Alcohol and Flagyl = disulfiram rxn? Where’re the data, dood?!

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.

  1. Bits and bobs from Exhibit A
  2. Bits and bobs from Exhibit B
  3. Final thoughts

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.

  1. 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.
  2. Metronidazole can nausea and even vomiting all by itself. It doesn’t need any help from alcohol.
  3. 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:

Blood ethanol concentrations during metronidazole therapy

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:

Blood ethanol concentrations during metronidazole therapy

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:

  1. 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.
  2. Flagyl is not a disulfiram-like drug, and should not be referred to as such.
  3. Flagyl will not absolutely cause the vomiting associated with Antabuse when consumed in conjunction with alcohol. Pharmacists should stop counseling that it will.
  4. Adverse events are too often attributed to metronidazole because it is convenient, and “everyone knows” that alcohol and Flagyl are a recipe for disaster.
  5. Flagyl remains an unpleasant drug to take; its side effects are real and often severe, and should not be downplayed.
  6. 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.

327 thoughts on “Alcohol and Flagyl = disulfiram rxn? Where’re the data, dood?!

  1. i am here debating to start drinking or not i had my last dose over 30hrs ago i would really like a beer plz let me know

  2. I am on Flagyl and am drinking my first beer of the evening. I plan on drinking 3 or 4 more. I am a small female who drinks regularly and ate a normal amount today. I will let you all know how it turns out! If you hear nothing, assume the best :) (or worst? haha)

  3. I think the upshot of this website is that no one can tell you whether you will have a reaction or not. Most people seem to be able to drink on Flagyl but some seem to have difficulty. I hate Flagyl because of its side effects but drinking makes no difference to how I feel on it. I would certainly try a drink after not taking Flagyl for a day.
    Good luck

  4. Thanks for the site. Nothing like being told no to make you want to have a drink. I am on day 3 of a 7 day regimine and decided to test my tolerance for my fav apple martini. Ate well before hand as well. So far so good. Will add an update if I do start to feel the I’ll effects. Cheers!

  5. I’ve been taking 500 mg of Flagyl 3xs per day for about a month. I had a friend in town for the holidays for a few weeks. The first few nights I would cautiously drink some wine and beer with no other side effects other than flushing, a little nausea, and feeling the “tipsy” effects more than usual. I guess I got over-confident and had two vodka drinks last night and the night before. I am regretting it still at noon the next day. I NEVER vomit when I drink (which is regularly), but was up all night throwing up and have the worst headache. My first hangover at 32 years old :)

    I think these posts are pretty right on. Not many people are affected. But it does help to be cautious and consider your dosage and the type of alcohol you’re drinking.

    And I also have to laugh at how attached we are to our alcohol that we can’t wait a week to abstain. Kind of eye opening

  6. I’m a 60 year male, just finishing a two weeks course of Flagyl (500mg thrice daily) along with Cipro (500mg twice daily) for suspected diverticulitis. After reading the comments at this site and others I decided to try a beer or two while taking the drugs. Last Friday I had one pint of beer with no effect; Saturday 2 pints of beer with no effect—I even washed my Flagyl pill down with beer. I’ve been drinking moderately (just a drink or two each night) since then. I realized later that I had accidentally been gargling mouthwash every day (Listerine @ 21% alcohol) with no effects either. Without alcohol the only side-effects I had from Flagyl before imbibing was brown-colored urine (harmless) and the bitter taste of the Flagyl—if you don’t swallow quickly. However, that was minor since I LOVE bitter foods and drinks–my favorite beers are very hoppy ales and my favorite mixed drink is the gin and tonic with the double whammy of bitter from the quinine as well as the lime rind. So I guess I’m in the category of people who can mix alcohol with Flagyl without side effects.

  7. I left a message back on 11/14… I ended up drinking a lot (I meake responsible decisions, lol) and was totally fine. I think my bad reaction was more fear driven than anything. Might not be the case for everyone but I thought I’d follow up.

  8. Urgent response required please…

    I am 5 days into a 7 day course of 3 x 500 metro i have missed two out three today (day 5) as its my BIRTHDAY tomorrow.

    2 days ago i felt like i had a mild migrane and felt sickish.

