I think probably the first “real” counseling point any pharmacy student learns is “Don’t drink alcohol with Flagyl!” If it’s not the first thing, it’s easily the second or third. In fact, I’ve seen this hand-written on prescription labels for added emphasis, even though the auxiliary labels that print out already say it. You don’t often see “Take with food” hand-written, even though it would probably provide more real-world benefit to the patient than the standard “Don’t drink alcohol” mantra.
“Heresy!” you shout. Well, hear me out…
You see, there’s almost no data to support the assertion that alcohol and metronidazole combine to create a disulfiram-like reaction. It’s crazy, I know. How could this age-old advice be wrong? The reason this is drilled into pharmacy and med students’ heads is because the conventional wisdom is old. It got here because “everyone knows” that ethanol + metronidazole = A Bad Time. Even though there’s no meaningful evidence to support this conclusion.
Regular readers know my distaste (hah!) for metronidazole. In fact, I missed out on my best friend’s 21st birthday drunkfestcelebration because of it. As it turns out, I missed out for naught. Alas.
Exhibit A is a meta-analysis of published anecdotes, “Do Ethanol and Metronidazole Interact to Produce a Disulfiram-Like Reaction” published in The Annals of Pharmacotherapy. Exhibit B is a double-blind, placebo-controlled study out of Finland, also published in TAOP entitled “Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol” which is a bit more science-y and a little less meta-analysis-y.
This is a long entry, so here’s a ToC.
Bits and bobs from Exhibit A (Back to top)
The first account of a metronidazole-ethanol interaction was noted in 1964. At that time, folks wondered if Flagyl could be used to curb alcohol abuse. A sort of proto-Antabuse, if you will. 8 of 17 studies found it to be marginally effective. But only marginally, and only 2 of the 8 positive studies were double-blind, and these 2 studies were statistically significant only when dropouts had been excluded.
My commentary after each quote.
revealed six case reports involving a total of eight patients. Tunguy-Desmerais reported on a two-year-old child taking acetaminophen and amoxicillin for pharyngitis. After a febrile seizure, ulcerative gingivostomatitis was diagnosed, phenobarbital–vitamin B6 syrup was added, and oral metronidazole was started. The next evening, the child was flushed but not febrile and, because both the analgesic and phenobarbital–vitamin B6 syrup contained ethanol, a metronidazole–ethanol reaction was considered likely.
I’m not an expert in pediatric liver function, but I do know that it takes longer for children to metabolize EtOH than it does for an adult. And the flushing is certainly a side effect of plain old alcohol consumption. Going right for the metronidazole-ethanol “reaction” seems a little too convenient, and more than a little irresponsible.
Another report involved three patients: a woman prescribed rectal metronidazole following hysterectomy, who became nauseous, pale, and dyspneic 36 and 60 hours postoperatively and was discovered to have taken a large amount of whiskey just prior to each episode; an 18-year old patient being treated with amoxicillin and metronidazole for pelvic inflammatory disease who experienced nausea, flushing, and headaches each evening after drinking ethanol; and a man who, after a 1g dose of metronidazole and a shared bottle of wine at his evening meal, vomited violently.
- Taking whiskey in a post-operative state is probably not advisable regardless of the circumstance. Hysterectomy, while relatively common, isn’t a walk in the park.
- Metronidazole can nausea and even vomiting all by itself. It doesn’t need any help from alcohol.
- See #2. 1g is a lot of metronidazole all at once, especially if you’re unused its GI effects. Would the man have vomited even if he’d not had a bottle of wine? We can’t be sure, but you can bet that it wouldn’t have been mentioned in the literature if it hadn’t. It would have been chalked up to a bad reaction to the medication.
Plosker reported a reaction following intravaginal use of metronidazole. This case involved a female pharmacist who, after two or three cocktails (each contained ~1 oz of (vodka), inserted a single vaginal suppository of metronidazole 500 mg and went to sleep. She awakened an hour later with a burning sensation in her stomach, nausea, and a severe headache accompanied by a cold sweat, which she believed was a metronidazole–ethanol reaction.
I could go for the easy ad hominem attack here, but it doesn’t serve any real purpose — and in any case, I am on my way towards showing that EtOH and metronidazole is not necessarily the End of the World. That said, the burning sensation and nausea could have been from the medication itself. Flagyl can cause this type of reaction, even when it’s not administered orally.
