From the Guidelines
You should avoid consuming alcohol while taking metronidazole, as this combination can cause a disulfuram-like reaction, and it is recommended to avoid alcohol for the therapeutic duration of metronidazole treatment. According to the study published in Gastroenterology in 2021 1, patients should be advised to consume metronidazole in divided doses with food and to avoid alcohol for the therapeutic duration due to a disulfuram-like reaction. This reaction can cause symptoms such as nausea, vomiting, flushing, headache, abdominal cramps, and rapid heartbeat.
Some key points to consider:
- Metronidazole can interact with alcohol to cause a potentially serious reaction
- The severity of the reaction varies between individuals, and even a few sips of alcohol might result in a milder reaction than larger amounts
- Iron tablets themselves don't typically interact with alcohol, but the combination might worsen stomach upset that either can cause independently
- The interaction between metronidazole and alcohol occurs because the medication inhibits an enzyme called aldehyde dehydrogenase, which is needed to break down alcohol properly
It is essential to follow the guidance of avoiding alcohol while taking metronidazole to minimize the risk of adverse reactions. If you have already consumed alcohol while taking metronidazole, it is crucial to monitor your symptoms and seek medical attention if you experience any severe reactions. The best course of action is to avoid all alcohol, including in foods, mouthwash, and medications, while taking metronidazole and for at least 48-72 hours after your last dose.
From the FDA Drug Label
Alcoholic beverages should be avoided while taking metronidazole tablets and for at least one day afterward. If patients receiving metronidazole drink alcoholic beverages, they may experience abdominal distress, nausea, vomiting, flushing, or headache.
You may not be ok, as consuming alcohol while taking metronidazole can cause adverse reactions such as:
- Abdominal distress
- Nausea
- Vomiting
- Flushing
- Headache It is recommended to avoid alcoholic beverages while taking metronidazole and for at least one day afterward 2, 2.
From the Research
Interaction between Metronidazole and Alcohol
- The interaction between metronidazole and alcohol has been studied extensively, with some studies suggesting a disulfiram-like reaction may occur 3, 4, 5, 6, 7.
- However, most studies have found no convincing evidence of a disulfiram-like interaction between ethanol and metronidazole 3, 4, 7.
- A study published in 2014 found that the warning against simultaneous use of alcohol and metronidazole appears to be based on laboratory experiments and individual case histories, rather than convincing evidence 3.
- Another study published in 2002 found that metronidazole did not raise blood acetaldehyde or have any objective or subjective adverse effects when used together with ethanol 4.
- A case-control study published in 2023 found no significant difference in disulfiram-like effects between patients who received metronidazole and had a detectable ethanol concentration, and a control group matched for age, sex, and ethanol concentration 7.
Disulfiram-like Reaction
- A disulfiram-like reaction is characterized by symptoms such as flushing, nausea, vomiting, and headache, and is typically associated with the use of disulfiram (Antabuse) in combination with alcohol 5, 6.
- Some studies have reported cases of disulfiram-like reactions in patients taking metronidazole and alcohol, but these cases are rare and may be due to other factors 5, 6.
- The majority of studies have found that metronidazole does not cause a disulfiram-like reaction in combination with alcohol 3, 4, 7.
Iron Tablets and Alcohol Interaction
- There is no evidence to suggest that iron tablets interact with alcohol in a way that would increase the risk of adverse effects.
- However, it is generally recommended to avoid consuming alcohol while taking iron supplements, as alcohol can interfere with iron absorption.