    Also being urinating a lot.

    not allergic to anything including kryptonite.

    does anyone think urinating, feeling rough, is a sign of potential intollerance it will be 24 hours pill free if i drink tomorrow.

    but i dont want to be ill?????

  9. Andrew –
    Metrodinazole just does weird things to your system. I had bad side affects (headache, lots of nausea, strange hot flashes…) when I was taking it, even when I didn’t have any alcohol. When I did have a few drinks that made it ten times worse.
    Some people are not as badly affected by the drug, and it seems like when these people drink that their system is not harmed. But some people definitely have strong reactions to the drug being in their system. (I am one of them.) So I would be very very careful about drinking if you are ALREADY having bad side effects, even if it is your birthday. Alcohol only irritates the affected area and makes your symptoms worse.

    Also, it is a bad idea to skip (or miss) taking some of your pills during the day because then you are not killing whatever bad stuff is in your system in the first place, and that could come back to haunt you. I did not finish my entire metrodinazole prescription the first time around because I was having such a nasty reaction (partly from the alcohol) that the doctor advised me to stop taking it and see what happened. The c.diff. came back, and I had to start an entirely new round of drugs. It was a huge pain because those pills are gross. So I would not mess with them any more than you have to. Which means I would take the full course of the medication and be done with it. And hold off drinking till then.

    Good luck.

  10. So Friday was day 5 of taking 2 X 500 metro. It was my second time getting drunk and it took much less alcohol than usual. I was very regretful the next day. I haven’t had a hangover that bad since I drank two bottles of Boones Farm on my 13th birthday. Awful. Vomit. Poop. Pounding headache. Poop. Vomit. Dizzy. Queasy. Headache. Vomit. Poop. 12 hours before I felt like a human being. Never will I take metro again. Never.

  11. All, after reading all the posts and pondering about drinking for my companys Christmas Party last weekend, I did. I had about 5 beers and i really felt nothing at all. At one point I felt a little flushed, drank a water and was fine. Maybe its the wine that causes problems but a few beers won’t hurt..

  12. Ive been on it for 5 days now, finished the course on friday and its now sunday. I dont see why can cant just stay sober??? im DEFFINITELY not drinking for a good 3-4 days after finishing it. Whats the point. Apparently it has a chemical in which has adverse reactions with alcohol, its not worth it guys. Stick to your red-bull and be merry and hyper :) alcohol isnt the BEST thing ever, and whats a couple of days//weeks without it!???

  13. perhaps you are right about conflating the reaction to flagyl alone with a reaction to flagyl and alcohol but I count myself emphatically among those who reacted violently to the combo. I took flagyl after returning from india with a gi bug (campylobacter–no nausea just diarrhea). I started flagyl, was not counseled to not drink alcohol, and after a night out with 3 glasses of wine was so wretchedly ill I vomited and could not eat or drink for 4 days. I went to the er twice to get rehydrated and on the second trip was hospitalized with a small stroke and venous brain blood clot. the neurologist said the extreme vomiting and dehydration was the cause. so while my case is probably unusually extreme I for one do not question the interaction. Even more so since I’ve been continiuing to take flagyl durinig my hospitalization and beyond to treat the infection, with no nausea.
    there’s no harm in being overly cautious and I could have died from my clot had it been less favorably placed. as it is I lost 3 weeks in the hospital and had some pretty scary effects (left side numbness, double vision, neverending headache, disorientation) from the brain clot.

  14. ive been precribed 200mg 3 times a day, have been taking now for 3 days and today is a friends birthday, i took my last tablet at about 12 noon and plan to go out tonight at about 8 o’clock, there is no doubt that i shall indulge in a few beverages, knowing me probly more than a few, so i shall let you no how i fared up tomorrow. x

  15. I am taking Metro 400mg x 3 a day for the next five days, 2 days in. My pharmasist nearly blew a vein telling me NO DRINK.

    Well I feel ill anyway, probably from the infection I have, lost appetite etc, So tomorrow i am going to have a glass of my beloved captain morgans spiced rum, and if i am still alive after the first i may venture a second, because really, i couldnt feel much worse!

