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. PS Oh yeah and you guys, I did a lot of reading on the internet and “missing doses” of this stuff can prevent your infection being cleared up in a timely manner….AND THEN WE HAVE TO GO BACK AND START ALL OVER AGAIN! AHHHH!!! LOL! :)

    This is like some kind of wierd head game j/k :)

  2. Wow, what and informative and entertaining blog! Like so many others here, I was brought to this site via Google after being prescribed this drug and reading the dire warnings. It seems to me that unless one is very sensitive or suffering for another reason, there is very little risk of any ill effects from combing the two drugs. I followed the advice here and have had one beer in about 45 minutes and feel fine. I will be having a couple more.

    Kudos to RJS for his skillful presentation of the subject matter. It was also a pleasure to read the many well-written and thoughtful responses (You Go, England!). This blog contains facts, fiction, humor, sarcasm and much more. It also provides a fascinating look into the human condition.

    Now as I enjoy the warm fuzzy feelings of the knowledge that my antibiotic and alcohol are working together for my overall well-being, I will ponder the following points and challenge you to do so as well.

    1) How much other information that we all take as gospel from our doctors, lawyers, teachers, clergy, politicians, institutions, media, and more is really bunk?

    2) Blogging is a very intimate way to experience diverse viewpoints from around the world and gain an understanding of our fellow man on this planet that is unprecedented.

    3) The internet is, bar none, the greatest and most important tool ever devised by mankind in human history, Thanks Al Gore! ;)

    4) And lastly, A+A≠D

    Best wishes to All:)

  3. I just finished my last pill today of a 500 mg pill 2 times a day for 7 days. I abstained from alcohol the entire time but I’m planning on going to Atlantic City on Tuesday (in 2 days). There’s no way I’d abstain from free drinks. :)So I Google searched alcohol and flagyl to see if the wait three days to drink alcohol was correct. I’m thinking I’ll be fine to drink by Tuesday. :)

  4. I have been taking 400mg 3 time a day for over 4 days for giardiasis. Spurred on by these posts I decided to have a beer and wait a bit. To fill in the time while waiting I had another beer, and then a glass of wine. I experienced a tiny bit of flushing at worst. I may not drink again until the course is finished, but will not be waiting too long after the last tablet.

  5. I am currently on day three of metronidazole. Unfortunately, I have BV about once a year, so I am very familiar with flagyl/metronidazole. A little background, I’m in pretty good shape physically (except for this dayum BV); I don’t usually react to metronidazole (except for the nasty taste when you first take it), and I don’t drink very often. I’ve never waited the requisite 48 hours before drinking after stopping metronidazole treatment, and never had any reaction. I still continue to use listerine and hand sanitizer with use of the medication, no effects there.

    I am going out tonight with a friend, and I have also had a rough week at work…so I thought I’d google “flagyl and wine” and see what came up, and I found this site.

    So I decide to “test the waters” with a glass of wine. I had the glass (about 6 oz) about an hour and a half ago, and no effects. I will say that I wouldn’t drink as much as I normally drink, but I think I’ll be okay. If you don’t hear anything else from me, then all went well :)

    I also find it hilarious that I would risk possibly getting sick for a glass or two of wine (and that I’m not the only one). :)

  6. I had been on Metronidazole and wanted a drink – I found this post and thought I’d test the theory. After a painful, alcohol free two weeks I had a dazzling array of drinks (beer, wine, rum, scotch and vodka) and felt great. My boyfriend had the spicy jambalaya and had a stomach ache. Funny!

  7. I am a woman aged 57 years.I have struggled to tolerate metro (dizzinees/thirst/low mood/ agitation/pounding heart sensation). No GI reaction even tho’ also on amoxicillin. Metro dose 200mg tds for 3 days for dental abscess. Took last dose 21.30 hrs yesterday – really missing 2/3 glasses of wine in the evening (after 6ish)- what are the odds if drink tonight? Any (honest) medics or pharmacists out there?. Anecdotal evidence suggests should not be a problem.
    Thanks for any help!

  8. After 1mg aprazolam and 2x330ml budweisers, I’m absolutely fine except for the runs that I had anyway!

    So far…

  9. I am elated to have found this tread through Google. Was just prescribed medication. I am flying to an all inclusive resort in 2 days. I am a registered nurse,and have always told my patients not to drink while on this medication. In fact, that’s the same thing my midwife told me after writing my prescription. Now, I will take it easy on vacation; but atleast I can enjoy a little of the alcohol I’ve already paid for.

