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Alcohol and Medications

Can You Drink on Metronidazole?

April 27, 2024
18 min read
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A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
April 27, 2024
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
April 27, 2024
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
April 27, 2024
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Reframe Content Team
April 27, 2024
18 min read

Alcohol and Metronidazole: Separating Facts From Myths

  • Metronidazole (Flagyl) is an antibacterial medication prescribed to treat abdominal infections, vaginosis, and respiratory infections, among many others. It comes in internal and topical forms.
  • Avoid drinking alcohol while taking metronidazole. Instead, nourish your body with plenty of water and vitamin-rich foods to help it heal more quickly. 
  • If going without alcohol for a while seems impossible, Reframe can help by empowering you with science-backed knowledge, tools, and motivation to reframe your relationship with alcohol.

It’s a common story: you go to a doctor, walk away with a prescription for your condition, then drive to your local pharmacy to pick it up. You’re excited, thinking how much better you’ll feel soon. You take it out of the crinkly paper bag, tear off what seems like an entire stack of papers with information in tiny print stapled onto it, and glance at it before tossing it into the recycling bin. Then something on the orange bottle catches your eye — that little wine glass with a line across it: “Don’t consume with alcohol!”

Yikes. It’s too late to get all those papers back to find out why, so you take your questions to Google: “Can you drink on metronidazole?” It’s probably not that bad, right? What’s all this about the disulfiram-like reaction between metronidazole and booze? Before you give yourself a panic attack searching for things like “Can metronidazole and alcohol kill you?” let’s get the facts straight. What exactly happens if you accidentally drink alcohol while taking metronidazole?

What Is Metronidazole?

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According to the National Library of Medicine, metronidazole (better known by the brand name Flagyl) is one of the go-to drugs for the treatment of infections. It’s equipped to handle several conditions: 

  • Intestinal amebiases
  • Liver amebiasis
  • Bacterial septicemia
  • Bone and joint infections
  • Meningitis
  • Brain abscess
  • Endocarditis
  • Endometritis
  • Bacterial vaginosis
  • Intra-abdominal infections
  • Lower respiratory tract infections
  • Skin structure infections
  • Surgical prophylaxis colorectal surgeries

That’s quite a long job description! And there’s even more. Topical metronidazole can treat a few gnarly infections, such as rosacea and bacterial vaginosis. Plus, it has several off-label uses: 

  • Bite wound infections from animals
  • Infections from human bites (eek!)
  • Clostridioides (formerly Clostridium difficile)
  • Crohn’s disease
  • Postsurgical resection management
  • Giardiasis
  • Periodontitis
  • Tetanus

How Does Metronidazole Work?

Flagyl works by attacking bacterial DNA through a four-step process. Here’s the gist:

  1. Breaking the barrier and taking out the anaerobes. Metronidazole breaks through the cell barriers of anaerobic and aerobic bacteria but only kills the first type of pathogen.
  2. Upgrading equipment. With the anaerobes out of the way, it’s time to attack the second enemy! However, this requires different equipment. Metronidazole undergoes reductive activation by special proteins, which change its chemical structure to allow it to torpedo the aerobes.
  3. Storming the command center. The next step? Destroying the “enemy’s” DNA. Metronidazole interacts with the host cells’ DNA, resulting in breakage and “fatal destabilization.”
  4. Cleaning up the mess. Final step? Breaking down the toxic byproducts of the reaction.

While metronidazole is quickly absorbed, it might take a couple of days to start feeling better. However, once it gets going, the medication does a powerful job of clearing out the infection.

Can You Drink on Metronidazole?

In general, Flagyl doesn’t mix well with other substances, including alcohol. This isn’t all that surprising — for one thing, alcohol tends to intensify the side effects of many medications. In the case of metronidazole, there are quite a few:

  • Headaches. Many people on metronidazole experience headaches. Since alcohol is known for causing the notorious “cocktail headaches,” adding it to the mix isn’t doing us any favors.
  • Digestive disruption. Some have gastrointestinal effects, including loss of appetite, nausea and vomiting, diarrhea, heartburn, or cramping in the stomach area, and constipation while taking metronidazole. Alcohol can disrupt digestion, causing nausea, heartburn, and even leading to gastritis. Needless to say, this makes for a potentially stomach-turning combo!
  • Metallic taste. Metronidazole might also cause a metallic taste in our mouth — so whatever we’re drinking might not taste that great.

