Transient retinal ischaemia induced by nifedipine

Metronidazole is given to patients with liver disease because of its efficacy against anaerobic organisms. Although relatively safe, it can cause uncomfortable gastrointestinal and neurological symptoms that may be related to prolonged high blood concentrations of the drug. Cirrhotic livers have an impaired drug metabolising capacity, but two recent studies of elimination of metronidazole in liver disease have produced conflicting results. We studied the disappearance of metronidazole from plasma in 10 patients with decompensated chronic liver disease and compared the results with those in nine healthy subjects. Rare ischaemic complications have been reported after oral nifedipine, but non of these affected the retinal circulation. We report on a patient who developed repeated transient unilateral retinal ischaemia after administration of nifedipine.