Several antibiotics and alcohol should not be mixed because of severe reactions. However, the interaction between alcohol and metronidazole is evidently different compared to other antibiotics.
Read this article to find out why.
What is Metronidazole?
Metronidazole (Flagyl) is an antiparasitic and an antibiotic that belongs to the drug class called nitroimidazole antimicrobials. It treats a wide range of infections by stopping the growth of bacteria and parasites. It is ineffective against viral infections and only works on bacterial infections, such as rosacea, skin infections, infected gums, dental abscesses, bacterial vaginal infections, pelvic inflammatory disease, and lower respiratory tract infections. It also treats parasitic infections, such as giardiasis and amebiasis.
Metronidazole can also be taken together with other drugs to treat certain bacterial stomach ulcers (H. pylori).
Can I Take Metronidazole With Alcohol?
It is advised to completely avoid alcohol while taking metronidazole. Alcohol use while taking metronidazole can have negative consequences ranging from moderate to serious effects, including death.
Is Having 1 or 2 Drinks OK?
As mentioned, taking alcohol with metronidazole is not recommended. Mixing metronidazole and alcohol can cause heart palpitations, nausea, vomiting, skin redness, and other serious side effects.
However, there is debate surrounding this reaction since some studies have indicated no issues with the combination. Still, other research found evidence that it is safer to refrain from mixing metronidazole and alcohol.
When used with alcohol, metronidazole is said to cause unpleasant side effects. This is believed to be caused by the hepatic aldehyde dehydrogenase enzyme being blocked, which then leads to acetaldehyde accumulation, causing symptoms.
Are Certain People At Risk When Combining Alcohol And Metronidazole?
When it comes to consuming alcohol or taking metronidazole, certain people are at an increased risk:
- People with liver damage: Both metronidazole and alcohol are broken down by the liver. If a person’s liver isn’t functioning correctly, there will be metronidazole and acetaldehyde accumulation in the body, causing negative side effects.
- Older people: Older people have a higher chance of developing liver disease and are more sensitive to alcohol. Compared to people under 65, older adults usually experience the unpleasant side effects of alcohol more rapidly or several hours after.
- People with certain illnesses: Alcohol intolerance has been connected to Hodgkin’s lymphoma. Additionally, it has been discovered that women with breast, uterine, and ovarian cancers are more prone to experience severe side effects from alcohol intake.
How Does Alcohol Interact With Metronidazole?
When metronidazole and alcohol are combined, a disulfiram-like reaction can occur. The following are symptoms of a disulfiram-like reaction:
- Nausea and vomiting
- Flushing of the face or upper chest
- Fast breathing
- Fast or racing heartbeat
- Chest pain
What Are the Common Side Effects?
The usual side effects of metronidazole can be comparable to those that people have after drinking alcohol:
- Abdominal pain
Are There Any Serious Risks Or Side Effects?
As stated above, serious complications, including chest pain and rapid heartbeats, can result from a disulfiram-like reaction. Whether you consume alcohol or not, metronidazole has certain health risks as well. Fortunately, these serious risks are rare and only occur after taking the medicine long-term:
- Skin redness or severe allergic reaction
- Peripheral neuropathy (a health condition that affects the nerves outside of your brain or spinal cord)
- Meningitis (inflammation of the linings that protect the brain and spinal cord)
- Encephalopathy (a condition that affects the brain’s structure or function)
- Neutropenia (a sudden drop in neutrophil count, a type of white blood cell)
- Stevens-Johnson syndrome (a severe disorder of the skin)
When Should I Get Medical Attention?
Seek medical attention right immediately if any of the above-mentioned adverse effects and any untoward signs and symptoms manifest. Disulfiram-like reactions, as well as other adverse effects, can be life-threatening.
When Can I Start Drinking Alcohol After I’ve Stopped Taking Metronidazole?
The FDA advises abstaining from alcohol consumption for at least 3 days following your final dose of metronidazole. However, if you have liver issues or take drugs like cimetidine (Tagamet), which makes metronidazole stay in your body longer, you may have to wait longer.
How Long Does Metronidazole Stay In The System?
The average person may still have metronidazole in their system up to 40 hours after their last dose. However, for those with liver problems, this timeframe may extend to 6 days.
