1ml
Tablet, coatedOral200 mg
GelTopical1 %w/w
Tablet, coatedOral250 mg
Tablet500 mg
Tablet, coatedOral400 mg
Unit descriptionCostUnit
MetroLotion 0.75% Lotion 59ml Bottle292.66USD bottle
MetroCream 0.75% Cream 45 gm Tube281.09USD tube
Metrogel 1% Gel 60 gm Tube200.93USD tube
Metrogel 1% Kit Box200.93USD box
Metrogel 1% kit193.2USD kit
Noritate 1% Cream 60 gm Tube156.44USD tube
MetroNIDAZOLE 0.75% Lotion 59ml Bottle89.86USD bottle
MetroNIDAZOLE 0.75% Cream 45 gm Tube80.87USD tube
MetroNIDAZOLE 0.75% Gel 45 gm Tube74.0USD tube
MetroNIDAZOLE 0.75% Gel 70 gm Tube68.53USD tube
Flagyl ER 750 mg 24 Hour tablet13.2USD tablet
Flagyl er 750 mg tablet12.7USD tablet
MetroNIDAZOLE 750 mg 24 Hour tablet8.07USD tablet
Flagyl 500 mg tablet6.24USD tablet
Metrocream 0.75% cream5.99USD g
Danazol 200 mg capsule5.63USD capsule
Flagyl 375 mg capsule5.45USD capsule
Metrolotion topical 0.75%4.77USD ml
Metronidazole benz powder4.74USD g
Flagyl 250 mg tablet3.49USD tablet
Danazol 100 mg capsule2.98USD capsule
Noritate 1% cream2.51USD g
Danazol 50 mg capsule1.99USD capsule
Metronidazole powder1.65USD g
Metronidazole 0.75% cream1.34USD g
Metronidazole vaginal 0.75% gl0.94USD g
Metronidazole 500 mg tablet0.72USD tablet
Metrogel 0.75 % Gel0.69USD g
Metrogel 1 % Gel0.63USD g
Noritate 1 % Cream0.58USD g
Rosasol 1 % Cream0.57USD g
Metrocream 0.75 % Cream0.52USD g
Metrolotion 0.75 % Lotion0.52USD g
Metrogel-vaginal 0.75% gel0.51USD g
Vandazole vaginal 0.75% gel0.48USD g
Metronidazole 250 mg tablet0.44USD tablet
Flagyl 10 % Cream0.25USD g
Apo-Metronidazole 250 mg Tablet0.06USD tablet
Flagyl 5 mg/ml0.03USD ml
Metro iv 500 mg/100 ml0.03USD ml
Metronidazole 5 mg/ml0.03USD ml
Metronidazole 500 mg/100 ml0.03USD ml
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US5536743No1996-07-162013-07-16US flag
CA2470492No2010-02-232022-11-07Canada flag
CA2161737No1998-10-202015-10-30Canada flag
US6881726No2005-04-192022-02-21US flag
US7348317No2008-03-252022-02-21US flag
US7456207No2008-11-252024-09-22US flag
US6350468No2002-02-262018-12-14US flag
US8946276No2015-02-032032-06-28US flag
US8658678No2014-02-252028-06-27US flag
US9198858No2015-12-012032-06-28US flag
US8877792No2014-11-042028-02-02US flag
US7893097No2011-02-222028-02-19US flag
US10238634No2019-03-262032-06-28US flag
US10596155No2012-06-282032-06-28US flag


Experimental Properties
melting point (°C)160
boiling point (°C)405.4
Predicted Properties
Water Solubility5.92 mg/mLALOGPS
pKa (Strongest Acidic)15.44ChemAxon
pKa (Strongest Basic)3.09ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count4ChemAxon
Hydrogen Donor Count1ChemAxon
Polar Surface Area83.87 Å2ChemAxon
Rotatable Bond Count3ChemAxon
Refractivity41.22 m3·mol-1ChemAxon
Polarizability15.82 Å3ChemAxon
Number of Rings1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterNoChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET Features
Human Intestinal Absorption+0.9805
Blood Brain Barrier+0.9297
Caco-2 permeable-0.5365
P-glycoprotein substrateNon-substrate0.5141
P-glycoprotein inhibitor INon-inhibitor0.8954
P-glycoprotein inhibitor IINon-inhibitor0.8755
Renal organic cation transporterNon-inhibitor0.7762
CYP450 2C9 substrateNon-substrate0.7318
CYP450 2D6 substrateNon-substrate0.8815
CYP450 3A4 substrateNon-substrate0.6767
CYP450 1A2 substrateNon-inhibitor0.9045
CYP450 2C9 inhibitorNon-inhibitor0.9242
CYP450 2D6 inhibitorNon-inhibitor0.9231
CYP450 2C19 inhibitorNon-inhibitor0.9401
CYP450 3A4 inhibitorNon-inhibitor0.9242
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.8483
Ames testAMES toxic0.9107
BiodegradationNot ready biodegradable0.5941
Rat acute toxicity2.0422 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.5
hERG inhibition (predictor II)Non-inhibitor0.8272