  10. Okay – was on this drug (in conjunction with Amoxicyllin) a couple of years ago (perio problems) – screamed at my doctor and told him to come up with a different drug – it was Labor Day weekend – he said “no” that the combo was the best for my mouth and the recently troublesome implant that cost me $3000.00. Anyway, stayed off the wine, but 24 hours after completing the drug – said to heck with it and had 2 glasses of wine or so. No problems.
    Now again, on Memorial day weekend, I get the same medications for another some perio pockets – just to see if they will improve – but have not taken the drug until after the holiday – I probably need to prove to myself that I don’t need the 2-3 glasses of wine everyday I so cherish – so I’ll stay off of the wine for at least 5 days – but think afer reading all of this – a glass next this weekend won’t kill me – I’ll respond if it does.

  11. Hi All-

    I just started taking Flagyl today. I am taking two 500mg twice a day for a week. Today is Monday, I am supposed to go to the Playboy Mansion on Saturday. I am a female in my early 20’s and to be perfectly honest, I drink A LOT (usually 3-6 glasses of wine a night). I’m 5′ and about 115 pounds- and can usually take down 8-14 drinks a night without and negative consequences.

    I am going to have a beer later and see how I feel. I also plan to drink at the party on Saturday. I will let you all know what happens on both occasions. If I get sick, so be it (it wouldn’t be my first time praying to the porcelain god, and I’m sure it wouldn’t be the last).

    PS- I too am glad I’m not the only one struggling with the idea of no vino for 7 days. SO LAME!! I will keep you all posted.

  12. Responding to my post of May 27th – I held out until June 1st – 7 days into the prescription – had a glass of wine (Savignon blanc)no reaction – have had a couple of glasses of wine each night since – finishing medication today. I guess either it effects you or not – glad I’m a not. Does however, really effect my stomach – (gas and loose movements) – but it was doing this before drinking the wine and may be attributed to the Amoxycillian I am taking in conjuntion.

  13. Just got a prescription of metronidazole today. When I found out I couldn’t drink on it, I couldn’t believe it. I work in a bar as a bartender , and part of my job is drinking with customers, way more tips that way. Anyway I came across this website , and saw that most people haven’t been affected by the drug. I am female, 5’3 125lbs and I weightlift 3 times a week. Lots of muscle mass. At 3pm I took my first dose, I usually eat pretty healthy and restrict my calories, but I figured I should up my calorie intake for the next 7 days just incase. So tonight I go to work at 830 pm which would be 5 and a half hours since my first dose. I had my first drink around nine pm , Absolute Vodka and tonic, which is the only thing I ever drink. I would say I have a high liquor tolerance, Usually about 10 to 12 vodka and tonics a night. I still felt fine after an hour , so then I drank 2 more, after another hour I still felt fine. I would say I may have felt a little light headed, but that may have been from all of my cigarette smoking. But after the first three drinks I drank as I would normally. Total of 7 or 8 drinks in about 5 hours. Right now it is 2:47 am and I still feel fine. I will post when I wake up to tell you all if I have any side affects later..

  14. Ok I woke up around 1 pm today and I am feeling fine. I will be taking my next dose at 3 pm and then 3am. I have to work again tonight at 8pm so I will be drinking. We will see what happens. Oh and I am taking 500 MG twice a day for 7 days.

  15. Second night of drinking , had about 9 vodka and tonics at work tonights still fine… I think I will be fine on this medicine. If I get sick at some point . I will let you all know.

  16. Hey Everyone-

    I have drank A LOT on 2×500 mg and nothing happened. I was hoping to get drunker faster, but no such luck. I probably finished about 2 bottles of champagne plus several vodka sodas and didn’t get sick. I made sure to have a good dinner and stayed hydrated with water, and didn’t experience anything out of the ordinary.

    I’m not a doctor, but perhaps it’s best to experiment with small amounts of alcohol to see if your stomach reacts negatively to the combination. Good luck to everyone- don’t get sick!!!

  17. I laughed out loud “literally” after reading another Jen’s comment (#9). That pretty much sums up what I went through last night. I really thought that the warning was on there because it decreases the potency of the antibiotic. OH NO, that is not the reason! I woke up last night after consuming some jagermeister after an argument with my most recent ex, then taking the pill before going to sleep, and I woke up this morning trying to figure out why I was dying. After throwing up for what seemed like forever, I finally managed to crawl to my laptop and found my answer via Google. I will never EVER drink on this again. I am sitting here at work feeling like I consumed several bottles of alcohol all by myself and I am afraid to take my next dose.

  18. thank god for google!!!

    i take flagyl for 2 weeks every 3 months and its always a pain trying to not drink… after reading the blog and all the comments… i am looking forward to my coors light tonight.. i’ll take my chances..