A potentially serious reaction involved a 16-year-old male who, nine days after resection of an hepatic echinococcal cyst, developed a staphylococcal infection. He was treated initially with intravenous vancomycin, followed by a combination of intravenous nafcillin, clindamycin, and gentamicin. This regimen was then changed to intravenous trimethoprim/sulfamethoxazole (TMP/SMX) and intravenous metronidazole, in addition to his chronic therapy with albendazole, docusate sodium, and ferrous sulfate. After 12 hours and for the following 60 hours until the TMP/SMX was switched to oral therapy, he vomited and experienced flushing, which was attributed to a metronidazole interaction with the alcohol in intravenous TMP/SMX.
Attributing these side effects to the EtOH in the TMP/SMX is easy. It’s also irresponsible, because a mechanism of action had been proposed by this point in time, but not substantiated. (Exhibit B will cover this more.) This reaction is not completely out of the question — metronidazole can indeed increase the levels of intracolonic alcohol dehydrogenase — but it’s still irresponsible to put down, for certain, that this was the cause of the boy’s distress. I wonder if the heavy antibiotics he was on could have contributed to this. It seems possible that by mowing down his normal intestinal flora, he’s in a position to experience these effects anyway.
Another potentially serious reaction reported by Harries et al. also involved intravenous metronidazole, this time combined with cefotaxime and papaveretum in a patient who had been drinking heavily and stabbed in the chest and abdomen. A chest drain was inserted and 500 mL of blood was drained; peritoneal lavage produced clear fluid only and the patient was admitted for observation. Four hours after an initial improvement, he became short of breath and nauseous; he vomited, had a headache, and was profoundly acidotic. This metabolic disturbance was attributed to a metronidazole–ethanol interaction.
Drunken guy stabbed in the chest and abdomen. Chest drain removes half a liter of fluid, and four hours later the patient complains of nausea, vomits, has a headache, and is acidotic. And then it’s attributed to a metronidazole-ethanol interaction.
I could think of a few things that’re more likely to have caused this. Can you? He’s been stabbed and he’s probably developing a hangover spring readily to mind.
This last one is a real doozy:
Toxicity due to an ethanol–metronidazole interaction appeared on the death certificate of a 31-year-old woman. Cina et al. described the case of an alcohol abuser who had been in frail health for four years following a serious car accident involving severe chest, abdominal, and closed head injuries. After being assaulted by a man, the patient had collapsed and died. Medications found at the scene included propoxyphene, acetaminophen, naproxen, metaxalone, carisoprodol, amitriptyline, hydroxyzine, vitamins, and cough syrup. No metronidazole or empty metronidazole container was found and she had not recently been prescribed metronidazole by her doctor. Because high concentrations of ethanol and acetaldehyde were found, assays were performed for disulfiram and metronidazole. There was no discussion of the methodology that reportedly found metronidazole in her serum, despite the fact that this was not one of the drugs found at the scene. In addition, there was no discussion about whether any of the other drugs in her possession, for which she was apparently not tested, may have cross-reacted in the metronidazole assay. It was concluded that she had probably ingested metronidazole without the knowledge of her physician and had discarded the bottle before she died.
I think the idiocy here speaks for itself. “It was concluded that she had probably ingested metronidazole without the knowledge of her physician and had discarded the bottle” my ass. Flagyl ain’t a drug people are likely to abuse.
Indeed the common thread throughout these cases has been the assumption that metronidazole and ethanol are the culprits without any real testing to verify whether or not this is the case. This study was published in 2000, and while there was a proposed mechanism of action for this EtOH-metronidazole reaction, there was no real evidence yet to support the proposed mechanism. There are also possible — and I would be so bold as to suggest more probable — causes for each of these adverse events, and I have done my best to explain them.
Now on to Exhibit B which talks about the science of the proposed alcohol-metronidazole interaction.
Bits and Bobs from Exhibit B (Back to top)
Disulfiram works its magic by inhibiting the hepatic low aldehyde dehydrogenase (ALDH) which increases blood acetaldehyde concentrations after alcohol is consumed. This is exactly like “Asian flush” — a common, genetic condition wherein those affected are unable to effectively metabolize alcohol completely leading to flushing, nausea, and a quickened pulse.
