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.
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.
Can anyone say hangover?!?
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.
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Interesting. I'll have to have a look at what my Stockley says.
Comment by ukcommunitypharmacist — August 17, 2007 @ 4:09 pm
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.
Comment by Miles — September 1, 2007 @ 9:42 am
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
Comment by Gaby — September 24, 2007 @ 11:49 pm
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.
Comment by RJS — September 25, 2007 @ 7:13 am
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.
Comment by BH — September 29, 2007 @ 2:19 am
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.
Comment by CG — October 6, 2007 @ 2:15 am
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.
Comment by Dan Irizarry — December 12, 2007 @ 1:31 am
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'.
Comment by Iain Carson — January 9, 2008 @ 11:51 am
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.
Comment by jen — January 10, 2008 @ 12:31 am
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.
Comment by CCC — January 11, 2008 @ 3:00 pm
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.
Comment by Random Anonymous — January 12, 2008 @ 11:14 am
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!
Comment by Kate — January 16, 2008 @ 10:37 pm
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!
Comment by Brooke — January 17, 2008 @ 2:38 pm
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?
Comment by Alex — January 21, 2008 @ 12:29 pm
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.
Comment by RJS — January 21, 2008 @ 10:55 pm
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.
Comment by Michael — January 23, 2008 @ 11:29 pm
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.
Comment by Diamond Dave — February 11, 2008 @ 1:14 am
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?)
Comment by RJS — February 11, 2008 @ 11:40 am
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!!!
Comment by TKW — February 22, 2008 @ 4:54 am
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.
Comment by BH — February 22, 2008 @ 3:32 pm
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.
Comment by Jake — March 1, 2008 @ 5:11 pm
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!!
Comment by TKW — March 3, 2008 @ 3:17 am
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.
Comment by Debbie Carr — March 5, 2008 @ 4:34 am
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.
Comment by Amanda — March 14, 2008 @ 4:34 pm
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.
Comment by Amanda — March 14, 2008 @ 4:36 pm
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.
Comment by Kent — March 19, 2008 @ 9:33 pm
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.
Comment by PDO — March 20, 2008 @ 11:59 am
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.
Comment by david cooke — March 25, 2008 @ 12:01 pm
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.
Comment by david cooke — March 26, 2008 @ 12:24 pm
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.
Comment by Diamond Dave — March 27, 2008 @ 12:09 am
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 by david cooke — March 27, 2008 @ 6:08 am
Comment 23 - I had a glass of wine and nothing happened.
Comment by Debbie Carr — March 27, 2008 @ 6:11 am
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?
Comment by RJS — March 27, 2008 @ 8:26 am
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.
Comment by GTO — March 27, 2008 @ 4:41 pm
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.
Comment by GTO — March 27, 2008 @ 10:16 pm
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
Comment by Kit Laughlin — March 31, 2008 @ 2:46 am
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.
Comment by Joan — April 4, 2008 @ 3:38 am
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.
Comment by BH — April 4, 2008 @ 3:53 am
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
Comment by Kit Laughlin — April 4, 2008 @ 4:15 am
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!
Comment by Rex Melville — April 4, 2008 @ 11:08 am
Sound advice, Rex.
Comment by RJS — April 4, 2008 @ 5:32 pm
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.
Comment by Mrl — April 8, 2008 @ 8:21 am
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
Comment by Mrl — April 9, 2008 @ 8:28 am
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?
Comment by david cooke — April 9, 2008 @ 9:22 am
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.
Comment by RJS — April 9, 2008 @ 2:43 pm
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.
Comment by Mrl — April 10, 2008 @ 10:27 am
Thank You all sooo much for this. iI was really scared. I am drinking some beers now after reading this and feel just fine!
Comment by tiffany — April 23, 2008 @ 7:07 pm
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!
Comment by Michael — April 25, 2008 @ 12:43 am
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.
Comment by Casey — April 25, 2008 @ 12:32 pm
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.
Comment by jim — April 27, 2008 @ 6:45 pm
Greetings fellow readers…I am on Day 4 of 500 mg, 3 x daily following a bout with diverticulitis. Feeling good enough to do a 4 mile hike today and doing a low fiber chicken pizza for dinner and really wanting a beer but freaked out with all the "drink it and prepare to ___________". Bought some Alcohol Free Beer but still unsure as it may have up to .5% alcohol. Saw some web sites that said even that would cause problems. Since I plan to leave my body for science, the least I can do is participate in this grand experiment. Thanks for this facinating web site and especially to Rex (comment 40) for his candor. My feedback tomorrow.
Comment by Mark — May 1, 2008 @ 4:41 pm
Started taking Flagyl 500mg twice a day for 7 days on Tuesday. I have been dying for a late nigwind down. I have heard all the warnings and did all the research and have decided to take my chances with a Grey Goose and grape juice tonight. So far so good (its only been a few min though!!!) I will give you all an update tomorrow! thanks for all the helpful info. Cheers!