  19. I am an 32 yro MD, and yes I’ve learned that Metro and Ethanol shuld not be mixed together. I very rarely consume alcohol. I was on 750mg 3x/day for 10 days. On 10th day I by accident consumed about 0.17 oz (~5-8ml) of wine. I didn’t get flushing, I got a bit of weird feeling in stomach after 2 hrs, a bit of gas the day after. Otherwise I was fine. However, I strongly, really strongly recommend others not to drink. I’m sure that you can stay away from alcohol for the few days you are taking it, and if you cannot, it means you have an alcohol problem.

    Every person reacts differently to drugs. Why experiment and risk vomiting (and vomiting the medictaion, thus missing the dose) when you can stay away from alcohol , complete your drug regimen and be fine?

    If you do drink while taking Flagyl, it’s AMA (against medical advice) and AYOR (at you own risk).

  20. “I’m sure that you can stay away from alcohol for the few days you are taking it, and if you cannot, it means you have an alcohol problem.”

    Go fuck yourself Phil.

  21. Wow, what a holier-than-thou comment, Phil. We are all human and make mistakes, and just because we drink a little, or a lot, doesn’t make us alcoholics. So, do us all a favor and get down off of your soapbox, mkay?!

  22. lol never again. like amanda up there said earler, everything is true. I has to take the meds for 7 days without drinking, my bday was June 19th, i had to drank. I took the med that morning, and i drunk that night a half pint of gin and two shots….Next morning i threw up all day til that night. I tasted the meds(i know TMI) when i threw it up. I almost called in to ER, i had to lay down on the bathroom floor for about an hour, would’ve been longer until one of my peeps bammed on the door. Stomach pain out of this WORLD. I thought i was going to die. Trust me when that label says NO ALCOHOL……it means NO ALCOHOL. Yall talkin bout i has a glass of wine, datz prob y u didn’t get sick. Don’t do it, just don’t do it lol.

  23. Aye…But maybe this medicine is good for all of “us alcoholics”. I bet it will make them stop dranking!!! lol We have the cure.

  24. to sum it up( i know i keep posting but…)i threw up all my insides and i will never want to feel like that again.

  25. I’m finishing a week of metro and went to a bbq yesterday. Nervous as hell, I took advantage of the free liquor! I consumed 4 large rum and cokes and 3 shots. I had a little stomach discomfort but I think that’s just my normal drunk reaction. I woke up expecting to feel horrible, but I’m ok.

    Concerned, I decided to see what damage I had done and found this page. Thanks for the info!

  26. A metronidazole in the morning, two margaritas that evening. I feel fine. No problems at all. Thanks to this page (I checked the internet before I tried this experiment). Thanks again, I couldn’t have done it without you!

  27. Well, I wish i would have found this site before i did all the crazy worrying!! I am a nurse and decided after 4 beers one night i would Start the Metronidazole. After swallowing the pills (drinking, hence the lapse of judgement) I freaked because of what i was taught would happen it the two should ever mix. I then proceeded to excercise a technique used by Bulemics, spoon to the back of throat. I HATE to vomit but felt i had no choice. Do it once or do it all night. After injuring myself slightly, i decided it was not going to happen. My Boston Terrier is now tramatized by my actions and the cuss words used in the ordeal.
    I then went to my trusty computer and began looking up the drug onces again. I then found this site!!!! I was more than relieved to read the posts. I then decided..Hell with it! and had another beer, took a bath and went to bed. Slept all night and not even one sign of nausea! Thanks to all who do support this finding!!

  28. The point was that there are NO other papers out there. This is the extent of the peer-reviewed literature.

  29. Thank you for this article. I am on day 5 of Metronidazole 1 pill every 12 hours. This medication in general is nasty. Although my side effects are annoying (headache, dizzyness, achey muscles in my neck, slight queezy stomach) they are very mild.

    I was prescribed the medication 2 days before I was due to leave for a vacation for BV and was not happy about the no drinking scare the pharmacist put into me. Since I am not one to take information doctors or pharmacists give directly at face value I decided to Google the topic. After reading the article I decided to go about my vacation as normal.

    I did not stop taking my medications at all! I mean why would you risk building up a tolerance to this anti-biotic?

    Day 3 I drank a margarita, and 2 gin/tonics. I did not have any adverse reactions. I did not get more drunk than usual, no stomach pains, no nothing other than a really good time! The next morning I woke up feeling great!

    Day 4 (lastnight) I did not even eat as much as I had been. I drank 2 glasses of wine and then went out for a night on the town and had 3 gin/tonics. The only thing I noticed my body telling me was wow I don’t even feel sick anymore from the meds. I ate a late/early morning dinner and took my pill while still drunk.