It was theorized that metronidazole may have a similar effect on ALDH. However, studies have shown that this is not true in rats. So, what about people?
Well, it doesn’t do it in humans, either. In fact, it had the opposite effect. Metronidazole caused a reduction in acetaldehyde production, opposite to the effect of disulfiram(!). Indeed, in Exhibit B, the graphs show (probably clinically insignificant) that the participants in the double-blind, placebo-controlled, alcohol-metronidazole study that the blood alcohol levels for the participants taking metronidazole were slightly lower than their placebo-controlled counterparts between the 40 and 80 minute marks:
None of the participants noted any dyspnea, flushing, vertigo, or headache during the test. Interestingly, the heart rates for the metronidazole group tended to be about 10bpm lower than the control group throughout the test. I don’t know that this is clinically significant, but it is interesting:
Final thoughts (Back to top)
So we’ve got some age-old advice that doesn’t stand up when tested properly, and we have a proposed mechanism of action that doesn’t hold up to closer scrutiny, either. Where does that leave us?
It leaves us with a couple things… Some people experience GI distress while on Flagyl. Sometimes they vomit. Sometimes they drink alcohol and vomit. Sometimes they drink alcohol and don’t vomit. That tells us that:
- Flagyl is hard on the stomach. It’s a difficult medication to tolerate for a good percentage of folks, regardless of its effect on blood acetaldehyde levels.
- Flagyl is not a disulfiram-like drug, and should not be referred to as such.
- Flagyl will not absolutely cause the vomiting associated with Antabuse when consumed in conjunction with alcohol. Pharmacists should stop counseling that it will.
- Adverse events are too often attributed to metronidazole because it is convenient, and “everyone knows” that alcohol and Flagyl are a recipe for disaster.
- Flagyl remains an unpleasant drug to take; its side effects are real and often severe, and should not be downplayed.
- Patients should be educated about these side effects, and how to minimize them. Avoiding alcohol is one way to do this. Taking it with food is probably more effective. Doing both is obviously better than doing just one of the two.
It is my suspicion that early researchers thought there was a link between metronidazole and alcoholism due to the medication’s side effects. Taste perversion. Smell perversion. These things will cause folks to avoid certain foods for the duration of the drug therapy. Alcohol is one of those things. It’s coincidental, and its usefulness in the real world is questionable.
Interesting. I’ll have to have a look at what my Stockley says.
Thank you for the post — universally, I always see: “NEVER – take Flagyl with Alcohol”. 3 years ago, I was prescribed this drug for about 20 days. I recall going out one night and drinking, and feeling no adverse effects, wondering if something was wrong.. but more likely, the packaging is wrong and outdated.
how long after taking Metronidazole can you drink a glass of wine. I was prescibed 8 pills to take in one shot doctar said 24hrs and the pharmacist said 48 hrs without having any violent reactions
The pharmacist is closer. Of course, you won’t have a violent reaction anyway, which you’d know, if you’d bothered to read the entry you’ve commented on.
This is useful information, contrasting to the end-of-the-world hysteria launched at me by a generally pleasant and I am sure well-meaning pharmacist. I was counseled “DO NOT USE ALCOHOL WITH THIS! I MEAN, NO MOUTHWASH, NO COLOGNE, NO ALCOHOL HAND STERILIZER.” (She was actually talking in all caps.)
But, out of habit, at the hospital, I used alcohol hand sterilizer and nothing dire happened. So I began to wonder about the real risks associated with this medication. Well phooie. I’ll buy THESE odds, any day.
Agree also on the taste of the pill — seismically horrible, though the taste and smell perversion have yet to emerge. Fingers crossed and knocking wood.
Thanks for the info. It was very useful! Hope mine helps anyone looking into this topic also.
I have taken Metronidazole in two different doses and neither bothered me when I drank wine during the the “don’t drink” time.I was just fine! Granted it was only a glass but hey if hand sanitizer is supposed to affect you then I’m sure a glass of wine would have.
First dose was 4 500 mg tabs all at once and second dose was 1 500 mg tab 2Xs a day for 7 days.
