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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 is 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)

Like most antibiotics, metronidazole is prescribed for approximately 10 days. Although a user might feel better within a few days, it’s important to follow the prescribed drug information guidelines and finish the entire course or the infection could return. 

Users of metronidazole should not consume alcohol while taking the medication. Mixing Flagyl and alcohol can cause serious side effects such as abdominal cramping, nausea, vomiting, headache, and seizures.

Metronidazole Statistics

5.8

Million

Estimated number of prescriptions for metronidazole in the United States.

$37.47

Average

Total drug cost of metronidazole.

$9.78

Average

Out-of-pocket cost of metronidazole.

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What Will Happen if You Drink Alcohol While Taking Metronidazole?

The adverse effects of metronidazole are unpleasant but relatively mild depending on the amounts of alcohol consumed. They include:

  • Diarrhea
  • Discolored urine
  • Dry mouth
  • Tingling in the hands and feet due to how the mixture affects the central nervous system

Mixing alcohol with metronidazole causes additional side effects, some of which are severe. These include:

  • Reddening or flushing of the face
  • Headaches
  • Abdominal/stomach pain
  • Cramps
  • Nausea and vomiting
  • Sudden blood pressure drop
  • Rapid or irregular heartbeat
  • Liver damage

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. First, it turns the alcohol into acetaldehyde. Acetaldehyde is a toxic compound that causes the undesirable effects of alcohol. Next, 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.

As a result, stomach and digestion-related side effects of metronidazole may be increased by alcohol consumption. Alcohol also can lower your seizure threshold. Because seizures are a side effect of metronidazole, people with a history of seizures should be extra careful to avoid alcohol while taking the medication.

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. It causes unwanted effects when someone drinks alcohol while taking the medication.

There have been reports of people having disulfiram-like reactions when mixing alcohol and metronidazole. This includes:

  • 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 know what sort of adverse effects will occur, it's best for everyone who takes metronidazole to avoid alcohol for the entire duration of the prescription.

SUMMARY

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

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Does alcohol make metronidazole ineffective? 

Yes, alcohol makes metronidazole less effective at healing infections. Even if you do not experience any of the negative side effects associated with mixing the two, you are at risk for not eliminating the problems if you drink alcohol while taking metronidazole.
 
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. He or she can provide medical advice or alternatives for treatment.

Can I drink alcohol 12 or 24 hours after taking metronidazole?

No, not without putting yourself at risk for potential side effects. Metronidazole remains in a person’s system for up to 48 hours after taking the drug. This means you should wait at least that long before consuming alcohol after your last dose of the medication.

When Is It Safe to Drink Again?

Doctors recommend that you should wait at least three days after your last dose of metronidazole before drinking alcohol.

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
  • Heartburn
  • Abdominal/stomach cramping
  • Metallic taste in your mouth

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 as alcohol makes the drug ineffective. If you want to drink, do so at least three days after your last dose of metronidazole. Watch out for symptoms of overdose. Call 911 or get medical help when the symptoms become severe.

What Other Drugs Will Affect Metronidazole?

Metronidazole is known to interfere with a variety of drugs in addition to alcohol. These drug interactions include prescription and over-the-counter medications, as well as nutrition supplements. 

Tell your doctor about your health history or if you are taking any of the following and he or she prescribes metronidazole:

  • Aspirin
  • Benadryl
  • Ibuprofen
  • Mucinex
  • Lyrica
  • Acetaminophen
  • Probiotics
  • Vitamin B12
  • Vitamin C
  • Vitamin D3
  • Antidepressants
  • Hydrocodone
  • Prednisone
  • Warfarin
  • Xanax

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 when used in combination with metronidazole.

Additionally, the use of metronidazole can be problematic for individuals with certain existing health conditions. For example:

Kidney or Liver Disease

Metronidazole, like many medications, is hard on the kidneys and liver and might not be appropriate for patients with kidney or liver disease.

Crohn’s Disease

People with Crohn’s disease have experienced complications while using metronidazole. Your doctor will likely alter the dose or opt for a different antibiotic if this is an issue for you.

Anyone using metronidazole should limit their time outdoors because the drug is known to increase sensitivity to sun exposure. If staying indoors is impossible, make sure you wear sunscreen and protective clothing.

SUMMARY

Take note of medications that may interact with metronidazole. People with kidney disease, liver disease, or Crohn's disease are advised to inform their doctor before taking metronidazole.

Signs of Alcohol Use Disorder

If you have a hard time giving up alcohol for the duration of your metronidazole prescription, you might want to rethink your relationship for alcohol. If you can't go 13 days without alcohol, or you experience alcohol withdrawal symptoms during this time, it may be a sign of an 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. All of your information will remain confidential. They will help you review your options and decide on the best course of action to start your path towards recovery.

Resources

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“Metronidazole: MedlinePlus Drug Information.” Medlineplus.Gov, Nov. 2019, medlineplus.gov/druginfo/meds/a689011.html.

“Metronidazole (Oral Route) Description and Brand Names - Mayo Clinic.” Mayoclinic.Org, 2019, www.mayoclinic.org/drugs-supplements/metronidazole-oral-route/description/drg-20064745.

Harries, D. P., et al. “Metronidazole and Alcohol: Potential Problems.” Scottish Medical Journal, vol. 35, no. 6, Dec. 1990, pp. 179–180, doi:10.1177/003693309003500608. https://journals.sagepub.com/doi/abs/10.1177/003693309003500608?journalCode=scma

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

Steel, B., Wharton, C. Metronidazole and alcohol. Br Dent J 229, 150–151 (2020). https://doi.org/10.1038/s41415-020-2012-x

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

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.

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.

“Metronidazole.” Metronidazole - Drug Usage Statistics, ClinCalc DrugStats Database, 2018, clincalc.com/DrugStats/Drugs/Metronidazole.

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