    For those that are getting sick…I am convinced it is just the medication itself and not the alcohol/metro combo.

    I would suggest eating milder foods drinking plenty of fluids and keeping your stomach full with several meals throughout the day. I also popped a few Tums (antacid) for the yucky feeling the meds give my tummy.

  30. Started Flagyl on Monday, Jul 6th. On Thursday, July 9th, 3 days into therapy, I had 3 glasses of white wine and 4 glasses of sangria. I was not advised of the potential alchohol hazards and therefore was clueless of the side effects. I did have a terrible headache the next day but no worse than I usually have after drinking sugary drinks.
    On Friday I went to the beach and had a rum drink to ease the headache. It helped… just really tired.
    On Saturday morning I felt like I couldn’t get out of the bed! I was so dizzy and groggy and had a ringing in my left ear. I felt like my head was underwater. I went to the gym and nearly fell over several times but I kept pushing myself. I went home and napped.
    That night, I had 2 glasses of wine (still have no clue about the side effects) with my dinner and went to bed really early. Slept 10.5 hours that night but felt great on Sunday. The ringing in my ear had stopped and had very little dizziness on Sunday.
    Today, Monday, feel really groggy and tired again.
    Overall, flagyl makes my head feel heavy and I don’t want to work or focus on anything. It’s making me very tired… and I’m a very active person.

    That’s my experience. My conclusion is that it depends on the person.

  31. thought id write after searching for info after freaking out forgetting i shouldnt use alcahol mouthwash with the flagyl…its however three hours later now and initially i did feel quite nauseous ( thought panic i think ..im really emetaphobuc , hate eing sick ) but now i think im calming down and there was no reaction ( other than in my head…)

  32. I just started taking flagyl today, Friday. I am supposed to take one 500 mg pill twice daily for 7 days. After reading this blog I am pretty assured about how I will go about having a drink when the time comes – skip my second pill, check for signs of distress after my first drink, make sure I have a good meal in me. My biggest concern is that I have a wedding to go to in 8 days, Saturday, which is technically the day after my dosage is supposed to be complete. It is a morning wedding therefore it will literally be an all day drinking event. As such, I am nervous to risk such taking on that much alcohol within likely less than 24 hrs of the meds.

    So to give myself more of a buffer, I am thinking that I will take 3 pills instead of 2 on a couple days within the cycle (to basically shorten it from 7 days to 5 or 6). Does anyone know if this is a bad idea? From this blog I can tell that dosages vary, so it seems to me that it is probably OK. I just obviously don’t want to do anything to make the drugs less effective.

    To add even more embarrassment to the fact that I am so concerned with my healing getting in the way of my drinking habits, I should admit that if I do choose to take extra pills on certain days, I will probably also omit a pill on a day or two within the cycle so that I can go out and have some drinks. Will this have any adverse effects?

    Normally this would not be such a big deal to me but there are extenuating circumstances – a good friend’s wedding and the fact that these are my last few days before I am moving and starting law school so want to live it up with my friends while I am still in town.

    Thanks for any insight! Can’t believe how long this blog is! It’s oddly comforting.

  33. I have now had diverticulitis 3x in the past 3 yrs, and have always been prescribed Flagyl. Every time I have taken this antibiotic I have had miserable side effects (nausea, bloating, awful metallic taste in mouth.) The last time I went through this, on day 9 of 10 of the meds, I decided I felt so putrid that I would try a few drinks, which I did and actually felt better. Last night, on day 4 of 10 (I am currently on Flagyl) I had a few beers as well, with no ill side effects. I am not recommending driking profusely while on antibiotics, but it has been my experience that there has been no problems associated with a combo of the two. However, I am not certain if it renders the medication less potent, or any other side effects, but I was just so nauseous that I figured it could not be much worse and I was right. I am off to grab a pint..Cheers

  34. Been on the “flag” (flagyl) for a few days now, timidly tested out two alcoholic beverages (diet coke and vodka) last night… was and still am in tip top shape. Not to mention working at a bank in which I use an obscene amount of hand santizer… so, I definitely believe that perhaps this “no alcohol” situation while taking flagyl is most likely an overstatement. Not to say that it couldn’t have adverse effects… but I am yet to experience them. I will again test this out later this evening…

  35. Been on Metrondazole 400mg three times daily and Erythromycin 250mg four times daily for a dog bite – both were a seven day course. I was given this cocktail as I’m allergic to Penicillin.
    Finished Flagyl yesterday lunchtime after forgetting to take one tablet the day before – meaning I took 800mg before 2pm, plus the Erythromycin – a dry seven days, awful! Then had a much needed glass of wine, before dinner, at around 7pm, and waited until 8pm to see if I was going to “die” – and I didn’t! Had a total of four medium glasses over four plus hours, still okay, and most definitely okay this morning – many thanks, RJS, and all of you for dispelling the myths.
    Additionally, I have been nursing for 20 years and was always suspicious of all the tosh surrounding this drug; now this has been confirmed! Saying that, I also accept that there is always going to be someone out there who will get a bad reaction to any drug, like I do to Penicillin….so my advice is to take it slowly and see how it goes, as I did. Bottoms Up, as we say in the UK!