Comment by nadia — May 2, 2008 @ 9:02 pm
I had a couple of glasses of wine on Thursday and did feel bad during the night, on Friday I felt very tired and a bit sick. However, I think it's because I have a virus and it's just coincidence that I had wine whilst taking Flagyl, as it's now Monday morning and I feel very 'flu like'.
Comment by Debbie Carr — May 4, 2008 @ 5:15 pm
I started taking it last tuesday and now its sunday i went out friday night and drank 3 beers and felt completely fine that night and day.. so saturday night i had like 6 and ended up throwing up in the middle of the night that could also just be because of the beers, but the next day (today) i have the worst stomach cramps its not unbearable but just veryyyy uncomfortablee =/
Comment by Alexa — May 4, 2008 @ 11:20 pm
I wondered about this because I have some kind of infection causing me to run a high fever. He gave me flagyl (with the warnings about alcohol!) and Bactrim.
I had my doubts anyway b/c my doctor knows I drink and maybe this is his way of treating me (forcing) off of alcohol for a week.
Well I took the plunge and will let you know soon. I believe the reaction should take place quickly b/c alcohol metabolizes so fast.
SD
Comment by SD — May 6, 2008 @ 2:14 pm
P.S It's rare that I DON'T experience some kind of reaction with powerful antibiotics anyway.
We'll see.
SD
Comment by SD — May 6, 2008 @ 2:15 pm
Well I've had quite a few beers and I feel fine.
Comment by SD — May 6, 2008 @ 9:17 pm
Absolutely no reaction. However, I don't think the antibiotics are working.
Comment by SD — May 8, 2008 @ 8:00 pm
I was on day 5 of taking my flagyl 500 mg bid (out of 7 days) and took 2 glassess of margaritas at a concert. I remembered that I wasn't supposed to take alcohol. Boy, did i have an interesting night. I was dancing and screaming for joy from the fast effects of the alcohol. However a couple hours later, I was vomiting the whole night! It was not fun. I will not do again.
Comment by mar — May 8, 2008 @ 9:56 pm
Hey All,
I LOVE my vodka/tonics & I was on flagyl for 4 days before I FINALLY broke down and said to myself "I am going to have a drink & if I get sick….I get sick" I had 3 vodka tonics and felt just fine….Although 3 hours after the drinks I did start to feel A LITTLE sick to my stomach.
I certainly did not get VIOLENTLY ILL like my doctor and pharmacist told me I would. I think flagyl is just a hard drug for some people to take and some people may get sick with or without drinking.
Comment by Michael — May 10, 2008 @ 2:24 pm
was given prescription for Flagyl 500 mg 2x a day for 7 days, well this morning was the first pill, took the second this afternoon, started reading about this crap and called the pharmacist to verify that this stuff is supposed to really make you sick when you drink on it…oh, of course, no alcohol!! My doctor didn't ask if I drank and the pharmacist did not counsel me on the side effects…..I flushed the rest down the toilet , will tell doctor to find something else for the bacteria, or maybe i will go the homeopathic way…
Comment by mary — May 14, 2008 @ 6:38 pm
Are you illiterate or just stupid? Probably the latter because you were able to write a response. But you apparently didn't read my block post or the 60+ comments on this entry.
This further confirms my above suspicions.
Educate yourself or watch a video, since you seem to have trouble actually reading.
Comment by RJS — May 14, 2008 @ 7:58 pm
excuse me, I've done nothing but read about idiots testing the theory of whether you're risking getting "sicker" than you are, just to prove a point….I am not that stupid…I don't need to test the theory…..have enough sense to quit the pills before I questioned my need for a drink on this medication… and by the way, 12 hours after quiting the first two pills, I drank two bottles of wine (my norm) and feel fine!!! ha!ha!ha! but for those 12%? that might have a reaction, quit the pills first!!
Comment by mary — May 15, 2008 @ 7:40 pm
if any of these posts prove anything other than take a chance, see what you get, "if (RJS) doesn't like your post, he will chastise you. If you support my loose "trials", (RJS) will support you"….have some common sense here….there is no support or non-support of homeopathic treatment, nobody says anything about it or changing meds due to the side effects….but the real truth is this drug should not be given out any more, of course with all the other drugs that have disclaimers a mile long, if your doctor prescribes it, refuse the prescription and ask for something else without the side effects and dangers, it is your right……
Comment by mary — May 15, 2008 @ 7:59 pm
I took a 1 dose of 4 Flagyl pills at 10 PM on Thursday. During the next day Friday, I had the metal taste in my mouth, water tasted like pills, and was I slightly lightheaded, but besides that no side effects. On Friday night about 24 hours after taking the pill I proceeded to drink quite a bit of hard liquor. I had about 6 shots I'd guess. I'm 5'5, 111 lb female. Nothing happened, the next morning I feel fine, not even nauseous.
Interesting, right?
Comment by Cassie — May 18, 2008 @ 12:01 am
I have no idea what that sentence is saying. If you're saying that no one ever had a side effect from homeopathy, of course you'd be right, because homeopathy is just water. There are no active ingredients, so the likelihood of having a side effect from taking one of these "remedies" is about as great as getting a side effect from taking a sip of water.
Er, why not? Flagyl is a great drug.