    I think people react in different ways because they tolerate, or dont tolerate the medication. Thats just my view. Fingers crossed that me and the old captain get a good evening and i get a decent nights sleep, but thats another story!

  16. I am presently taking a metronidazole derivative at present for amebiasis & have gone through the web to read more on the effects & side effects of these drugs.I came across this blogsite & would like to post a comment.

    I am a doctor & aware of alcohol as a contraindication to metronidazole treatment. My advise is: DON’T DISMISS THESE PRECAUTIONS TOO EASILY.

    Just because a majority of people did not experience adverse effects does not mean it can’t happen. What about those few percentage that would have it?

    Drug manufacturers spend a lot to develop drugs safe to use for everyone. Drug monitoring agencies tries to monitor & enforce the laws. Sad to say, there is no single drug that’s 100% safe.

    Would you prefer to have your doctors or pharmacists tell you a drug is totally safe just because only a few percentage will suffer some side effects? Don’t be naive.. Even those few % matters much to us to ignore!

    For those who don’t want to take metronidazole, there are newer drugs that provide the same efficacy in much lower doses, shorter courses of therapy, and lesser side effects. Ask your doctors’ experiences about these drugs.

    I am planning to take my beers today after 24 hours of therapy for personal experience. NOT RECOMMENDED TO BE FOLLOWED!

    Comment by echotanjr

  17. Man I hate to rain on the parade here, but I had a relatively bad experience. I’m a standard binge drinker, going to parties and bars on weekends, and have been drinking heavily like this for 15 years. I know my limits and what alcohol does to me. Anyway I got an IV of metronidazole the day before I was to throw a new years party. I started drinking approximately 28 hours after the IV. After 1 beer and a half glass of wine over 2 hours, I I had a strong response, with a headache, flushing, and slight dizziness along with a drunken feeling. Mind you I can drink 10 shots of tequila and hold my own, but with this I just felt out of sorts. I felt completely fine before I took my first sip of alcohol. Over the evening I drank quite a bit, but I would have to stop for half hour intervals when I felt I reached some limit. It was clear that if I drank at a faster rate I would quickly become nauseous. I was able to throttle my drinking rate and didn’t get really sick throughout the evening. Today (the day after), I don’t feel nauseous, but I feel like I ran a half-marathon. My head is pounding and my body aches all over the place.

    Unfortunately it seems that I’m one of the people that can’t process alcohol so well while on flagyl.

  18. Been taking the meds for over a week. Had some wine last night. Feel fine this morning. I missed having a drink on New Years because of this old, out dated advise. My Sister a Pharmacy Tech. told me I would be SICK AS A DOG, if I drank. Can’t wait to tell her she was wrong…again. Thanks for this HONEST info. Does anyone know if the drug still works the same?

  19. I honestly forgot about the fact that I was taking these pills and went out for a drink with some co-workers to celebrate a new job offer. Came home in a panic realizing that I had two rum and cokes. I feel fine.

  20. I’m taking 500×2 a day and have big plans tonight… I’m going for it!! Ill let ya know tomorrow!

  21. Drank the night before beginning Flagyl. The following evening I awoke and went to the bathroom. I became dizzy, experienced nausea, and felt as if I would pass out. When I returned to bed I felt some relief. The following morning upon waking, I experienced the same episode. I would like to drink for the super bowl. I took one pill (250mg) this am but plan to stop taking it and hope it will be out of my system by Sunday pm.

  22. I have taken Flagyl several times over the past 8 years or so. Once no response after drinking wine. Another time – nothing. But then – I took it and had some Bailey’s Irish Cream. It was a HORRIBLE experiance. I was so sick and I have never felt so bad. I cannot drink Bailey’s now, as a result and that was about 5 years ago.

    Since that time I have not had a need for flagyl, until now and took one dose – 2 G for BV. That was Wednesday night. I felt odd all day yesterday and all my food, and even water was GROSS! I feel good today and I have been invited out to have a drink tonight. I really want to go, but I admit I a bit scared.