As a current pharmacy student who has worked previously in the retail setting….THANK YOU!! I’ve always struggled to find the evidence for the “disulfiram” reaction associated with Metro. My brother is a doctor and told me years ago the reaction was bogus. I still think it’s a C.Y.A. warning, though. It’s better to err on the side of caution when someone asks, “Can I take this with alcohol?” in this sue-happy nation.
Thanks for this useful information – I was lectured twice yesterday by my dentist and pharmacist. Both of them told me that there is extensive evidence to suggest metronidazole and alcohol are an absolute ‘no-no’.
I TOOK IT AFTER DRINKING 2 GLASSES OF WINE. I WENT TO BED AND TWO HOURS LATER WOKE UP IN HELL. I VOMITED FOR 3 HOURS STRAIGHT, CHILLS, WEAK AND BAD BURNING IN STOMACH FOR SEVERAL DAYS.I ALMOST WENT TO THE HOSPITAL, WORST NIGHT EVER. I TOOK IT FOR THREE DAYS FINE UNTIL I HAD WINE. MAYBE ONLY WINE MAKES YOU ILL, NOT GRAIN ALCOHOL. IT DEFINATELY HAD AN EFFECT ON ME.
I tried to have a glass of wine while on Flagyl and immediately got a headache and just didn’t feel good. After that I had no desire to drink while I was on it.
ok- I have taken Flagyl 500 mg twice daily for 5 days. On the 6th day I took the am dose but had skipped the pm dose. I had gone out with friends to dinner and drank a significant amount of alcohol. ( more than 6 drinks) I experienced NO vomiting or nausea at all. I woke up the next morning took my am dose on time and have still had no problems. A previous doctor that put me on it- claimed it would cause SEVERE sickness and I couldnt even take Nyquil b/c of the alcohol. These claims about Flagyl and alcohol are bogus.
I have a history of diverticulitis and have been prescribed flagyl and cipro too many times to count, sometimes for two weeks at a time. I’m on it right now, have had a very hard day at work and need a few drinks!! I’ve drank SMALL amounts of alcohol while taking the flagyl several times, always anticipating the terrible vomiting nightmare I’ve been warned about, but have never experienced it. So, after reading this I am going to bite the bullet and actually try to enjoy two full glasses of Bacardi and diet coke while on the medication. If I get violently ill as I’ve been told I will by every pharmacist and doctor, I will add a comment tomorrow to this site, but the entry above is convincing enough to me that I’m going to take the chance. Cheers!
I have been prescribed Flagyl and was also given the “you will experience horrible things if you even touch a drop of alcohol” speech. I am a flight attendant who uses hand sanitizer constantly throughout a day. No effects. I also am a perfue whore…no effects. Going through a divorce, to quote Bridget Jones, “my most significant relationship is with a bottle of wine”, I really enjoy my glass or two a night. I’m on day three and about ready to go postal. (Maybe I should check into AA…hmmm) ANYWAY, I am encouraged to at least try a tiny glass with my dinner. Cheers!
I don’t want this to sound like an endorsement. But, I’m taking Metronidazole for diverticulitis (500MG 3xs daily) and skipped my PM dose last night and had three normal (small) glasses of white wine.
I drank it slowly over a period of a few hours, had a full stomach of food, and drank plenty of water as well.
I had no nausea at any point at night or this morning. I have no headache, and am otherwise fine.
Again, this isn’t meant to be an endorsement. Like mixing ibuprofen and alcohol, so many people have done it with no noticeable side effect, but that doesn’t mean that it isn’t damaging the liver…right?
Ibuprofen (Motrin, Advil) with alcohol is fine. You don’t want to mix Tylenol (acetaminophen, paracetamol) with booze. Always check the labels before you imbibe.
Day 7 of taking Flagyl 3 x 400mg daily. 83kg male, mid 20s.
-twice daily mouthwash (listerine mint) without problems (hoping to keep the oral bleeding wounds germ free)
-Tested 2 pints of guinness with dinner. Last pill taken 6 hours ago (next pill in 2 hours).
This was obviously not a clinical trial and I do not recommend others to experiment on their own, but in my limited flagyl+alcohol experience I was not able to detect an adverse reaction nor any other identifiable symptoms during or within the 2 hours following (“now”). YMMV
What I can definitely recommend AGAINST is “After 8” dinner mints. I ate one on day 1, and my tongue/throat reacted on contact, leaving sores on my tongue (split areas, bumps and bleeding), and a swollen and sore throat that persisted for the 6 following days. Neither hard mint candies nor mint mouth wash duplicated this for me — could it be the chocolate? If anyone else can confirm this, I would be interested to know.
