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Metronidazole & Alcohol

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What is Metronidazole (Flagyl)?

Metronidazole, also known by its brand name Flagyl, is an FDA-approved antibiotic and antiprotozoal drug. 

It’s used to treat various bacterial infections, especially those that affect the:

  • Gastrointestinal system
  • Stomach or intestines
  • Respiratory tract
  • Skin
  • Brain
  • Heart
  • Liver
  • Reproductive system and vagina, specifically bacterial vaginosis (not yeast infections)

Metronidazole is typically prescribed for approximately 10 days

Although a person might feel better within a few days of starting metronidazole, it’s important to finish the entire course of medication or the infection could return. 

The most serious adverse effects reported for metronidazole are encephalopathy, seizures, and tingling of the hands and feet. Other side effects are usually mild and include:

  • Metallic taste
  • Discolored urine
  • Diarrhea

People taking metronidazole should not consume alcohol during treatment. 

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What Happens When You Drink Alcohol While Taking Metronidazole?

Mixing Flagyl and alcohol can cause unpleasant side effects such as:

  • Reddening or flushing of the face
  • Headaches
  • Abdominal/stomach pain
  • Cramps
  • Nausea and vomiting

Summary

Metronidazole is an antibiotic and antiprotozoal medication used to treat bacterial infections. Drinking alcohol while taking metronidazole results in unpleasant side effects that may range from mild to severe. It is highly recommended not to mix alcohol and metronidazole together.

Risks of Mixing Metronidazole and Alcohol 

After you consume alcohol, your body begins breaking it down by turning the alcohol into acetaldehyde

Acetaldehyde is a toxic compound that causes the undesirable effects of alcohol. The body uses an enzyme called aldehyde dehydrogenase to reduce acetaldehyde to acetate. Metronidazole stops this enzyme from working.

This means that someone taking Flagyl cannot metabolize alcohol properly. Acetaldehyde stays in their bloodstream, causing a toxic buildup.

This may be a cause of the disulfiram-like reaction that some scientists have observed. Disulfiram is a medication used to treat alcohol use disorder. 

Unwanted effects occur when alcohol is combined with disulfiram, which discourages drinking. 

There have been reports of people experiencing disulfiram-like reactions when mixing alcohol and metronidazole. These effects include:

  • Nausea and vomiting
  • Headaches
  • Facial flushing
  • Rapid heartbeat
  • Low blood pressure

It should be mentioned that this disulfiram-like reaction has not been proven to be a scientific fact. Severe reactions may be a result of alcohol use, metronidazole use, the combination, or other unknown factors.

The effects of mixing Flagyl and alcohol seem to vary greatly from person to person. 

Since there is no way to predict how a person will respond, it’s recommended to avoid alcohol for the duration of treatment and for 3 days following the last dose of oral medication. 

For topical metronidazole, alcohol should be avoided for 24 hours after the last application.

Summary

Metronidazole prevents the body from properly metabolizing alcohol. This results in the buildup of a toxic compound called acetaldehyde which may cause a disulfiram-like reaction. To prevent this from happening, do not mix alcohol and metronidazole.

Does alcohol make metronidazole ineffective? 

While alcohol may not impact the therapeutic effectiveness of metronidazole, the combination may lead to significant unwanted effects.

Make sure you speak to your healthcare provider about your concerns if you are prescribed metronidazole and do not believe you can abstain from alcohol use during the entire length of the antibiotic course. They can provide medical advice or alternatives for treatment.

Can I drink alcohol 12 hours after taking metronidazole?

No, not without putting yourself at risk for potential side effects.

Metronidazole remains in a person’s system for a period of time after taking the last dose of medication. This means you should wait at least 3 days before consuming alcohol after your course of treatment is complete. 

When is it Safe to Drink Again?

Doctors recommend waiting at least 3 days after your last dose of metronidazole before drinking alcohol.

For topical metronidazole, alcohol should be avoided for 24 hours after the last application.

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Can You Overdose on Metronidazole?

Yes, it is possible to take too much metronidazole and overdose. Symptoms of overdose include:

  • Nausea or vomiting
  • Loss of appetite
  • Headaches
  • Problems with muscle coordination
  • Pain, burning, tingling, or numbness in the hands or feet
  • Seizures
  • Diarrhea

If you or someone you know thinks they may have taken too much metronidazole, call your doctor or the American Association of Poison Control Centers (1-800-222-1222).