  23. I took Flagyl 250mg Friday am and then drank Saturday pm with no problems. It was about 30 hours after my last dose.

  24. YES! you are SO right my friend. so i was put on a two week med run due to a bacterial ulcer and was told DO NOT DRINK ALCOHOL. DO NOT USE MOUTHWASH, PERFUME, ETCETC. to me? i flipped out. i had plans, man!! i’m not an alcoholic but i sure felt like one once my doc put me on flagyl.

    turns out? bs. total, complete uber bs, bc i drank a glass of wine and was fine. then i went out on a friday and drank the night away, and guess what? as long as i ate enough food, I WAS FINE. stupid wives tale. thanks for all of your research and efforts!! definitely made me grin.

  25. I am currently drinking 2nd bottle of wine. I dont feel anything bad yet, after a bottle of wine. will inform you whether there is a adverse effect soon.

  26. I am a nursing student at ohio state and have a glass of wine 3-4 nights per week. I was actually so sick with an intestinal infection that I was not allowed to work in the hospital at which I am currently placed. The Flagyl actually made me feel SO much better (even though my mouth tasted like metal for a week).

    I was curious about Flagyl’s reaction with alcohol so I decided to look it up in a drug guide. Just so you all know, the onset of Flagyl is rapid, but its half life is only 6 hours and the duration is between 8 and 24 hours. That means that the drug is TOTALLY out of your system within a day.

    So, if do buy into the hype that Flagyl + Alcohol makes you incredibly ill, you only have to wait 24 hours after your last pill to have a drink, not the 3-4 days that all of the pharmacists tell you. This is just their way of covering their behinds if you are the ONE person whose body gets rid of the drug more slowly, drinks, and dies from an incredibly rare reaction.

    Thank you again for this article.

  27. Also, to respond to Tammy from Jan 30th,

    The reason you might have gotten so ill from baily’s irish creme may be because of the fact that flagyl wipes out a lot of normal bacteria in your intestines. They have actually found that people with Giardasis and other intestinal bacterial infections can end up having lactose intolerance for up to 6 months after the original infection. Just stick to non-dairy drinks and I bet you’ll be fine!

  28. I’m prescribed Flagyl 500 mg PO BID (by mouth, twice a day) for 7 days. I’m on Day 5. I’ve suffered no side effects so far but haven’t consumed any alcohol. I’m a nursing student who has learned about “detrimental” effects of Flagyl and alcohol but it’s the boyfriend’s 21st birthday.. hence the dilemma. After reading this website, this is what I plan on doing for this weekend:

    -Taking my last dose late afternoon on days I plan on drinking (3 or 4ish)
    -Having one drink around 9-10 PM (Bacardi and coke– no milk products) and look for any type of side effects.
    -If no side effects occur, I plan on drinking like most college kids drink during times of celebration– 4 to “I don’t know how many” drinks. I will only be drinking rum and coke. I’ll try to monitor my BAC and any “abnormal” side effects for this purpose.
    -When I wake up, I’ll take my AM dose 2 hours after rising and then my early evening dose around 3-4 PM again if to go out the following night.

    Yeahh.. I’m a planner. I’ll let you know how it goes; probably not the smartest thing, I realize, but I’m willing to experiment.

  29. I am a child care provider w/2 kids of my own. I work 5 days a week 9 hrs. a day. Today is Thursday and my X-mas party is tomorrow night Fri. I am taking Flagyl 500mg 2xs a day for 10 days. I was looking forward to getting buzzed w/my coworkers until my doc. said that BS!! I asked her what if I skip my evening dose and the next morning dose or just skip a whole day and ahalf? Absoultley Not! Ok I know everyone has done it before but my doc. really made me nervous, BUT I still want a F@#$$^ drink…. so I did some investigating and found this page Flagyl & alcohol! I have been on it for 4 days now and I am going to skip tomorrows dose am & pm and probably Sat. mornings just incase my hang over is bad dont need any added sickness:) So I will let u know what happens Sat. CHEERS!!

  30. I am a child care provider w/2 kids of my own. I work 5 days a week 9 hrs. a day. Today is Thursday and my X-mas party is tomorrow night Fri. I am taking Flagyl 500mg 2xs a day for 10 days. I was looking forward to getting drunk w/my coworkers until my doc. said that BS!! I asked her what if I skip my evening dose and the next morning dose or just skip a whole day and ahalf? Absoultley Not! Ok I know everyone has done it before but my doc. really made me nervous, BUT I still want a F@#$$^ drink…. so I did some investigating and found this page Flagyl & alcohol! I have been on it for 4 days now and I am going to skip tomorrows dose am & pm and probably Sat. mornings just incase my hang over is bad dont need any added sickness:) So I will let u know what happens Sat. CHEERS!!