I, too was fed the old “you will vomit if you consume alcohol while taking this drug” mantra by my friendly pharmacist, but after reading this page I decided to challenge that notion and perform my own trial. I headed to the closest bar after work last night, and ordered up several Black & Tan pints. After the first couple, I was not able to detect any ill effects of the Flagyl/alcohol interaction, so I continued on. However, after a few more, I began to experience slight dizziness and started having trouble with my balance. I also began slurring my speech, which became nonsensical, and was having a hard time gauging the attractiveness of the female sitting next to me. The worst part of this experiment came this morning when I awoke to find that this drug combo had left me with a pounding headache and slight loss of memory.
Alright, in all seriousness, I did pound several drinks last night and saw no ill effects of the Flagyl/alcohol interaction – other than those normally associated with a good night out. This led me to conclude that my pharmacist was spouting baseless rhetoric, and I now have reason to question any further instruction I receive from her.
I wouldn’t go that far; it’s not her fault. In fact, you will probably never find a doctor, pharmacist, nurse, physicians assistant or any other medical professional that will tell you anything other than Flagyl + EtOH = vomit.
It’s pounded into heads in pharmacy school, med school, and every other type of school where one learns about drugs. Blame the establishment, not her. It’s just one of those things that you are taught that you never think to question. (Because honestly, why would you?)
Hey there — Firstly, I’m just a consumer……not a medical professional, just a consumer or “patient” if you will. Secondly, thank you for such an extremely informative and brilliantly candid look into this “interaction”. — I myself have just come from the doctor & chemist who both put the fear of death into me about consuming alcohol whilst on Flagyl, telling me that I will be violently ill if I have a drink! I’m not a huge drinker to start with, but I do like a drink at the end of the day to wind down, so needless to say I was somewhat disappointed! So once home (and after staring hopelessly at my red wine bottle, bourbon bottle and the evil flagyl packet) I decided to Google this waring (complete with a bourbon & cola in hand)! – OK, I am yet to take my very first flagyl tablet “after” my evening meal, however if I start feeling weird or vomitting, or even feel fine, then I’ll certainly let you know……but then I’m having take-away for dinner……….maybe that’ll be worse than the flagyl!?!?!! Cheers!!!
I posted comment number 5, and have followed this thread with interest. I now have a pretty firm belief that the violent reactions anecdotally associated with Flagyl are based largely (possibly solely) on its HORRIBLE TASTE.
I am no stranger to the taste of antibiotics — as I child, my mom gave me a penicillin tablet and I chomped down on it, thinking it was a Chocks chewable multivitamin. ALL antibiotics taste horrible, but Flagyl abuses the privilege. Its taste alone is enough to be powerfully emetic, and one burp could bring its essence right up one’s esophogus and onto one’s tastebuds. This phenomenon might be especially acute if the medication were taken on an empty stomach, moreso if one were drinking on an empty stomach. Visions dancing in my head of a cocktail hour featuring Flagyl daiquiris, bourbon-and-Flagyl, Flagyltinis and Flagylritas are intrusive and nauseating even now, and I haven’t taken the stuff in six months.
I’ve been on Flagyl for probably 4 years now for Crohn’s disease, and it doesn’t look like I’ll be getting off it anytime soon. This information eases my mind quite a bit, as I’m going off to college next year. I’ve managed to avoid all high-school drinking, but I doubt this’ll be possible in college.
And I don’t know what this nasty taste you’re all talking about is. It’s just a pill. As long as you don’t let it sit on your tongue for too long it’s fine, and this is the case with many meds.
Continuing on from my post (# 19), I’ve returned to give my feedback on my recent flagyl experience. Yep, I felt sick in patches….no denying it. Although I think I can safely say that this was not because of consuming alcohol. In the first two days of my week-long course I felt great (I was taking 200mg, 3 times a day combined with 2x courses back-to-back of Augmentin Duo Forte, taken twice daily). By the night of day 2, I was sick with vomitting and a rather turbulent lower tummy. – I’ve haven’t been on antibiotics for about 5 years, but had my fair share of them in my teens with cronic tonsils and numerous ear infections and even back then they managed to throw my system out in some way (as to be expected).