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)


Mass Spec (NIST)
Download (9.68 KB)
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Mass Spectrum (Electron Ionization)MSsplash10-0ul0-9300000000-2268b08f47fed3f6d263
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-QTOF , positiveLC-MS/MSsplash10-004i-1900000000-659f2bbb83f8ef5a85d1
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-50c7cfe79eb17c4440a8
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-00di-0900000000-b06d808767cc01c0d494
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-00fr-0900000000-e9c07cc448b8fb519022
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-8ad03b44aa7557127e34
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-ed7ba5c872a6309a31d4
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-2900000000-e0ead4b0eec72b9c44b6
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-5900000000-2da8a7b45537f9063220
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-00di-0900000000-24d94f1704e577b05eb7
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-00fr-0900000000-fbb1c4e8457cd3d799b9
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-fd6166313a17f944f530
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-5ebb32a580e1f5d00170
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-2900000000-811a6e7e45b7ea1a6184
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-5900000000-082e6de6c0fa3f382d84
LC-MS/MS Spectrum - LC-ESI-ITFT , positiveLC-MS/MSsplash10-004i-0900000000-baf9e195c01d875e77b5
LC-MS/MS Spectrum - LC-ESI-QQ , positiveLC-MS/MSsplash10-00di-0900000000-ec181c008a10dac8040b
LC-MS/MS Spectrum - LC-ESI-QQ , positiveLC-MS/MSsplash10-004i-1900000000-2a218e19a8fadb9c66d6
LC-MS/MS Spectrum - LC-ESI-QQ , positiveLC-MS/MSsplash10-003r-9500000000-ed02acd36b190c189cc9
LC-MS/MS Spectrum - LC-ESI-QQ , positiveLC-MS/MSsplash10-001i-9000000000-71ea79659ccd75c64bef
LC-MS/MS Spectrum - LC-ESI-QQ , positiveLC-MS/MSsplash10-001i-9000000000-3f7795597c6629540426
1H NMR Spectrum1D NMRNot Applicable
13C NMR Spectrum1D NMRNot Applicable


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Helicobacter pylori (strain ATCC 700392 / 26695)
Pharmacological action
General Function
Oxidoreductase activity
Specific Function
Reduction of a variety of nitroaromatic compounds using NADPH as source of reducing equivalents; two electrons are transferred (By similarity). Capable of reducing metronidazole; inactive RdxA rend...
Gene Name
Uniprot ID
Uniprot Name
Oxygen-insensitive NADPH nitroreductase
Molecular Weight
24067.775 Da
  1. Sisson G, Jeong JY, Goodwin A, Bryden L, Rossler N, Lim-Morrison S, Raudonikiene A, Berg DE, Hoffman PS: Metronidazole activation is mutagenic and causes DNA fragmentation in Helicobacter pylori and in Escherichia coli containing a cloned H. pylori RdxA(+) (Nitroreductase) gene. J Bacteriol. 2000 Sep;182(18):5091-6. [Article]
  2. Chisholm SA, Owen RJ: Mutations in Helicobacter pylori rdxA gene sequences may not contribute to metronidazole resistance. J Antimicrob Chemother. 2003 Apr;51(4):995-9. Epub 2003 Mar 13. [Article]
  3. Debets-Ossenkopp YJ, Pot RG, van Westerloo DJ, Goodwin A, Vandenbroucke-Grauls CM, Berg DE, Hoffman PS, Kusters JG: Insertion of mini-IS605 and deletion of adjacent sequences in the nitroreductase (rdxA) gene cause metronidazole resistance in Helicobacter pylori NCTC11637. Antimicrob Agents Chemother. 1999 Nov;43(11):2657-62. [Article]
  4. Pisharath H, Parsons MJ: Nitroreductase-mediated cell ablation in transgenic zebrafish embryos. Methods Mol Biol. 2009;546:133-43. doi: 10.1007/978-1-60327-977-2_9. [Article]
2. Anaerobic bacterial DNA
Not Available
Pharmacological action
This group represents the DNA of various anaerobic bacteria as a drug target.