If your symptoms are severe, call 911 or head to your nearest emergency room for immediate care.

Summary

Do not take metronidazole with alcohol. If you want to drink, do so at least 3 days after your last dose. Get medical help if side effects become severe.

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What Other Drugs Interact With Metronidazole?

In addition to alcohol, metronidazole may interact with other prescription and over-the-counter medications, as well as nutrition supplements. 

It is important to tell your doctor about your health and medication history before taking metronidazole. Medications that may interact with metronidazole include:

  • Disulfiram
  • Warfarin
  • Lithium
  • Busulfan

Metronidazole boosts the efficiency of blood-thinning medications, which can increase someone’s risk for abnormal bleeding. 

In many cases, doctors will reduce the dose of a patient’s usual blood-thinning medication, such as warfarin, when used in combination with metronidazole.

Metronidazole can increase sensitivity to the sun. It is important to limit sun exposure by using sunscreen, wearing hats, and protective clothing.

Summary

Take note of medications that may interact with metronidazole. Tell your doctor about your health and medication history beforehand.

Signs of Alcohol Use Disorder

Having difficulty giving up alcohol for the duration of metronidazole treatment, or experiencing alcohol withdrawal symptoms during this time, might be a sign of alcohol use disorder.

Other symptoms of an alcohol use disorder include:

  • Drinking more or for longer than was intended
  • Unsuccessful attempts to cut down or stop alcohol use
  • Spending a lot of time obtaining, using, or recovering from alcohol consumption
  • Cravings for alcohol
  • Failure to fulfill responsibilities at work, school, or home due to drinking alcohol
  • Continuing to drink despite having social problems caused by the effects of alcohol
  • Important social, work, or recreational activities are stopped or reduced because of alcohol use
  • Drinking in physically dangerous situations
  • Continuing to drink even though it is known to have negative effects on your health
  • Developing a tolerance to alcohol
  • Having withdrawal symptoms after stopping alcohol use

If you or a loved one is struggling with alcohol addiction, help is nearby.

Reach out to an addiction specialist to talk about your options. Your information will remain confidential. They’ll review your options and decide on the best course of action toward recovery.

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Updated on March 25, 2022
9 sources cited
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  2. Metronidazole. labeling.pfizer.com. http://labeling.pfizer.com/ShowLabeling.aspx?id=4524#b3f082bd-cbf3-4372-b843-fb6db4ef0454
  3. “Metronidazole: MedlinePlus Drug Information.” Medlineplus.Gov, Nov. 2019, medlineplus.gov/druginfo/meds/a689011.html.
  4. “Metronidazole (Oral Route) Description and Brand Names - Mayo Clinic.” Mayoclinic.Org, 2019, www.mayoclinic.org/drugs-supplements/metronidazole-oral-route/description/drg-20064745.
  5. Williams, Caroline S., and Kevin R. Woodcock. “Do Ethanol and Metronidazole Interact to Produce a Disulfiram-Like Reaction?” Annals of Pharmacotherapy, vol. 34, no. 2, Feb. 2000, pp. 255–257, doi:10.1345/aph.19118. https://journals.sagepub.com/doi/abs/10.1345/aph.19118
  6. Steel, B., Wharton, C. Metronidazole and alcohol. Br Dent J 229, 150–151 . https://doi.org/10.1038/s41415-020-2012-x
  7. Visapää, Jukka-Pekka, et al. “Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol.” Annals of Pharmacotherapy, vol. 36, no. 6, June 2002, pp. 971–974, doi:10.1345/aph.1A066. https://journals.sagepub.com/doi/abs/10.1345/aph.1a066
  8. Giannini, A J, and D T DeFrance. “Metronidazole and Alcohol--Potential for Combinative Abuse.” Journal of Toxicology. Clinical Toxicology, U.S. National Library of Medicine, July 1983, www.ncbi.nlm.nih.gov/pubmed/6668631.
  9. Wilson, C. W. M., et al. “The Effect of Metronidazole on the Human Taste Threshold to Alcohol.” Wiley Online Library, John Wiley & Sons, Ltd, 24 Jan. 2006, onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1973.tb01230.x.

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