In addition to these common side effects, there are some potentially serious (but rare) side effects of metronidazole that don’t mix well with booze: 

  • Seizures. The potentially serious side effects of metronidazole include seizures. In large amounts, alcohol has been known to induce seizures as well (as does alcohol withdrawal), so combining the two could be even more dangerous. It’s important to stay vigilant and be aware of telltale symptoms such as unusual behaviors or sensations, uncontrollable movements, or, in severe cases, loss of consciousness.
  • Cancer risk. As the warning label on metronidazole says, it may also be carcinogenic based on animal studies. Given that alcohol is a known carcinogen as well, the combo isn’t great.
  • Possible brain damage. If used for a long time, metronidazole could be neurotoxic. Knowing what alcohol does to our brain, the mixture of the two could cause serious trouble.
Staying Safe When Drinking on Metronidazole

Metronidazole and Alcohol: What Else Is Behind the Warning?

If you’re taking disulfiram — a medication used to treat alcohol use disorder (AUD) — there’s yet another reason to pause and reconsider before taking metronidazole.

Disulfiram works by causing extremely unpleasant side effects, such as facial flushing, nausea, and cardiovascular abnormalities. The idea is that taking disulfiram will make drinking so unenjoyable we won’t want to do it anymore. (For more details, check out our blog “How Does Disulfiram Work?”)

What does any of this have to do with Flagyl? As it turns out, metronidazole has a negative, and potentially dangerous, interaction with both alcohol and disulfiram.

Let’s look at both effects in a bit more detail:

  1. Metronidazole is thought to induce a “disulfiram-like” reaction when mixed with alcohol. When we combine alcohol with metronidazole, we might experience nausea, vomiting, stomach cramps, headaches, and facial flushing. According to a recent study, it doesn’t make much to trigger the reaction!
  2. Metronidazole also doesn't mix well with disulfiram. Taking both medications puts us at risk of hallucinations and psychosis (definitely not what we want, especially when we’re already not feeling our best!).

Negative Interactions Between Metronidazole and Alcohol: Myth or Science?

Some scientists now think that the side effects of mixing metronidazole and alcohol are a myth. 

According to an Emergency Medical News article, doctors have been warning patients against mixing the two for years to avoid a “disulfiram-like reaction.” And yet, the author asks:

“If this interaction is so important, where were the cases? Millions of prescriptions for metronidazole are written each year. Despite clear warnings, it's inevitable that a significant number of patients would continue to consume alcohol with the drug. Yet I've never seen a patient come in with a disulfiram-like reaction from that combination. Is the metronidazole-ethanol drug interaction really a thing?”

The author goes on to explain how the accumulation of acetaldehyde is responsible for the disulfiram reaction and how the “original thinking” was that metronidazole also blocked its breakdown. However, as he points out, recent evidence shows that this might not be the case. When 18 patients who were on metronidazole were compared with a control group who had a similar blood alcohol concentration, none seemed to show any signs of a disulfiram-like reaction. 

Likewise, a study in WMJ set out to investigate whether or not there was any truth to the disulfiram-like reaction claims and found that the answer isn’t as clear as scientists once thought. Their findings suggest that there’s no increase in acetaldehyde when both substances are present in our system.

How Long After Taking Metronidazole Can I Drink Alcohol?

Still, disulfiram-like reaction or not, metronidazole does interact with alcohol in potentially problematic ways, so the recommended wait period is at least two weeks for disulfiram and three days for alcohol after taking it. 

What If I Already Had a Drink?

Some of us might be thinking, “Oh no! What if I already had a drink before that warning label on the medicine package caught my eye?”

First of all, don’t panic. This probably happens quite often, and usually leads to no harmful effects, according to the Emergency Medical News study. However, it’s good to keep in mind that this is just one study arguing against the negative effects, and even if the “metronidazole and alcohol myth” is responsible for the alcohol warning, there are still other reasons why Flagyl and alcohol are not a good mix.

So, can metronidazole and alcohol kill you? It almost certainly won’t, especially given the evidence that there might not be a disulfiram-like reaction at play after all. 

Still, it’s best to stay vigilant and avoid mixing metronidazole and alcohol. And if there’s any doubt in your mind at all that you’re having a dangerous reaction, please don’t hesitate to call your doctor immediately! There are many individual factors at play here, so erring on the side of safety is key.