Comment by RJS — May 18, 2008 @ 3:13 pm
you all are idiots, looking to pump yourself up on BS, go ahead , drink on flagyl, encourage medications with a mile disclaimer etc….and downplaying something such as homeopathic treatments as "water", ok……………………at this point not quite sure what your site is worth but a venting blog for those who don't feel well and need some kind of ear, which I guess I was guilty of also….so ciao baby!!
Comment by mary — May 18, 2008 @ 4:19 pm
Whoa, Mary, there are some pretty sensible and reasonable, and thoughtful, people here, so sometimes it's better to pause before unloading.
To RJS: homeopathy definitely cannot be understood in the allopathic framework, for sure (Avogadro's number, probability of getting an active molecule, etc. given the extreme dilutions), but may be effective nonetheless for many reasons. And I agree, Flagyl is an excellent drug, as well as having been around—and effective—for what? 40 years? More?
No side effects does not equal no effect, either, does it? I can think of a few mechanisms that are respectable in the scientific framework that may explain homeopathy's benefits.
Getting back to the original purpose of this thread, it dies seem anecdotally, at least, that the original assertion (that Flagyl and alcohol do not play nicely together) is not the case. Cheers to all, KL
Comment by Kit Laughlin — May 19, 2008 @ 4:06 am
Precisely one reason: placebo.
I'm all ears. Really. Homeopathy has exactly zero peer-reviewed studies to back any kind of therapeutic efficacy.
Comment by RJS — May 19, 2008 @ 8:02 am
The placebo effect is not trivial, though, is it. As well, if in play, the placebo effect has the benefit of being effective and has the additional benefit of no side effects. Given the apprehension of many posting here directly about side effects (although mistaken in this instance, probably) I think that point is adequately made by the existence of this thread: orthodox Western medicine's prescribed drugs have benefits and costs. Side effects are one of the costs.
As for other reasons, I am thinking of the water "imprinting" that the homeopaths and their researchers claim is the process responsible for the diluted substance's effects.
This is not my field, but I keep an open mind. Seems there are a few studies; I am too busy right now to look further into this.
http://nationalcenterforhomeopathy.org/articles/view,173
Happy to reconsider this after July; book deadline is looming. Cheers, KL
Comment by Kit Laughlin — May 19, 2008 @ 6:07 pm
On flagyl for mouth infection.. throwin a party this weekend, and thought I would check the exact nature of the flagyl-alcohol interaction, make an informed and educated decision about how to approach saturday night.
GOOGLED of course… And found this lot!!!! Thankyou thankyou thanyou!
Going to hedge my bets and will most likely skip sat night's dose but take it easy on the beer anyway, see how I go. AND make sure I start the night on a full stomach!
Have to say I find it incredibly interesting that Mary touts these 'pills' as evil, yet 'normally' drinks two bottles of wine…
Hilarious!
Comment by Lex — May 22, 2008 @ 7:20 am
Well I just finished reading all of your posts. I have been taking metronixadole, 2 250 mg twice a day. I started it last Friday and haven't drank for this entire week. Being all my drunk friends sober driver can make you want to drink heavily. My doctor told me not to drink so I haven't but I finish this evening and it is memorial weekend and being that I live next door to my local watering hole I have been dying for that one glass of wine or vodka soda now for a week. I have a big weekend coming up being Memorial, have a concert on Saturday and lake for sunday and monday. According to all that I have found online they recomment not drinking for 3 days after finishing the drug but I will definitely take it early evening tonight and drink plenty of water and maybe cranberry juice all day tomorrow and eat a big dinner in hopes that I don't get sick. I am a very experienced drinker and have been in a foul mood all week, missing out on all the fun. I will let you all know how it effects me.
Comment by Bacahl — May 22, 2008 @ 2:33 pm
started taking metrogel for a vaginal bacterial infection on sunday but had to switch to oral 500mg tabs 2x a day because period came on tues. and Dr. said the internal gel wouldn't work while having period. I hate taking antibiotics to begin with. Last year took this and after a night of drinkinng got really drunk and major vomiting. Normally the amount of drinking I did wouldn't get me "shit-faced" and sick but that time it did. I think a couple of drinks on a full stomach would be ok for most people but a night of drinking could hit you hard with some nasty side effects.
Like the previous blogger I want to have fun this weekend and have some beers so am thinking of stopping the pills today (friday).
Do you think I have eneogh in my system to kill the infection?
Comment by Kim — May 23, 2008 @ 11:53 am
Wow, this is so helpful. Seeing an analysis of the evidence and hearing others' experiences is helping me make an educated decision.
I finished my 7-day circut last night and want to drink with friends tonight. . .
Having read the entire thread, my conclusion: Eat a full meal, with one drink, wait an hour or two, then have one or two more if there are no adverse effects.
Thank you.
Comment by Sherry — May 23, 2008 @ 12:54 pm
What about drinking before going on Flagyl? I found out i have to be on it for 2 weeks (ugh) so had half a beer at 6pm, took the Flagyl at 9pm. I feel somewhat dizzy and lightheaded, so not sure if side effects of drugs or combo of drugs and the 1/2 beer. I hope I feel ok tomorrow!!