However, the length of time metronidazole remains in the body is determined by a person’s overall health and body composition. Other factors, such as age, may also slow down the body’s ability to eliminate metronidazole.
For this reason, it is highly recommended to consult a medical provider if you believe you have an increased risk of experiencing any interaction.
Are There Any Antibiotics That Aren’t Affected By Alcohol?
In contrast to other antibiotics, metronidazole has a different mechanism of action. Therefore, there might not be an ideal substitute. Medical professionals will prescribe antibiotics based on certain infections. Shifting to a different type of common antibiotic may not be the best course of action for metronidazole.
This is why doctors strongly discourage alcohol consumption during metronidazole treatment to prevent antibiotic interactions. It is recommended to talk to your healthcare provider about this, especially if you have an existing alcohol use disorder.
Other Considerations For Using This Drug Safely
Metronidazole is not suitable for everyone. Inform your healthcare provider of any of the following to ensure that the tablet, liquid, gel, or suppository form of the antibiotic is safe for you:
- Are having dialysis or have high blood pressure
- Are pregnant or breastfeeding
- Have existing Crohn’s disease
- Have liver problems
- Have an allergy to other antibiotics, metronidazole, or other medicines
- Are unable to quit drinking alcohol while taking metronidazole
- Are using blood thinner medications (metronidazole may raise your risk of experiencing unusual bleeding)
Make sure your doctor is aware of the certain medications you take, including vitamins, herbal supplements, over-the-counter medications, and prescription drugs, in order to keep you safe.
Watch Out For Alcohol
While using metronidazole, completely avoid drinking alcohol and be extra cautious with any products containing alcohol. When you drink alcohol, a chemical reaction that stops your body from metabolizing the alcohol can be triggered.
Watch out for alcohol in these home products:
- Cough syrups
- Hand sanitizers
- Breath strips
- Body washes
- Hair sprays
- Bug sprays
Find Alcohol Treatment Center Near You
Speak with your medical provider if you have any concerns regarding the adverse effects of metronidazole. If you drink alcohol and have unhealthy consumption that ranges from mild to severe, including binge drinking and alcohol use disorder, you may need treatment.
Find a treatment center near you, or contact us to assist you in exploring your options.
Learn more about mixing alcohol with other drugs:
 Meth and Alcohol
 Synthetic Marijuana and Alcohol
- National Health Service. (n.d.). Metronidazole. Retrieved February 2, 2023, fromhttps://www.nhs.uk/medicines/metronidazole/
- Tally, F. P., & Sullivan, C. E. (1981). Metronidazole: in vitro studies, activity, pharmacology and efficacy in anaerobic bacterial infections. Pharmacotherapy, 1(1), 28–38. https://doi.org/10.1002/j.1875-9114.1981.tb03551.x
- Cina, S. J., Russell, R. A., & Conradi, S. E. (1996). Sudden death due to metronidazole/ethanol interaction. The American journal of forensic medicine and pathology, 17(4), 343–346. https://doi.org/10.1097/00000433-199612000-00013
- Fjeld, H., & Raknes, G. (2014). Is combining metronidazole and alcohol really hazardous? Journal of the Norwegian Medical Association: journal for practical medicine, new series, 134(17), 1661–1663. https://doi.org/10.4045/tidsskr.14.0081
- Alonzo, M. M., Lewis, T. V., & Miller, J. L. (2019). Disulfiram-like Reaction With Metronidazole: An Unsuspected Culprit. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 24(5), 445–449. https://doi.org/10.5863/1551-6776-24.5.445
- University of Maryland School of Medicine. (2008, August 7). Disulfiram-like reactions. https://umem.org/educational_pearls/487/
- U.S. Food and Drug Administration. (n.d.) Metronidazole Tablets USP. Retrieved February 2, 2023, fromhttps://www.accessdata.fda.gov/spl/data/0ac46539-9e00-4797-8ff8-8f43f07b34ad/0ac46539-9e00-4797-8ff8-8f43f07b34ad.xml
- National Center for Biotechnology Information (2023). Metronidazole (Compound). Retrieved February 2, 2023, from https://pubchem.ncbi.nlm.nih.gov/compound/Metronidazole.
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