Tips To Stay Safe

So, how can we stay safe while taking metronidazole as we’re trying to stay away from booze for the time being (or, perhaps, for even longer)? Here are a few ideas:

  1. Avoid the mix. Mixing alcohol and metronidazole is asking for trouble. Instead, focus on healing and nourishing your body with plenty of water and vitamin-rich foods. You’ll heal faster and your body will thank you!
  2. Follow your doctor’s advice. Always follow your physician’s advice about taking medications, and don’t hesitate to ask if you have questions. They’re there to help!
  3. Get support. If you’re having trouble staying booze-free, find like-minded people who will be happy to support you. They can be friends, family members, or others just like you who are already part of the Reframe community! Everyone’s alcohol journey is different, so whatever your goals are, you’re bound to find helpful advice and support.
  4. Get sober curious. Use this time as an opportunity to explore a sober-curious lifestyle. Approach it as an experiment — what if instead of having a glass of wine with dinner you had a fun mocktail instead? Who knows, you might find a new favorite! Plus, a hydrating, nutritious drink is bound to make you feel better as you heal.

Summing Up

In the end, as with any situation that compels us to set alcohol aside for a bit, it’s always best to see the situation as an opportunity. Perhaps it’s even a blessing in disguise! Who knows, by going booze-free for a few days or weeks, you might discover new activities you love or find that you enjoy waking up feeling refreshed. Maybe your skin looks better or maybe you’ve even dropped some weight. All in all, you might see that cutting back is something you want to continue in the long run to see what new benefits are waiting for you (and trust us, there are lots!). If so, Reframe is here to help you and cheer you on every step of the way.

Summary FAQs

1. What is metronidazole, and what infections does it treat?

Metronidazole is an antibiotic and antiprotozoal medication used to treat a wide range of infections. It's effective against anaerobic bacterial infections, protozoal infections, and microaerophilic bacterial infections, among others. 

2. Can you drink on metronidazole?

No, you should not drink alcohol while taking metronidazole. Doing so can intensify side effects, such as headaches, nausea, vomiting, and a metallic taste in the mouth. More seriously, it can cause a disulfiram-like reaction, leading to severe nausea, vomiting, and cardiovascular issues.

3. Is there any truth to the metronidazole and alcohol interaction myth?

Recent studies and articles suggest that the disulfiram-like reaction between metronidazole and alcohol may not be as common or severe as previously thought. Investigations have shown that many patients do not experience significant adverse reactions from mixing the two. However, it’s still best to be careful!

4. How long should I wait to drink alcohol after taking metronidazole?

It's recommended to wait at least three days after finishing your course of metronidazole before drinking.

5. What should I do if I accidentally drink alcohol while taking metronidazole?

If you accidentally drink on metronidazole, don't panic. Most people will not experience severe effects from a single incident. However, monitor yourself for any adverse reactions, such as nausea, vomiting, or severe headaches, and seek medical advice if you're concerned or if symptoms persist. It's always better to err on the side of caution and discuss any concerns with your healthcare provider.

Ready To Meet the Healthiest Version of Yourself? Try Reframe!

Although it isn’t a treatment for alcohol use disorder (AUD), the Reframe app can help you cut back on drinking gradually with the science-backed knowledge to empower you 100% of the way. Our proven program has helped millions of people around the world drink less and live more. And we want to help you get there, too!

The Reframe app equips you with the knowledge and skills you need to not only survive drinking less, but to thrive while you navigate the journey. Our daily research-backed readings teach you the neuroscience of alcohol, and our in-app Toolkit provides the resources and activities you need to navigate each challenge.

You’ll meet millions of fellow Reframers in our 24/7 Forum chat and daily Zoom check-in meetings. Receive encouragement from people worldwide who know exactly what you’re going through! You’ll also have the opportunity to connect with our licensed Reframe coaches for more personalized guidance.

Plus, we’re always introducing new features to optimize your in-app experience. We recently launched our in-app chatbot, Melody, powered by the world’s most powerful AI technology. Melody is here to help as you adjust to a life with less (or no) alcohol. 

And that’s not all! Every month, we launch fun challenges, like Dry/Damp January, Mental Health May, and Outdoorsy June. You won’t want to miss out on the chance to participate alongside fellow Reframers (or solo if that’s more your thing!).

The Reframe app is free for 7 days, so you don’t have anything to lose by trying it. Are you ready to feel empowered and discover life beyond alcohol? Then download our app through the App Store or Google Play today! 

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At Reframe, we do science, not stigma. We base our articles on the latest peer-reviewed research in psychology, neuroscience, and behavioral science. We follow the Reframe Content Creation Guidelines, to ensure that we share accurate and actionable information with our readers. This aids them in making informed decisions on their wellness journey.
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