  31. I was prescribed Metro and experienced a horrible reaction to it via using wine in a dish I was preparing. I was told not to drink alcohol or use mouthwash, etc. So, I did not. But, when I was making a chicken and peppers saute, it called for two tablespoons of white wine. Thinking that the alcohol would “burn off” in the cooking process, I used it. Four of us ate dinner that night and within 20 minutes, I was so violently ill and dizzy that I could barely stand up. Everybody else was fine, so my only conclusion was that the alcohol did NOT burn off and it was the Metro that caused the reaction. I was ill most of the night into morning. After reading this blog, it seems that some react and some don’t. Personally, I would err on the side of caution. It is not worth the possible interaction problem I experienced.
    Also, as a side note, yes – I did experience the metallic taste on my tongue for the entire course of its use. My doctor recommended this bio-med mouth spray that you get at the pharmacy. It is a minty flavored artificial saliva. It really helped to get that awful taste out of your mouth.
    Good luck to future users. It helped cure me, so I think it was worth using for a good final result.

  32. Interesting site. I typically consume about 6-9 beers daily. Now I have a wisdom tooth issue, and lo and behold, I have Metronidazole 3x a day with the no alcohol warning. Looked at all these posts, and will chance a couple and let the forum know my results. Just a point of fact; my stomach is already flipping out a few hours after my first dose without the beer. Food might make a big difference I would think. Maybe more so than the alcohol consumption.

  33. I was prescribed this drug and I went on a bender the night before because my doc told me no alcohol. I don’t mean like I had a few drink, I mean I was piss drunk came home and puked my guts out hadn’t been that drunk since i was a teenager (In my own defense it was my best friends birthday, I just found out I had to have surgery and be on crazy meds and I was feeling reckless, I normally don’t drink to excess like that). I started it when I woke up the next day and I felt like crap…i’m pretty sure it was the hangover though, maybe combined with the nasty side effects of the drug itself but I didn’t have any horrible unusual side effects. The other week I went to a bar while still taking this stuff (850 mgs every 8 hours) and had maybe 2 or 3 shots of vodka and I was fine…absolutely no side effects. I’m going to a birthday party tomm and my plan is to drink LOTS of water, eat a healthy dinner, have 1 drink let it sit and have another.

  34. Oh, one other thing, although I think that maybe some people might have nasty effects after drinking and taking flagyl I wonder if some of it might be psychosomatic? Our minds are powerful tools and if you are convinced that you are going to get sick if you drink while taking it you might subconsciously make yourself sick…just a thought ;-)

  35. I’m on my 5th day of taking Metronidazole 500mg 2x/day. I have actually followed the “DO NOT DRINK ALCOHOL” warnings thus far and have suffered no adverse side effects other than the nasty taste of the pill. I’ve been kind of bummed that I would not be able to drink anything at a St. Patty’s Day party tomorrow (6th day).
    My instructions say not to stop taking them until the meds are done (7 days) and then do not drink alcohol for one day after. After reading all these comments, I am actually thinking about taking a chance and having a pint or two. I plan on being very carefuly (i.e. having a full stomach and drinking water in between beers). I will let you know if there are or aren’t any adverse effects. If there are, I will hopefully have learned a good lesson and abide by the instructions on the bottle!

  36. Ugh! I don’t know what to do! I have am on my 2nd day of Flagyl 375 mg BID for BV. I’m already getting a yeast infection, this med is making me dizzy with some vertigo. I feel like I’ve been drinking when I haven’t had any alcohol at all.

    I react badly to lots of meds (allergic to Tylenol, Tramadol, Cephalasporins, codeine, among others.) I have lupus and am taking Plaquenil & have had problems in the past with it not playing well with alcohol (dizziness, flushing, nausea.) I have a date on St. Patrick’s Day in four days. If I wasn’t already having problems with this med or didn’t have problems with so many other meds, I would definitely feel fine with drinking. But since my situation is not typical, I really don’t want to chance ruining my 2nd date with this guy by getting sick! And I definitely don’t want to say, “Hey, I know it’s St. Patrick’s Day, but I can’t have a glass of wine because of this med I’m taking for BV.” Yeah, that would be just great!!

