Drug Interactions Newsletter

Volume 2, Issue 30, 08/10/2010

Question

Does metronidazole (Flagyl) use with lopinavir/ritonavir oral solution (Kaletra) cause a disulfiram like reaction and is this risk clinically relevant?

Answer

It is well known that many patients with human immunodeficiency virus (HIV) are at increased risk for the development of different types of infections.  Some of these infections can include anaerobic bacterial and protozoal infections for which metronidazole (Flagyl) may be used as a treatment.  While metronidazole use does not normally result in problems with antiretrovirals used in the management of HIV infection, this may not be the case for patients taking highly active antiretroviral therapy (HAART) that includes the protease inhibitor, lopinavir/ritonavir oral solution (Kaletra).  The approved product package insert for lopinavir/ritonavir oral solution includes a warning about the coadministration of metronidazole due to an increased risk for a "disulfiram like reaction".(1)  It is important to emphasize here that the dosage formulation of lopinavir/ritonavir where this is applicable is only with the... 

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