  1. Samuelson J: Why metronidazole is active against both bacteria and parasites. Antimicrob Agents Chemother. 1999 Jul;43(7):1533-41. [Article]
  2. Soule AF, Green SB, Blanchette LM: Clinical efficacy of 12-h metronidazole dosing regimens in patients with anaerobic or mixed anaerobic infections. Ther Adv Infect Dis. 2018 May;5(3):57-62. doi: 10.1177/2049936118766462. Epub 2018 Apr 3. [Article]
  3. Flagyl (Metronidazole) FDA Label [Link]
3. Protozoal DNA
Not Available
Pharmacological action
This group is created to include the DNA of various protozoans.
  1. Uzlikova M, Nohynkova E: The effect of metronidazole on the cell cycle and DNA in metronidazole-susceptible and -resistant Giardia cell lines. Mol Biochem Parasitol. 2014 Dec;198(2):75-81. doi: 10.1016/j.molbiopara.2015.01.005. Epub 2015 Feb 12. [Article]
  2. Nasirudeen AM, Hian YE, Singh M, Tan KS: Metronidazole induces programmed cell death in the protozoan parasite Blastocystis hominis. Microbiology. 2004 Jan;150(Pt 1):33-43. doi: 10.1099/mic.0.26496-0. [Article]
  3. Flagyl (Metronidazole) FDA Label [Link]


Pharmacological action
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 2C9
Molecular Weight
55627.365 Da
  1. Kudo T, Endo Y, Taguchi R, Yatsu M, Ito K: Metronidazole reduces the expression of cytochrome P450 enzymes in HepaRG cells and cryopreserved human hepatocytes. Xenobiotica. 2015 May;45(5):413-9. doi: 10.3109/00498254.2014.990948. Epub 2014 Dec 3. [Article]
  2. Hersh EV, Moore PA: Three Serious Drug Interactions that Every Dentist Should Know About. Compend Contin Educ Dent. 2015 Jun;36(6):408-13; quiz 414, 416. [Article]
  3. Sychev DA, Ashraf GM, Svistunov AA, Maksimov ML, Tarasov VV, Chubarev VN, Otdelenov VA, Denisenko NP, Barreto GE, Aliev G: The cytochrome P450 isoenzyme and some new opportunities for the prediction of negative drug interaction in vivo. Drug Des Devel Ther. 2018 May 8;12:1147-1156. doi: 10.2147/DDDT.S149069. eCollection 2018. [Article]
  4. CYP table [Link]
Pharmacological action
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
  1. Kudo T, Endo Y, Taguchi R, Yatsu M, Ito K: Metronidazole reduces the expression of cytochrome P450 enzymes in HepaRG cells and cryopreserved human hepatocytes. Xenobiotica. 2015 May;45(5):413-9. doi: 10.3109/00498254.2014.990948. Epub 2014 Dec 3. [Article]
  2. Michalets EL: Update: clinically significant cytochrome P-450 drug interactions. Pharmacotherapy. 1998 Jan-Feb;18(1):84-112. [Article]
  3. Spina E, Pisani F, Perucca E: Clinically significant pharmacokinetic drug interactions with carbamazepine. An update. Clin Pharmacokinet. 1996 Sep;31(3):198-214. doi: 10.2165/00003088-199631030-00004. [Article]
Pharmacological action
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 2C8
Molecular Weight
55824.275 Da
  1. Kudo T, Endo Y, Taguchi R, Yatsu M, Ito K: Metronidazole reduces the expression of cytochrome P450 enzymes in HepaRG cells and cryopreserved human hepatocytes. Xenobiotica. 2015 May;45(5):413-9. doi: 10.3109/00498254.2014.990948. Epub 2014 Dec 3. [Article]
Pharmacological action
General Function
Steroid binding
Specific Function
UDPGT is of major importance in the conjugation and subsequent elimination of potentially toxic xenobiotics and endogenous compounds. This isoform glucuronidates bilirubin IX-alpha to form both the...