    So, I’m thinking maybe I should contact the doc about metrogel instead or a different antibiotic. Any suggestions?

  37. Well, after a couple days of drinking, I’ve had absolutely no ill effects, although I will say that on the one occasion I took the Flagyl without eating I thought I would die. A quick meal took care of that. I’ve found that as long as I eat before taking the pill, there are no real side effects. And alcohol didn’t have any effect on me whatsoever.

  38. Just finished my very first ever round of Flagyl. Dr said no alcohol, pill bottle had alcohol warning on it, so I gave up my morning coffee with a splash of Irish Creme (only 17%). Even when I eat, this drug makes me feel nauseous and leaves a bad taste in my mouth, though I pop the pill with water and don’t let it hit my tongue). Finished my therapy today and was wondering how long before I could enjoy my coffee which led me to this page. Wish I had read it earlier. But since I’m having adverse reactions anyway, maybe it’s best I didn’t add to it. But I’m not waiting 48 or 72 hrs. I had already planned to stay home tomorrow since I have felt awful on this drug. I’ll just have a nice breakfast with my coffee and hope for the best. If I get sick, I’ll be home to deal with it. Will let you know tomorrow how it goes.

  39. Was on 500mg Flagyl 3 times a day for 3 days. Drank 3 12oz beers at 5% alcohol less than 5 hours after taking my last dose. No issues, felt 100% fine.

    To inject some more science into the discussion: Flagyl supposedly creates a “Disulfiram-like” reaction when taken with alcohol. Disulfiram makes you sick when you drink because it blocks the action of the enzyme “acetaldehyde dehydrogenase” and you end up with tons of acetaldehyde in your system, which makes you feel like shit. The important part is this: the accumulation of acetaldehyde in your system happens VERY quickly after you drink, like 5 to 10 minutes (stomach contents will make this vary a little, obviously). So if you slam a beer (or 3) and don’t start feeling sick within a short period of time, you’re good to go. None of this “I drank, went to bed, and woke up 3 hours later feeling terrible” stuff, because the reaction is MUCH too swift for that to happen.

  40. Last night my nausea turned into real pain. After dealing with that all night, I got up, ate breakfast and had my Irish Creme coffee. No nausea today, but still having stomach pain. Going to dr today cause I don’t think it has a thing to do with the Flagyl. I looked up gallbladder attack, but symptoms a little different than what’s listed. Could be the stress of going cold turkey on the coffee!

  41. I’m a nurse and was also always taught no alcohol with metronidazole. I am on day 5 of 500 mg twice a day. Had a scotch on the rocks tonight. No problems. If anything, the alcohol helped get the nasty taste of the med out of my mouth. It’s been 3 hours since I had the drink.

  42. In my case, the drug caused my reactions, WITHOUT the alcohol. Dr could find no other problems. It’s 3rd day after finishing and feeling much better. Regardless of alcohol intake, this drug can be fierce on the stomach. Last time I take it.

  43. Well, I survived St. Patty’s Day, night and the next day without having ANY ill effects. I’m apparently one of the lucky
    ones who didn’t develop any nausea or pain whatsoever. I’ve been off the medication now for over a week. I did finish off
    the prescription like it said. I agree with Nursemom, the alcohol took away the bad taste! It lingered on for days after I finished the bottle but thankfully it’s gone.

  44. I just started taking this medication for a gum infection, and I’m also taking amoxicillin with it. I was looking up something about alcohol with this med. because I, as a few other people have said, like to have some wine after work. I got the whole speach from the pharmacist too on how I would get violently ill if I had any alcohol at all. Now, I HAVE taken this type of med. before for another kind of infection in different form, and was told the same thing for that med. I had absolutely no reaction taking it at all at the time.

    After reading pretty much the WHOLE thread, I decided to test it out very carefully myself tonight. I had no effect at all. If anything, like someone else had mentioned, I think I even felt a little better. Don’t ask me why though…lol Have no idea. lol I don’t want to over indulge…just have a couple of glasses of wine.

