Summary
In five patients with Crohn's disease long-term therapy with metronidazole (400 mg b.i.d.) was followed by a significant reduction of total serum cholesterol from 179 mg/dl to 156 mg/dl, 134 mg/dl, and 143 mg/dl, after 2–4 months, 6 months, and 9–12 months, respectively. Lipoprotein analysis before and after 3 weeks of administration of metronidazol (400 mg/day) to five normolipemic volunteers revealed that LDL-cholesterol was reduced by 21% (P<0.05), whereas HDL-cholesterol remained unchanged. Biliary secretion of cholesterol and bile acids were reduced by 13% and 20% (P<0.05), respectively, which might suggest a decreased sterol synthesis. The amount and percentage of intestinal cholesterol absorption were decreased by 33% and 22% (P<0.05). Thus, a possible decrease in sterol synthesis and a reduction of cholesterol absorption might be responsible for the serum-cholesterol-lowering effect of metronidazole. However, caution should be taken when considering metronidazole for long-term treatment of patients with hypercholesterolemia due to possible side effects.
Similar content being viewed by others
References
Berg D, Regel E, Harenberg H-E, Plempel M (1984) Bifonazole and Clotrimazole. Their mode of action and the possible reason for the fungucidal behaviour of bifonazole. Arzneim Forsch/Drug Res 34:139–146
von Bergmann K, Gutsfeld-Epple M, Leiss O (1984) Differences in the effects of chenodeoxycholic and ursodeoxycholic acid on biliary lipid secretion and bile acid synthesis in patients with gallstones. Gastroenterology 87:136–143
Bilheimer DW, Grundy SM, Brown MS, Goldstein JL (1983) Mevinolin and colestipol stimulate receptor-mediated clearance of low density lipoprotein from plasma in familial hypercholesterolemia heterozygotes. Proc Natl Acad Sci USA 80:4124–4128
Davis JL, Schultz TA, Mosley CA (1983) Metronidazole lowers serum lipids. Ann Intern Med 99:43–44
Eggstein M, Kreutz FH (1966) Eine neue Bestimmung der Neutralfette in Blutserum und Gewebe. Klin Wochenschr 44:262–266
Einarsson K, Grundy SM (1980) Effects of feeding cholic acid and chenodeoxycholic acid on cholesterol absorption and hepatic secretion of biliary lipids in man. J Lipid Res 21:23–24
Grundy SM, Metzger AL (1972) A physiological method for estimation of hepatic secretion of biliary lipids in man. Gastroenterology 62:1200–1217
Gugler R, Schulte H, Steinhoff R, Jensen C (1983) Wirkstoffkonzentrationen von Metronidazol und klinischer Verlauf bei Morbus Crohn. Fortschr Antimikrob Antineopl Chemother 2–4:662–667
Hunninghake DB, Probstfield JL (1977) Drug treatment of hyperlipoproteinaemia. In: Rifkind BM, Levy RI (eds) Hyperlipidemia — Diagnosis and Therapy. Grune and Stratton, New York, pp 327–362
Leiss O, von Bergmann K, Streicher U, Strotkoetter H (1984) The effects of three different dihydroxy bile acids on intestinal cholesterol absorption in normal volunteers. Gastroenerology 87:144–149
Lipid Research Clinic Program Manual of Laboratory Operations Department of Health, Education of Welfare Publication. NIH 1974; 75–628
Mabuchi H, Sakai T, Sakai Y, Yoshimura A, Watanabe A, Wakasugi T, Koizumi J, Takeda R (1983) Reduction of serum cholesterol in heterozygous patients with familial hypercholesterolemia. Additive effect of compactin and cholestyramine. N Engl J Med 308:609–613
Roeschlau P, Bernt E, Gruber W (1974) Enzymatische Bestimmung des Gesamt-Cholesterins im Serum. Z Klin Chem Biochem 12:226–231
Sedegath AP, Samuel P, Crouse JR, Ahrens Jr EH (1975) Effects of neomycin on absorption, synthesis, and/or flux of cholesterol in man. J Clin Invest 55:12–21
Author information
Authors and Affiliations
Additional information
This project was supported by a grant from “Sandoz Stiftung für therapeutische Forschung”.
The authors thank Mrs. P. Pitters, G. Westphal, H., Ahten und Mr. S. Weiner for their technical assistance
Rights and permissions
About this article
Cite this article
von Bergmann, K., Streicher, U., Leiss, O. et al. Serum-cholesterol-lowering effect of metronidazole and possible mechanisms of action. Klin Wochenschr 63, 279–281 (1985). https://doi.org/10.1007/BF01731475
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01731475