Comment by Krista — May 29, 2008 @ 10:27 pm
My question is the same as krista #75 above. I was prescribed flagyl this morning (500mg 2x daily x7 days) and I just picked it up at the pharmacy. My pharmacist said to not drink while on the meds and also for 7 days after I finished the medication, which I thought was a bit overboard. I was really bummed to learn I couldn't drink once I started it since I have a bbq Im going to tomorrow and want to be able to have a beer or two!
I asked my pharmacist about drinking and then starting the meds the following day, he said thats not good either. He even went so far to give me a scientific explanation of what occurs when alcohol is in your system and you add flagyl. That they bind together in the liver and create a toxic chemical that can possibly cause organ damage. If that isnt a deterent to drinking alcohol on flagyl, I don't know what is (other than warnings of death).
So I hopped online as soon as I got home to find out how much time you should wait to take flagyl after drinking. There is NO info available anywhere. Thankfully I did run across this site and have read through all the comments and find that obviously the warnings from the pharmacist are completely overkill. But I am probably one of those people that will have a reaction because I am highly sensitive to medications in general usually. And I have had a severe vomiting experience in the past and absolutely don't want to go through that EVER again. Like one poster above was told that 'if it doesn't kill you, you will wish it had'. Thats not something I want to endure again.
Thus leading to my question, as the above poster asked as well, which was not addressed here. Should you go by the general rule that alcohol stays in the bloodstream for 24 hours after consumption and wait that long before starting the meds (if you are assuming you will be in the low percentage who get violently ill)?
Comment by Brooke — May 30, 2008 @ 8:38 pm
JUST FINISHED A 7 DAY COURSE OF 200MG METRONIDAZOLE TABLETS AND HAVENT DRUNK AT ALL DOCTOR TOLD ME NOT TO DRINK FOR 3 DAYS AFTER TOO WELL B*****CKS TO IT AFTER SEEING ALL THE POSITIVE COMMENTS ABOUT DRINKING ON IT COMPARED TO THE FEW NEGATIVE ONES IM GETTING RATTED TONIGHT
Comment by KARL — June 3, 2008 @ 3:54 pm
Brooke, I felt lightheaded and dizzy when I drank 3 hours before the Flagyl, but I really think that is a side effect of the drug itself. I haven't touched liquor since and a few hours after I take Flagyl I feel woozy. If you are sensitive to med's, I wouldn't drink prior to taking it..
Comment by Krista — June 3, 2008 @ 10:21 pm
i was recently prescribed metronidazole (500mg, twice daily for 5 days), and was quite put out when i was told to abstain from drinking entirely during my course of treatment, because my sisters birthday is this weekend. i googled the drug and found numerous warnings about the effects of metronidazole and alcohol, one site claimed "even death may occur"! well thanks to the author and all of you who posted comments and recommendations. i will initially "take it easy" this weekend in order to ensure i don't get sick, but i'm sure i will be fine and all in all, will have a great weekend. thanks again!
Comment by Sarah — June 4, 2008 @ 1:49 pm
Thanks for the work rjs.
It would be really neat if you could keep collecting the literature to see more about the formal debate
here is my contibution from a bit a poking around on google.
These may (do) duplicate the references in the meta study
Comment by chad — June 7, 2008 @ 6:18 am
So here are the titles ofthe things I found
Lack of disulfiram-like reaction with metronidazole and ethanol. : Ann Pharmacother. 2002 Jun;36(6):971-4
The Effect of Metronidazole on the Human Taste Threshold to Alcohol (1973)
Sudden Death Due to Metronidazole/Ethanol Interaction American Journal of Forensic Medicine & Pathology.
pubmed related articles at http://www.ncbi.nlm.nih.gov
Comment by chad — June 7, 2008 @ 6:33 am
hey it worked by accident so
here is the pubmed ref
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=2077651&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&log=relatedarticles&logdbfrom=pubmed
I could not open all of these.
Comment by chad — June 7, 2008 @ 6:36 am
Here is the Ann Pharmacother ref
http://www.ncbi.nlm.nih.gov/pubmed/12022894?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log=relatedarticles&logdbfrom=pubmed
Comment by chad — June 7, 2008 @ 6:38 am
One last point as there have been studies that have involved subjects taking both alcohol and metronidazole the researchers conducting these studies must have thought that the risk of taking alcohol and metronidazole together did not pose too much of a risk to the subjects. And one would expect these researchers to have been the well informed.
thanks again for the info
Comment by chad — June 7, 2008 @ 6:38 am
Ok so i'm going out to a BBQ right now. I plan on drinking around 15 beers. I have about 5 down already and no probs yet. I'll keep you all updated. If you dont here from me that means it did not go well and this site is a myth about giving information. Stay tuned…..Cheers
Comment by Conweezzy — June 7, 2008 @ 5:05 pm
OK so I'm alive. Bottom line is all that talk about getting sick is definitely a bunch of BULL. I probably housed around 15 beers last night and I felt nothing drunk…Thats about it, no sickness or nothing like that. I woke up this morning and feel fine. I am prescribed a 500mg dose twice a day and have been taking this for over a week. It's so nice out I think I will have some beers today as well.