Initially, I didn’t feel like alcohol and deliberately avoided it for the first 3 days for fears of feeling worse. It wasn’t until I had a friend drop in to visit after work on day 3 and we had a couple of drinks together……ironically, the alcoholic drinks (icey cold chardonnay) seemed to calm my tummy down and I suffered no adverse effects (no nausea, vomitting, headaches, etc……nothing!). I felt great again!!! I also consumed bourbon and cola in subsequent nights and again, suffered no effects. I doubt this is reliable data, but it is based on my own personal findings.
Flagyl is horrible, I grant you that …..not as bad as ciproxin (now that in an IV form is nasty, but that’s another blog!!). Bottom line is that I survived my week on it and the rather large abcess I once had is practically gone.
I agree with post 20……The one thing I really hated was the occassional ‘flagyl burbs’ (maining in the morning and I dare say because I normally don’t eat a lot for breakfast) which left a horrible taste in my mouth and a feeling of nausea. – But when washed down with plenty of food, I barely noticed it’s taste. Cheers!!
I was put on Flagyl for Crohn’s Disease a few years ago but decided I didn’t want to stay on it because of the taste and interfering with my social life! So ditched it, I have been on it a few times since and on it today 5 x 200g tablets for an infection. I felt a bit sick this morning when I took it and have had a horrid taste in my mouth all day, it’s been 12 hours and I am going to take a glass of wine and will report back if anything happens. I beleive in the power of the mind and I told my doctor and myself when diagnosed with Crohn’s that I would keep really fit and it wouldn’t affect me – and it doesn’t, people find it hard to believe I have it. I think if you THINK and BELIEVE you will get sick taking Flagyl with wine you will. I don’t BELIEVE I will so here is the test.
Mixing metronidazole and alcohol is DEFINITELY asking for severe sickness. Maybe it varies from person to person but here’s my experience:
When first prescribed it, I remember a doctor telling me no alcohol while I took it. I listened, but on the day I finished my prescription, I went out that night and drank. The next morning, I didn’t just wake up with a hangover, I was heaving for hours. I couldn’t get comfortable. It was TERRIBLE.
Recently, I took metronidazole 500 mg for a week and the NEXT night, I thought it would be safe to drink. I had like 3-4 glasses of wine and woke up the next day at like 6am and had to run to the bathroom. I almost didn’t make it. I was SO sick. I came back to bed hoping to sleep it off, but my body would start heaving pretty much every half hour. I was overheating and laying on the bathroom floor feeling like I was going to die. I almost had someone take me to the ER. Anyone who says this is bad interaction BS is…full of BS. I experienced it firsthand and trust me, I will always wait at least 3-4 days after FINISHING the meds to even touch a drink.
Oh and also, I do get that nasty taste in my mouth after awhile that some people noticed.
Maybe some people just react more severely than others. And no, it wasn’t me psychologically making myself sick because I thought it would happen. I actually drank both of those times thinking that there wouldn’t be a problem, then woke up running to the bathroom without giving it a thought. Ugh, so terrible.
I’m on the Metro, and it’s Thursday… and tomorrow is Friday… so naturally I’d like to have a few drinks. I will stick to beer, but will probably commence to drink at a natural rate until adverse effects take over. I’ll report my findings. Also, I noticed that several people who had booze skipped their evening dosage. That could definitely be a factor in reducing negative effects.
I am currently taking Flagyl and Cipro for diverticulitis. I have been on this regimen before and tolerate it quite well. By yesterday I was starting to feel relief from the diverticulitis until after lunch when I began experiencing intense nausea, severe chills, and increased abdominal pain. Last night I was planning on calling my doctor first thing in the morning, but when morning came I was OK again. I was baffled by this episode until I remembered I had miso soup for lunch. I suspect the soup was the culprit. Miso is fermented soybean paste–i.e., it contains alcohol. The miso had been in my frig for a while, so it probably contained more alcohol than usual. Other people’s comments suggest that there is a lot of variation in reactions to the combination of Flagyl and alcohol, but personally I’ll take pains to avoid the mix in any form. I am a senior which may have made the reaction more severe.
