Drinking and taking metronidazole, am I doomed?

I had been warned not to drink alcohol whilst taking the above antibiotic, however tonight I completely forgot and had 1 glass of G&T. I don’t normally drink much as it is !

Am I going to die? It’s been about 1hr since I drank it and no ill effects yet.

When will the severe flushing, dizziness, nausea & vomiting, irregular heartbeat, headaches, breathlessness all start ???

I’m no doctor, but I’d guess drinking to any extent could lessen the effect of the antibiotics. I doubt a cheeky drink would make any difference.

Also it will give you AIDS! The really bad kind.. Arse AIDS!

The interaction between metronidazole and alcohol “probably” exists but is generally mild or even unnoticeable

Yes, you may feel a bit flushed, maybe a bit sick and just possibly your heart might flutter as though you’d just seen your birthday present being unloaded in a big box from a bikeshop van

but probably nowt, especially if it was a single pub measure of gin

Edit:

Here we go, one I nicked from an online textbook (4 years) earlier

(IMO, it’s so well known among health care workers that we get quite a lot of confirmation bias and again IMO, probably only really see it in folk who’ve had a proper skinful – that said, note at least 1 fatality has been attributed to it)

A man who had been in a drunken stupor for 3 days was given two “metronidazole” tablets (a total of 500 mg) one hour apart by his wife in the belief that they might sober him up. Twenty minutes after the first tablet he was awake and complaining that he had been given disulfiram (which he had taken some months before). Immediately after the second tablet, he took another drink and developed a classic disulfiram-like reaction with flushing of the face and neck, nausea and epigastric discomfort. 1 Other individual cases have been reported, 2 including a reaction with a “metronidazole” vaginal insert. 3

In a test of the value of “metronidazole” 250 mg twice daily as a possible drink-deterrent, all 10 alcoholic patients studied experienced some disulfiram-like reactions of varying intensity (facial flushing, headaches, sensation of heat, fall in blood pressure, vomiting) when given alcohol. 4 In another study in 60 alcoholic patients, given “metronidazole” 250 to 750 mg daily, most developed mild to moderate disulfiram-like reactions during an alcohol tolerance test. 5 A lower incidence of this reaction, between 2 and 24%, has also been reported. 6-8

Pharmaceutical preparations containing alcohol have also been implicated. A 2-year-old child became flushed and dyspnoeic when “metronidazole” was given with both Stopayne syrup (an analgesic/sedative combination) and a phenobarbital syrup, both of which contained alcohol. 9 Another reaction has been seen in a patient receiving intravenous “metronidazole” and a co-trimoxazole preparation containing alcohol 10%. 10 A further patient who had just finished a 7-day course of “metronidazole” developed severe, prolonged nausea and vomiting postpartum: she had received a single 800-mg dose of prophylactic clindamycin intravenously before the birth and it was thought that the benzyl alcohol present in the clindamycin preparation could have caused the reaction. However, other factors such as intrathecal anaesthesia may have also contributed to the adverse effects. 11 For mention of other preparations containing alcohol, see ‘Alcohol + Disulfiram’.

An interaction has also been reported in association with metabolic acidosis in an intoxicated man 4 hours after he was given intravenous “metronidazole” as prophylaxis following injury. 12 A fatality occurred in a frail 31-year old woman, which was attributed to cardiac arrhythmias caused by acetaldehyde toxicity resulting from the interaction between alcohol and “metronidazole”, linked to autonomic distress caused by a physical assault. 13 Alcohol is also said to taste unpleasant 1,4 or to be less pleasurable 8 while taking “metronidazole”. Some drug abusers apparently exploit the reaction for ‘kicks’. 14

In contrast, a study in 207 patients with inflammatory bowel disease, assessed using a phone survey, the presence of adverse reactions to alcohol in patients taking chronic “metronidazole” and/or mercaptopurine or neither drug; all of the patients consumed less than 4 alcoholic beverages per day. There was a trend towards more adverse effects in both the “metronidazole” and mercaptopurine study groups, but no statistically significant interaction between alcohol and “metronidazole” was found. 15 There are other reports, including two well-controlled studies, showing that “metronidazole” has no disulfiram-like effects. 16-18
Mechanism

Not understood. In the disulfiram reaction, the accumulation of acetaldehyde appears to be responsible for most of the symptoms, see Mechanism, under ‘Alcohol + Disulfiram’. Some workers have reported an increase in acetaldehyde levels due to the interaction between “metronidazole” and alcohol, 13 but others have reported no effect 18 or a reduction in plasma acetaldehyde levels. 19 Furthermore, some studies with “metronidazole” indicate a lack of a disulfiram-like reaction, 16,17 and it has been suggested that if such a reaction does occur it may be by a mechanism other than the inhibition of hepatic acetaldehyde dehydrogenase. 18 It appears that “metronidazole”, like disulfiram, can inhibit other enzymes related to alcohol metabolism including xanthine oxidase and alcohol dehydrogenase. 20,21 Inhibition of xanthine oxidase may cause noradrenaline excess, and inhibition of alcohol dehydrogenase can lead to activation of microsomal enzyme oxidative pathways that generate ketones and lactate, which could produce acidosis. 12

Mattyfez. Neither correct nor funny. Tell me your line of work and we can make some guesses about that. 🙂

Metronidazole is the only commonly used antibiotic we warn about. There is a rather nasty interaction that some people get with it and alcohol. But not all, and only some severe. Google is your friend. However if you are ill in a way which needs other antibiotics, getting bladdered probably isn’t a brilliant idea anyway.

I believe FD has some medical connections, might be wrong. Let’s see what happens. 😉