Comment by Conweezzy — June 8, 2008 @ 10:13 am
wow, what a great thread. seems like you're all european (british?) of some sort. well, this american can relate to your love for booze. i just came home with a prescription for flagyl (or metronidazole) to be taken twice daily. the bad thing is, i have a weeklong vacation with 15 of my friends coming up in 2 days..thus, the predicament: to drink heavily, or not to drink heavily.
im going for this approach: start off slow and see what happens. i will know by the first day if i should continue binging or not. ive vomited plenty times in my day, whats a few more?
Comment by dan — June 26, 2008 @ 6:59 pm
I finished a 10 day run of flagyl and cipro 2 days ago and was warned not to have alcohol for three days after finishing the run. I was so concerned that drinking a beer in only 2 days would be a problem but after reading the comments from the alchys above I guess it will be bottoms up!
Comment by Morty — June 28, 2008 @ 1:43 pm
just finished a weeklong drinkfest with a bunch of friends on vacation, taking one pill twice a day..no serious interactions with the two drugs..could possibly have made me more drunk than usual, but no puking/vomiting/dizziness occured when using flagyl/alcohol
Comment by dan — July 5, 2008 @ 1:12 pm
I've just finished 10 days of 500mg 4x/day of flagyl and 500mg 2x/day of cipro for diverticulitis. I was told vomit stories by the pharmacist and even talked to one guy who had the worst-possible experience (ruptured abdominal sutures while heaving and required more surgery). It's been 48 hours since my last dose, so I will try some wine tonight. I drank the .5% beer during the 10 days with no ill effects. This site has been quite interesting to read, and opened my eyes.
I have to say that if you view a few days without alcohol as unacceptable, think about where booze is on your priority list. Should a few days of abstinence be such a huge deal?
Comment by carolyn — July 7, 2008 @ 5:13 pm
I am on 250 mg of Flagyl three times a day. I have been sick for a month with severe intestinal distress. I was hospitalized a week ago and severely dehydrated. All of the stool tests came back negative. Then I went to my gastro doctor 2 days later for a partial sigmoidoscopy and it was negative. I have not been able to keep any food down for a month. My gastro doc finally said we would try Flagyl b/c the tests that they did in the hospital could have had a false negative.
I currently have two autoimmune diseases, Hypothyroidism and Polycystic Ovarian Syndrome. They were diagnosed when I was 31 and I am now 35. I also spent two weeks in Ireland before becoming sick and now the doctors want to blame it on that. (travelers diarrhea) but I have vomitted also. I've taken pregnancy tests, stopped eating white foods (breads etc.)
Anyway, I have been on Flagyl 5 days now three times a day and am still sick with diarrhea any time I eat. Last night I decided to try the theory of drinking = violently being ill. I was warned by two doctors in the hospital, my gastro doc and the pharmacist.
I met some girlfriends out last night and told myself I would only have two light beers. I did and I was fine. Then we came back to my house and I had about 8 ounces of Bailey's in a 3 hour period. At 8:00 this morning I woke up vomitting violently. I didn't make it to the bathroom. 10 minutes later the same thing. 10 minutes later the same thing. Everything out of my system I went back to bed and slept until noon. Now I am fighting the urge to vomit.
My husband is convinced it's the alcohol. I am sure it contributed to it but I don't believe it's the only reason. I also ate dinner last night which has been making me sick. I also take Janumet for the PCOS, Synthroid for my thyroid and ADHD medication (have been taking that for years and years).
I am not sure about this medication. After reading these posts I am wondering if the medication is contributing to my ongoing intestinal distress. I am so tired of being sick. That's why last night I said screw it and drank but it was a mistake.
I think that everyone's body chemistry is different and the healthier you are, the less likely you are to react to me (maybe - - just a theory). I have lost 15 lbs this month. I am at a loss. I had a colonoscopy several months ago because of anemia so I don't know what is wrong with me.
Thanks for the information about the Flagyl. It was very interesting reading everyone's views.
Comment by Becky — July 13, 2008 @ 3:29 pm
Started taking Metro yesterday…a couple of drinks after work and a couple of glasses of wine with/after diner…no reaction.
Thanks for the site.
Comment by Jim — July 15, 2008 @ 9:23 am
wow, am i glad i found this site. i am currently taking flagyl for bv, and my doc also put the fear of god into me about drinking. "NOT EVEN MOUTHWASH YOU'LL BE SO SORRY!" now, i work 11 hour days and sometimes have to take a bus/walk home when my husband has to use the car for work, and i have my lazy routine when i get home at 8pm… shower, eat, get online with a drink one hand and the mouse in the other, until 11 or so. then i go to bed, get up and do it all over again.
i was irritated about no drinking but scared enough to listen. and i started googling today, ended up here, and guess what? considering the fact that this medicine has given me NO other side effects (besides the rotten corpse taste on my tongue), i'm going to assume i'm one of those it won't hurt.
it's my day off, so i'm going to have a sparks (an orange flavored 'energy beer') and do some housecleaning. i'll post my findings at the end of the night.