    I actually have sort of a medication phobia here. I rarely even take a tylenol. I even went through post knee surgery taking not a single med at all. Meds just make me nervous in general. My point in all of this is just that I’m really not sure that freaking out patients with worst case scenario warnings is a good idea. Many times I’ve also quit taking,or not taken a med at all after being told that have to endure some horrible reaction that seems MUCH worse than the affliction. I realize how the pharmasedical companies want to cover their asses, and that the physicians simply cite the textbooks, but I think this has all just gotten too ridiculous. Like commercials for meds on TV. I keep thinking John Cleese is going to pop out…”And now for something comlpetely different!” It’s just all so surreal. It’s overkill, and just making people paranoid.

  45. Taking 500mg of Flagyl twice daily for a bacterial infection. Ive been sitting here (bored) reading these comments and having a few beers. Its been about 2 hours since my first beer and I feel fine, although i notice i feel like I drank a few more than I actually did. I washed my nightly dose down with a beer – but no pains or sickness! I feel great and think I may go to the bar for a while….I will post again if I start to feel sick later….

  46. Started taking Metro today (2 x 500mg) after drinking several drinks last night.
    I am soooo out of sorts today. Light headed, tired, queezy, heart racing, sweaty palms, chills… Ugh…

  47. I have taken a course of Flagyl about 3 to 4 times over the past 15 years. The only thing that stands out for me is the bitter, metallic taste I experienced when I tried to swallow and that it turned my urine orange. I was a teen and wasn’t drinking yet the first time. The next times I was an adult. At first I strictly adhered to the no alcohol directions. The next time I had been taking it twice a day for 7 days and on day 4 or 5 I drank. I have never vomited from drinking and didn’t vomit this time. I think that someone may be onto something when they say that some of the population has a genetic predisposition to this so called alcohol-flagyl reaction. Have you ever drank orange juice after brushing your teeth? I read in some magazine( at the Dr’s office) that most people find OJ after brushing has a bitter taste. However, for a small population of people who have been found to have a certain type of tasting gene, OJ tastes just fine after brushing! So I think that most of us who have proven this alcohol-flagyl myth wrong, are part of the lucky population of people who are predisposed not to get sicker (already sick if on flagyl, ha ha) if they drink while on flagyl. I must admit though, some of you posters are braver than most. I wouldn’t wash the pill down with alcohol…that’s pushing it! Nice comprehensive post

  48. Hi Fellow peeps wanting to drink booze on this drug…:),

    I am, on 5oomg twice a day for 7 days of this horrible drug for PID and am on day two…I caved and bought beer at the store…But didn’t have the balls to drink it yet..LOL!

    So I have been comforted by the legions of alcoholics like myself who have to take this God awful drug and have found themeselve’s on this site as we WANT TO DRINK AHHHHH!:)

    AS IF it’s not bad enough to be sick and that makes you want to “chill out with a cold one” ….YOU CAN’T!

    Or, turn yourself into your own personal science experiment and…

    SEE…However slowly …at first….If we are going to “REACT”…” Jesus!

    I haven’t had the cravings for a drink outwiegh my fear yet..although….Thats saying alot for the worry as I AM DYING TO DRINK…:) (Duct taping self to table as we speak to keep hands away from beer and mouth)

    I will let you guys know if I cave..drink..get sick or not…die ..whatever…

    But if it helps anyone out there..This will teach me not to sleep with an a$shole ever again…as I got sick because of that..this drug is making me sick.. and now I CANT DRINK ..to forget about it..

    And thats sickening..But oh yeah…I was drinking and thats how I ended up sleeping with him in the first place..

    Which is what landed me at this site at this time of night blogging about why I cannot have a beer…or whatever else I want to drink LOL!

    Oh..the tangled web we weave..This will definitley teach my as$ …

    hugs to everyone ….Im going to TRY to stay sober….if not I’ll be back :)

    peace all! hugs and all of that jazz! :) L.

    PPS And oh yeah, I really am an alcoholic…So if I cannot drink and stick to this ANY BODY CAN! :)

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