Gene Name
Uniprot ID
Uniprot Name
UDP-glucuronosyltransferase 1-1
Molecular Weight
59590.91 Da
  1. Williams JA, Hyland R, Jones BC, Smith DA, Hurst S, Goosen TC, Peterkin V, Koup JR, Ball SE: Drug-drug interactions for UDP-glucuronosyltransferase substrates: a pharmacokinetic explanation for typically observed low exposure (AUCi/AUC) ratios. Drug Metab Dispos. 2004 Nov;32(11):1201-8. doi: 10.1124/dmd.104.000794. Epub 2004 Aug 10. [Article]
Pharmacological action
General Function
Steroid hydroxylase activity
Specific Function
Exhibits a high coumarin 7-hydroxylase activity. Can act in the hydroxylation of the anti-cancer drugs cyclophosphamide and ifosphamide. Competent in the metabolic activation of aflatoxin B1. Const...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 2A6
Molecular Weight
56501.005 Da
  1. Pearce RE, Cohen-Wolkowiez M, Sampson MR, Kearns GL: The role of human cytochrome P450 enzymes in the formation of 2-hydroxymetronidazole: CYP2A6 is the high affinity (low Km) catalyst. Drug Metab Dispos. 2013 Sep;41(9):1686-94. doi: 10.1124/dmd.113.052548. Epub 2013 Jun 27. [Article]
Pharmacological action
General Function
Oxygen binding
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 3A5
Molecular Weight
57108.065 Da
  1. Pearce RE, Cohen-Wolkowiez M, Sampson MR, Kearns GL: The role of human cytochrome P450 enzymes in the formation of 2-hydroxymetronidazole: CYP2A6 is the high affinity (low Km) catalyst. Drug Metab Dispos. 2013 Sep;41(9):1686-94. doi: 10.1124/dmd.113.052548. Epub 2013 Jun 27. [Article]
Pharmacological action
General Function
Oxygen binding
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 3A7
Molecular Weight
57525.03 Da
  1. Pearce RE, Cohen-Wolkowiez M, Sampson MR, Kearns GL: The role of human cytochrome P450 enzymes in the formation of 2-hydroxymetronidazole: CYP2A6 is the high affinity (low Km) catalyst. Drug Metab Dispos. 2013 Sep;41(9):1686-94. doi: 10.1124/dmd.113.052548. Epub 2013 Jun 27. [Article]


Pharmacological action
Curator comments
Evidence regarding this transporter inhibition is conflicting in the literature. Various references have been attached, some of which may provide conflicting evidence.
General Function
Xenobiotic-transporting atpase activity
Specific Function
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells.
Gene Name
Uniprot ID
Uniprot Name
Multidrug resistance protein 1
Molecular Weight
141477.255 Da
  1. Tan SY, Kan E, Lim WY, Chay G, Law JH, Soo GW, Bukhari NI, Segarra I: Metronidazole leads to enhanced uptake of imatinib in brain, liver and kidney without affecting its plasma pharmacokinetics in mice. J Pharm Pharmacol. 2011 Jul;63(7):918-25. doi: 10.1111/j.2042-7158.2011.01296.x. Epub 2011 May 19. [Article]
  2. Kim KA, Park JY: Effect of metronidazole on the pharmacokinetics of fexofenadine, a P-glycoprotein substrate, in healthy male volunteers. Eur J Clin Pharmacol. 2010 Jul;66(7):721-5. doi: 10.1007/s00228-010-0797-2. Epub 2010 Mar 20. [Article]
  3. Page RL 2nd, Klem PM, Rogers C: Potential elevation of tacrolimus trough concentrations with concomitant metronidazole therapy. Ann Pharmacother. 2005 Jun;39(6):1109-13. doi: 10.1345/aph.1E399. Epub 2005 Apr 26. [Article]

Drug created on June 13, 2005 13:24 / Updated on September 19, 2021 19:53