Comment by leah — July 15, 2008 @ 8:56 pm
two cans, 8% alcohol each, no discomfort in the slightest. i'm a couple hours late taking my second pill for the day (usually take it at 10) so i'm taking it now, and going to bed. if anything out the ordinary occurs i'll post tomorrow, otherwise assume i came out fine.
to becky, who posted above me: i hope they figure out what is wrong with you, and make it better. sincerely, good luck. i'm dealing with a similar situation myself (unrelated to the reason for taking flagyl) and i've unexpectedly experienced a decrease in my GI symptoms since taking it, so i'm pretty happy about that.
thanks again to the person responsible for starting this discussion. i drank and didn't die.
Comment by leah — July 16, 2008 @ 1:09 am
I drank two bottles of wine and "suffered" from severe intoxication, tendency towards foolish talk, good times, and even ate a full dinner and kept it down. BAH HUMBUG to no flagyl and alchohol! No ill side effects.
Comment by jammaster82 — July 19, 2008 @ 5:28 pm
Been taking 600mg of metro a day for nearly a week, skipped my evening dose yesterday, went out had 7 vodkas, not even my usually headache! lol. metro and alcohol reaction in my case at least is a MYTH!!! Although I did skip a dose to avoid tempting fate!! Thanks for this article, very interesting, I asked on Yahoo Answers and they all told me I would end up in ER get brain bleeding and die! (I didn't) x
Comment by Gemma — July 20, 2008 @ 10:30 am
i'm on 500 3X daily. i probably have crohns, waiting on test results. i've ben on it since may 5th. long day at work, i am looking to get F***ed up. i appreciate people actually talking about this instead of the dire warnings from doc and pharmacist. i've been rather sick lately from a number of different things so i think i'd like to avoid booze for the moment. F*** it, i'm just gonna smoke a fat bowl. no reaction there baby!
Comment by Mike — July 22, 2008 @ 10:50 pm
Well I am almost finished with my flagyl one more day and i have to say, I drank two more bottles of wine and no reaction other than wicked buzz.. lol I have to say I did refrain from drinking for the first four days until I read this blog and then I decided to try 1/4 glass of wine with food and wait.
Regardless, flagyl with or without alchohol is wholly, ungodly and a nasty horrible experience so if your body isnt hating a quarter glass of wine after an hour or so, I would say go for the drink. But flagyl is gonna tear your stomach to shreds and make you wish for the day it will be over, so if you can you might want a buzz with it.
Combining alchohol and flagyl may not cause the reaction. It really makes me think about our future. Are there other things that need to be examined. The power of the press is now in the hands of the blog user. I wonder how many other medical myths may now become exposed the way they do when large amounts of cash are applied to them.
If this idiotic trend continues, we may end up talking to Dr. Lexi (on my favorite movie, Idiocracy), about injuries we received from following the stampede off the side of that broken bridge, without even watching to see if there is even more road ahead before we continue driving. It is just about to the point where you could jump on the public transit and use the following ebonics soundboard to make people think you were listening to them:
Ebonics Soundboard
That's my 2 cents.
jammaster82
Comment by jammaster82 — July 23, 2008 @ 4:33 am
I just started taking Flagyl 4x a day 500 mg which im assuming is a high dose….i need to take this for 10 days. I am supposed to be going to an all day concert on day 4 of taking this medication…im debating having a few drinks on that day. After reading all this helpful information im thinking if i have only a few over several hours and eating in between might be ok…..has anyone been on this high of a dosage and had a few drinks along with some food and been ok? My body tends to be sensitive so thats why im not too sure yet. Thanks so much!
Comment by smf — July 23, 2008 @ 9:33 pm
I'm currently taking 250mg 3x a day. On my second day taking the dosage, I went to a Coldplay concert and decided to go for it and drink wine and beer. I had about 6 drinks. I had an amazing time at the concert and the only thing that was in pain was my voice from singing along. These past couple of days have been awful! And I haven't had a sip of alcohol since Friday night. My side effects are clearly from the Flagyl and not from alcohol combined with the Flagyl. I'm pretty sure Flagyl itself just causes a lot of stomach issues. This article reassured me!
Comment by Ann — July 28, 2008 @ 8:49 am
i am currently taking metronidazole and penicillin for an sore tooth, had some wine last night, felt great last night and this morning. Plan on going on vacation tomorrow and will defintely be comsuming alcohol. Don't think there is a problem with mixing it, maybe it depends on the person? So far so good though.
Comment by nikki — July 30, 2008 @ 12:57 pm
australia vacant glass go kitchen ocean bag ibm girl america land yes
Comment by areuglyengla — August 4, 2008 @ 12:08 am
As I told my doctor "I LUUUVVV BEER!!"