I’m on Metrodinazole, 3 x 400mg/day, since Good Friday, for 10 days. I like a pint but stayed off over the weekend, because of the warnings, until I found this site. I had a pint yesterday, Easter Monday, with no ill effects, so I’ve had 2 today. I’ll let you know.
I wrote # 28.
No ill effects after 2 pints, so I’ve had 3 today and I’m going to try 2 more tonight. Will keep you posted.
I have a new in-law who is a pharmacist, and ran my experience described in post #17 by him on Easter Sunday. He claims that Flagyl is chemically very similar to some drug called ‘Antabuse’, which apparently is used to treat alcoholics by making them violently ill when they drink. He said that maybe 25% of people taking Flagyl will have a negative reaction with alcohol. This could explain why some people report vomiting, etc., while others do not. I don’t know this guy well enough to know if he’s a blowhard, but he was really good at pronouncing 27-letter words.
Nos. 28 & 29. I think 5 pints (lager 4.5%) may be one too many, I felt “whoozy” drinking the last one, but I’m quite happy to drink 3 or 4 a day. Good luck everyone, my advice would be to try it, but go steady, in moderation.
Comment 23 – I had a glass of wine and nothing happened.
A common misconception in medical circles is that they’re chemically similar, but they are not.
Antabuse (disulfiram)
Flagyl (metronidazole)
They are completely different.
Don’t think he’s a fool, though. Like I said in a comment above, Flagyl + booze = bad is drilled into everyone’s head so much that they don’t even think to question it.
And the % of people who have a bad reaction changes depending on who you ask. 25% is a nice, safe number in that if you have a reaction, it’s not hard to believe that you’re part of that 25%, and if you don’t have a bad reaction, well I guess you’re just part of that 75% who’re safe. See what I’m getting at?
I’m totally flabbergasted. I’m half-way through a 10-day course of Flagyl and make my living in the drinks industry. Naturally it’s been rather trying! I heeded the “not one drop” rule up until now, which has been quite unpleasant. My doc said essentially “a drink could kill you, and if it doesn’t, you’ll wish it had”. So, up until now, total abstinence. Tonight I’ll have my taxes done and tomorrow the weekend arrives….and I’ve read all these posts. Now I have no idea what to believe. A glass of wine or beer would be awfully nice. I wish I knew whether to risk it, but thanks for sharing your experiences.
See #34 above. Okay, so I just went out and had dinner with three drinks. I’m on 500 mg, 3 x daily. I can’t say what effect this might have on anyone else, but I feel EXCELLENT. My weekend is saved. Thanks for the straight-up info, folks.
Great summation of the available evidence. I do not know who RJS is (first time I have visited this site) but I love the way he/she writes—more science should be written this way, IMHO. Reading the scientific literature most of the time, you’d think the articles have been written by identity-less robots.
I am taking Flagyl (3 x 200mg/day) for a gum infection, and have been abstemious, so far. Tonight a glass of wine with the girlfriend—let’s see what happens (this is the empirical approach, embodied!).
RJS, I will read your other articles, for sure. TIA, kl
I had taken only my first pill, was fixing dinner, and drank one glass of wine without thinking. When I realized what I had done, I called the pharmacist and was told I was very foolish and to call my doctor. I was terrified I would die with this horrible mistake, but nothing happened. I went online for information and found this article. Thanks for the reassurance that nothing horrible should happen.
I posted comment number 5, and have followed this thread ever since. It is remarkable and gratifying to me the comfort this resource has brought to folks. Makes me wonder how many people are out there quaking from hysterical warnings that have little if any basis in reality.
Now finished the course of Flagyl. Gums perfect.
I was able to have a glass or two of fine red wine each of the last four nights. Absolutely no reaction of any kind, apart from a warm glow. Cheers, KL
I am a physician working in sexual health(“Genito-urinary medicine”,in the UK), and have been driven crazy for years by colleagues and patients insisting they couldn’t have alcohol with metronidazole(Flagyl)or Tinidazole.These antibiotics are very valuable and useful,as they are required to treat up to 20 percent of all our female patients(with bacterial vaginosis, pelvic infection or Trichomonas)and a few male ones.