  36. I started a course of Flagyl on Thursday (500mg 3xday). I actually forgot about the alcohol restriction and had a beer Friday night not long after my afternoon dose. No adverse effects at all. After having that beer I took my late Friday night dose and Saturday morning dose today and still no ill effects; so I decided to push the envelope and have a few beers this afternoon. After several Budweisers (I’m American…can you guess?), I still haven’t noticed anything different or out of the ordinary so I suppose I’m one of the lucky ones who isn’t bothered by the combination. I would never suggest that anyone should ignore their doctor’s orders but I can definitely say that drinking beer while taking Flagyl has not been a problem for me.

  37. The last time I took Flagyl I observed the alcohol restriction, although the day before I started was my birthday and I drank plenty (16-20 beers). Just started another dose Monday. Drank 3-5 beers Sunday, Monday and about 7 tonight (Tuesday). All is good. After reading over 200 posts, I really think it’s all about genetics. Some people will have the bad reaction, some none at all. I would have liked to have seen more info on whether or not alcohol reduces the effectiveness of the meds.

  38. I started my prescription to Flagyl (500 mg 2x day) last night after dinner. About 30 minutes after taking it I started to feel slightly lightheaded and lethargic. This started to get increasingly worse as the night went on. Around 11:00 I felt like I had taken some sort of strong painkiller or muscle relaxer, and I ended up just going to bed because I felt so out of it. I got up this morning around 9:00 and it was really hard to wake up and get myself out of bed, plus I still felt quite intoxicated. I called the doctor to report my symptoms and he asked if I had consumed alcohol in the past couple of days (which I had 3-4 beers the day before). He said that this was probably a side-effect of the alcohol and the drug mixing (not sure how much of that is the case and how much was just my reaction to the drug) and that I needed to stop taking it. I didn’t technically drink while on the medication so it isn’t as relevant as most people’s reports but I just thought I’d add my story.

  39. Ok Im on my last 2 pills 500mg each >>> Ia arrived in Miami going out with friends tomorrow and i think im going to have to try to beat the system and drink … The plan have first dose early in the morning and second dose when i get back at night. Im sticking to beer.. having a good meal and snacks in between some Tums just incase and plenty of water, at the end of the night some more food with the last dose… So thats the plan i will keep you posted lol.
    Im also a nurse (us nurses dont listen) !!!

  40. wow i never thought this was true, but i am able to think things are true because if i believe it in my heart its not really a lie…. i steal from homeless people..

  41. i tried this and didnt get sick… davidlhancock

    – “I steal from homeless people and claim to be a christian”

  42. I’ve been on the Metro 500mg for 4 days now, decided to have a couple of Long Islands tonight, so far I am fine. I have had no side effects so far even without the alcohol,not even the awful taste other people are complaining of, so after reading all these comments I decided to risk it, I never usually have side effects from prescriptions and this one is no different. Yeehaw!

  43. Finished 7 days of 3 x 500mg/day metronidazole about 20 hours ago. It tore my GI tract to shreds, almost worse than the infection itself. Started drinking about an hour ago — why not?

  44. im taking metronidazole (flagyl) for a bacterial infection, 500mg 2x daily for 7 days. ive taken 7/14 pills and ill taking my 8th in a couple hours. at dinner tonight i had two sips of wine and some tiramisu that had kahlua in it. i totally forgot that i wasnt suppossed to drink – which at that point my heart started racing and i got really hot so i drank a ton of water.
    im pretty sure that that happened only because i had did something ‘bad’ and not because of a wine and metronidazole reaction.

    i dont really know if i had a reaction or not..im still calling the pharmacist in the morning ):

  45. starting to get a little stomach ache, but its also been around an hour since i drank some, still havent taken next dose.

  46. I took Flagyl at 5pm yesterday and forgot about the ‘no alcohol rule’ and proceeded to have dinner and drinks with friends. 2 glasses of wine later I realized my mistake, but I never had any nausea or vomiting. Maybe it is based on a personal physiological reason more so than the combination of the two drugs alone.

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