2 things from my experience with metronidazole. First, when I was given the prescription and saw the NO ALKY label and did some research I was very distressed because I had a big golf tourney scheduled for Day 3 of my prescription and also Day 8 coincided with the beginning of my summer vacation. I found this website and thought all is not lost. Talked to a pharmacist who is a very good friend. After her originally trying to talked me out of drinking, "thats one drug you can't drink with", she told me since I was early on in the dosage to skip the morning pill (500mg) drink 1 beer, wait 1/2 hour, and if no bad reaction, I was set to go. Drank 1…waited…nothing…smooth sailing!! Skipped the evening pill also to let the beer try to get out of my sysytem and resumed the next morning. Went 7 days without a drop, no big deal until the vacation rolled around.
Secondly, finished the 10 day prescription Saturday evening, started vacation Sunday, waited til approx 24 hours after the last pill and said "Screw It" I'm drinking. Forget waiting the 3 days for the drug to clear your system, I'm going for it. 1 Killer Beach Cookout, 12-14 beers and 1 great time later….I still live! Felt nothing out of the ordinary. Maybe it screw some people up, but not this one.
Comment by Jim — August 4, 2008 @ 7:56 pm
Just like to add my experience, I was given Metronidazole yesterday morning for a gum infection, my dentist told me do not drink, I thought yeah yeah, been told that so many times with painkillers and other antibots, took my script to the pharmacy he laid down the law absolutely no alcohol, said I would be very very sick, I was a stunned mullet instantly I thought no vodka for what 7 days, I even considered not taking the tablets but the pain was extreme, anyway googled and found this page, thank god!! and decided to carry on with my after work/wind-down drinks (habit of a lifetime) I didn't get hammered but had my usual amount (seasoned drinker here), and very pleased to say had no side effects except of course that nice relaxing feeling.
Thanks again for this site.
I say Cheers!!
Comment by AB — August 12, 2008 @ 6:12 pm
busy kitchen boy site stay house
Comment by valium — August 16, 2008 @ 12:44 pm
The number of posts by people who had no to mild reactions amazes me. It seems as though there is a small percentage of people that cannot tolerate Flagyl and alcohol.
Several years ago I was given Keflex and Flagyl for a suspected case of diverticulitis (sp.) I did as I was directed and did not consume any alcohol during the course of the medication. Not drinking is unusual for me as I typically have 2-4 beers after work per day and usually get a load on once per weekend.
The second day after I was finished with the antibiotics I went out drinking with my brothers. I stopped drinking after 5 because I felt as though I had already consumed more than a 12 pack. I did not make it home that night. I had my brothers drop me off at my parents house at 11 pm and I passed out on their couch.
The next morning when I awoke on their couch I ran to the bathroom and vomited violently. After about a half hour when I could stand my mother drove me home.
My wife refused to believe that I did not have extraordinary amount to drink. I can understand her skepticism as I spent the rest of the day either over the toilet vomiting bile or shivering on the bed in a cold sweat with a debilitating headache.
My advice, for what it may be worth, is to proceed as many of the others who have posted here. Test your personal reaction in small steps. Hopefully you will not be one of the unlucky ones such as myself.
I absolutely believe that my experience was directly attributable to the Flagyl still in my system two days after finishing the prescribed course.
JJR
Comment by Jeff Ryan — August 16, 2008 @ 3:51 pm
btw
The reason I ended up on this site today is that I am currently on Keflex for an inner/outer ear infection. I could not recall if it was the Keflex or the Flagyl that made me sick and I intend to get a load on tonight. I never want a repeat of that last time.
Comment by Jeff Ryan — August 16, 2008 @ 4:13 pm
More likely, Jeff, it was a combination of your getting over diverticulitis — which is very hard on the whole GI tract, not just where it's localized — and not having consumed alcohol in a while.
Frankly, I'm just amazed that people are so attached to their booze that they can't give their GI tract a rest for a couple of days after having a serious GI problem, irrespective of what drugs they take for said condition.
It's just common sense.
All that said, had it been the Flagyl, you would have had a reaction much, much quicker than you did.
Comment by RJS — August 16, 2008 @ 4:16 pm
Just wanted to leave a comment….
I was prescribed Flagyl also, as wel as Amoxicillin, by the dentist. I received the warnings here like everyone else. NO DRINKING!! The pharmacist was also very adamant about it. I decided to try drinking a few beers while on the medicine and…..no issues at all. It seems that there IS a small percentage of people who have had problems but it appears that this is just a small amount of people.
It's probably a unwritten law in the medical community that if there are a few people who can get dangerous side affects, they HAVE to warn you about it to cover their backs.
Bottom line is, I havent received ANY bad results from mixing alcohol with Flagyl.
Comment by Mike — August 16, 2008 @ 7:39 pm
Hi, I'm taking Metronidazole 400g x4 a day post hysterectomy. I was concerned about drinking on these tablets but again, after discovering this website, am going to bite the bullet.
I'm 35, have two kids and post surgery am feeling down and feel like I need to let my hair down - I have been looking forward to this weekend for so long and thought I would be fine to drink but then contracted this horrible infection, hence the metro.
I actually finish the course on Thursday and arrive to a champagne reception at the hotel on Friday. I'm going to take it easy and just have a couple and see how I go.
Saturday night may be a little different as cocktails are on the menu - but still, will try and be a little bit sensible.