Alas,many of our patients/clients tell us that they stopped their pills a few days after starting,or had an interval without medication,because they had been told by the nurse not to drink alcohol with them.SO THEY STOPPED THE PILLS,NOT THE ALCOHOL! Rather clever really, but unfortunately their infection never went away!
I had always intuitively disbelieved this general ban on alcohol,or at least thought that any inherited genetic defect in metabolising metronidazole with alcohol affected only a small fraction of the population(5%?). Thanks to RJS for adding some scientific clout to our rebellion against this old wives'(and husbands) tale.
As a consequence,I have been trying to train our staff to go easy on our warning about alcohol,while still mentioning it.My current advice is that if the client is needing to have some drinks during their therapy, then wait 45 minutes hour after the first glass; if they don’t have any reaction of dizzyness,vomitting,flushing,ec,then they can carry on all night!(drinking that is..).
If the reaction doesn’t happen early,then they are not genetically programmed to be sensitive,and they are not going to get a reaction later.
AND THE OTHER FABLE ABOUT ANTIBIOTICS NOT WORKING IN THE PRESENCE OF ALCOHOL HAS NEVER HAD A SCRAP OF PROOF–it’s crap.
Of course,I hope I’m right, or there’s going to be an angry crowd knocking on my door tomorrow!
Remember,I may be a medical doctor, but all my decisions can’t be strictly scientific.Especially if all the science ain’t there to scrutinise.
So go and enjoy your Stella,Jacob’s Creek or(if your lucky) champagne!
Sound advice, Rex. :)
Thank god for this website, I have been pescribed flagyl 200md three times daily for mouth infection and was not looking forward to a week without a drop of the red stuff. I took the plunge and had a third of a glass of wine and after an hour there has been no ill effects, no flushes, no increase in heart rate, no numbness, no headaches and no nausea. I will post again if I do and thanks for the valuble info.
The morning after having about one full glass of wine I felt fine, in the late afternoon I felt like I was about to pass out, This only lasted about half an hour. In the evening at about 2100 felt odd sensation like my thighs are really cold. Have had one glass of wine and feel ok apart from cold sensation. Have noticed my pulse is slower than normal. I am not going to drink antmore
How old are you? You were “ok” in the morning? Felt “funny” in the late afternoon, and “odd” around 9pm. I would suggest that there is more amiss? Go see your GP?
David, I think you missed the memo: anytime you take a pill and feel funny a couple of hours later, it’s the pill’s fault, not anything else’s. No matter that you may be dehydrated, overtired, overweight, or drunk. Or all of the above.
If it were an interaction between the drugs and the booze, it would have happened *much* quicker than that. Within 30-60 minutes.
That’s not to say that it might not be a side effect of the metronidazole in general, however.
I decided to have a few drinks tonight to see what happened. After 3 glasses of wine I did not have any of the symptoms I have mentioned previously.
Thank You all sooo much for this. iI was really scared. I am drinking some beers now after reading this and feel just fine!
I got bombed the night after my final course a few months ago for divertiulitis. Had a beer the night before just to test it. I never had any adverse reactions. I’m taking it again now for a flare up and had a beer last night and did feel a little strange, but then again I hadn’t ate anything for 48 hours, so go figure. This article has helped me out, but I’d still drink a beer and wait an hour to see how you feel before you tie one on. Cheers!
Sooo i went out last night, only been on flagyl for a few days, and completely forgot about the whole “Don’t drink and take flagly” part. well it was about 4 hours after i took my afternoon pill and i went and took two shots of vodka, about 45 mins later i drank half a beer, and by the time i did that i was feeling like a light weight!! and it lasted for a good 3 hours, then i went and drank one more beer and called it a night. woke up in the morning feeling fine, never threw up or anything, but i realized that i drank and shouldnt have!!! it kinda scared me so i had to look the information up. it sucks because i want to drink tonight but i’m kinda nervous. i jsut thought i’d include everyone in that three drinks after dinner and i still felt that numbness in my lips and the buzz was a bit strong. but nothing severe.
I am on 1/2 of a 250 mg flagyl twice a day for 2 weeks. For the first 8 days, didn’t have anything to drink for the past 5 nights I’ve had one to 2 drinks per evening and have not had any ill effects from it. Alcohol has vaired between red wine, margarits, and vodka tonic.