I'll let you know how I get on next week - if I'm still alive that is (?!!!??!) x
Comment by Nicky — August 19, 2008 @ 5:43 am
I was on Flagyl for a bacterial infection. 500 mg. 2 times a day for 7 days. I had two verbal warnings to not drink while on this medication, one from my doctor and one from the pharmacist. I heeded their advice and did not drink any alcohol whatsoever for 7 days.
My question is why chance it? Can't most people go without a drink for a measly 7 days? Most of you sound like if you didn't have a drink for week the end of the world was coming! LOL! I find it humorous!
Comment by Gail — August 25, 2008 @ 9:53 am
#108 has me laughing - I was just prescribed Flagyl and read through the posts, I was waiting for someone to comment about why it is such a big deal to give up alcohol for a week. Having said that, I did put off starting the medication by two days because I wanted to drink wine with dinner! Anyway I had googled the effects of alcohol with this medication mainly out of curiosity; just wanted to know what the effects were (my dr told me no alcohol but didn't make a big deal out of it).
I'm more distressed to learn that the nausea and vomiting may occur just as a side effect of the medication - I have a terrible phobia of vomiting. Seems from the posts that there is less of a chance of feeling sick if you take the medication with food, so hopefully that is true in my case.
Anyway, thanks for the great reading and good laughs! I miss Mary…
Comment by SDV — August 26, 2008 @ 8:24 pm
Aight well I am taking 500 mg every 6 hours planning to go out for a lil bit tonight hopefully i can have 1 drink and enjoy it…I'm a lil bit nervous though but this article is really pushing me to say screw it and drink one well hopefully i will post when i get back…
Comment by Deanna — August 27, 2008 @ 10:14 pm
well i drank one drink vodka and cranberry i really felt buzzed when i laid down to go to sleep my stomach started to hurt and this morning it hurts a little bit but I really think it hurts only because I didn't eat a good dinner last night….
Comment by Deanna — August 28, 2008 @ 7:09 am
i was on a course of metro and was assured by a pharmaceutically knowledgeable friend that the only problem with drinking on metro is that it will make you sick as a dog. so (was at a winetasting/stag do/drinkfest) i had a few and took it slowly and then had some more… felt fine at the time but pretty rubbish the next day but imagine i would have done anyway.
Do we think it is definitely the case that the infection is adequately treated regardless of drinking during the course?
Comment by Sonia — August 28, 2008 @ 2:41 pm
I am on my last dose of this medicine I have had 500mg two times a day for a week and this is my last day. I have not taken my morning dose because this is my one day off. I do not have class and I do not have work. This never ever ever happens so i wanted to enjoy a few drinks tonight. i really do not want to get sick but i am dieing to just experiement and see what happens for the near future. I have been prescribed this medicine before. I will let ya know! is one kind of alcohol better than another?
Comment by andrea — September 2, 2008 @ 1:51 pm
This is a really interesting site, I got prescribbed metro today for my infected wisdom tooth (third time now grrrr)! I've had a crap day and really want just half a glass of red, everything I read before this warned me not to even breath in alcohol! Very refreshing to read these comments, I do believe that if you do things in moderation, there's no harm in anything! I'm off to have a glass of red and will report back.
ps RJ I really like your site, it's interesting and scientific but very readable and easily understandable, thanks! x
Comment by Lucy Edwards — September 3, 2008 @ 4:45 pm
pps #112, #108 had me laughing too, I know it seems silly about not drinking but A. you're either prescribed antibiotics directly over some event which would be much more enjoyable with a drink (eg Birthdays, bank hols etc) or B. even if you have nothing on, if someone tells you you CANNOT have something, it makes you REALLY want it lol…..the 'big red button' scenario!
Comment by Lucy Edwards — September 3, 2008 @ 4:50 pm
First, I have to say that this forum is hilarious. The thought of all these folks before me going home after their visit to the doctor's office so worried about not being able to have a drink or two (or 3…or more) that they have to do a little 'net research cracks me up! Mostly because I am one of them!
Like most of the people before me, after reading the mix of stories, I felt I had to experiment with my tolerance of the alcohol-metronidazole combo. I started my scrip on Thurs evening, two 250 mg tabs twice a day, and by Sat night, I was tired of not being able to have a drink (I've been taking anxiety meds that, right on the bottle, say "Do not drink alcohol with this medication," for two years with no problems - that has to say something about my tummy tolerance, right?).
I took my evening pills on schedule, and I went out last night and (slowly) enjoyed 3 glasses of Chardonnay (and food) with zero reaction! I have to say thanks to RJS for creating this forum. Had I not found it, I probably would not have been brave enough to try to drink alcohol with the metronidazole.
Yay alcoholism!
Comment by mindy — September 7, 2008 @ 1:04 pm
yeah but: do the meds actually work if you drink with them? my experimentation proved that i didn't die or even get sick from drinking on metroblabla but as i never noticed the symptoms of the infection i don't know if the course cleared up what it was supposed to treat…are there any pharm experts who can tell me that side of the story? ie does drinking with metroblabla affect its efficacy?
Comment by sonia — September 7, 2008 @ 1:17 pm