Drinking on Antibiotics: Can Metronidazole And Alcohol Be Mixed?

Last Updated: April 5, 2021

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

Can one drink while taking antibiotics? Mixing antibiotics and alcohol is an immensely broad topic. Having a glass of wine and necking a couple of Zynox pills can be very different from mixing a few vodka shots with Flagyl. The severity of side effects and symptoms will vary greatly, depending on the amount and type of a drink consumed, and the same goes for different antibiotic classes.

For example, the Metronidazole and alcohol myth has been widespread, with numerous opinions on the possibilities of interaction between both substances. Those with Metronidazole and alcohol experience have played their part in providing extensive information on the occurrence of such interactions. Others have asked recurrently, why can’t one drink alcohol with Metronidazole?

Drinking liquor on Flagyl may happen with or without one’s knowledge. While some accidentally drank ethanol while taking Metronidazole, others may have taken substances that contained significant amounts of ethanol, such as cough medications and others. So, what happens if one drinks ethanol while taking Metronidazole or other antibiotics?

The Truth About the Antibiotics and Alcohol Interaction

According to the healthcare experts at the Columbia University in New York, a person who had consumed negligible amounts of alcohol while under the influence of antibiotics might not experience any harmful effects on their bodies. This, of course, does not deter the severity of this potentially deadly combination. Drinking impairs the body’s self-healing ability by depriving it of its water and tiring it out. Drinking may not make the medications ineffective, but it slows down the recovery process.

Alcohol and most antibiotics have similar side effects, including dizziness, drowsiness, and upset stomach. These side effects are intensified when alcohol and antibiotics are taken together.

It is quite a simple affair. Most antibiotics affect the central nervous system (CNS) and lead to side effects like drowsiness, dizziness, sedation, or confusion. ethanol is also a CNS depressant. When taken with antibiotics, the side effects intensify. This combination, therefore, is dangerous enough on its own, not to mention when one is driving or is within the sensitive age groups.

Most alcoholic content in the liver is broken down by an enzyme alcohol dehydrogenase (ADH). If one drinks copious amounts of alcohol—an intoxicating volume—with the antibiotic, ADH may be inhibited. This means neither the alcohol nor the drug can be broken down efficiently and excreted from the body. The build-up can raise the ethanol level in the blood to dangerous proportions and increase the possibility of drug toxicity.

On the other hand, if a person has severe drinking problems, the same enzyme in their liver has already been hindered. Such individuals are then at an increased risk of damaging their organism, which has decreased self-healing properties.

Glass of whisky and antibiotic pills.

What Antibiotics Should Not Be Mixed With Alcohol?

The National Institute on Alcohol Abuse and Alcoholism lists the antibiotics known to cause adverse side effects when taken with a drink.

There is a vast amount of antibiotics available on the market, each targeting a specific health condition. Metronidazole (Flagyl) is typically prescribed for dental or vaginal infections and to treat leg ulcers or pressure sores. Tinidazole (Tindamax) performs many of the same functions as Metronidazole and, additionally, is prescribed to treat certain gut bacterial infections. Cefotetan is usually prescribed for infections of the lungs, gut, bones, joints, blood, urinary tract, and skin. These antibiotics react with alcohol to produce side effects like severe abdominal cramps, nausea, headache, vomiting, facial flushing, chest pain, and rapid heart rate.

These symptoms are similar to the side effects of a drug called Disulfiram, which is used to treat alcohol dependency. When on Disulfiram, the counter effectiveness is so strong that even one drink is enough to trigger these unpleasant effects. It is crucial to dissuade alcoholics from drinking more after they have experienced these symptoms.

Taking antibiotics while drinking carries aggravated risks if the person is a chronic alcoholic. Drugs such as Rifampin, Pyrazinamide, and Voriconazole can increase the risk of liver damage in chronic alcoholics, while Didanosine may raise the risk of developing pancreatitis in such people. These drugs should either be avoided or prescribed with caution for alcoholics or people who have been drinking daily. The doctor needs to know if a patient is not an alcoholic to prescribe a safe dosage and prevent dangerous reactions from occurring.

Individuals are urged not to drink while taking Metronidazole, Tinidazole, and Cefotetan, ideally abstaining from drinking in the 72-hour window following the last dose.

The Following Antibiotics Should Never Be Taken While Drinking:

  • Metronidazole
  • Tinidazole
  • Isoniazid
  • Ethionamide
  • Cycloserine
  • Cefotetan
  • Thalidomide

Drinking on antibiotics is never a good idea. Medications such as Cycloserine and Ethionamide can cause CNS toxicity and increase the risk of seizures and psychosis. Taken with alcohol, Thalidomide too depresses the CNS and can suppress motor abilities. Isoniazid can seriously deter health in people who chronically abuse the substance and can skyrocket their risk of liver damage.

Man having severe headache.

Mixing Metronidazole And Alcohol – Is It Safe?

Alcohol makes a person easily susceptible to seizures, especially those with high alcohol tolerance, while Flagyl on its own can cause seizures. Hence, individuals who may have a genetic history of seizures may be at risk of combining Flagyl and ethanol. Metronidazole gel and alcohol may have different reactions due to differences in the route of exposure.

Drinking liquor on Metronidazole may cause a reaction due to the mechanisms of action of both substances. Ethanol is metabolized down into a compound known as acetaldehyde.

It is toxic and causes adverse effects in the system. Acetaldehyde is further broken down into Acetate by an enzyme called acetaldehyde dehydrogenase. The metronidazole alcohol mixture introduces the drug into the reaction where the drug blocks the effects of the enzyme. As a result, Metronidazole stops the breakdown of the toxic acetaldehyde. When the poisonous compound builds up in the system, it can lead to various health risks.

One of the common dangers of alcohol and Flagyl is the disulfiram-like reaction. This is a side effect of Disulfiram mixed with ethanol which results in various health conditions such as:

  • Face flushes
  • Headaches
  • Nausea
  • Low blood pressure
  • Vomiting
  • Palpitations
  • Sweating

A case was reported in 1996, where a sudden death was recorded. The death was traced to the Metronidazole ethanol reaction. The interaction was said to be caused by the accumulation of cardiotoxic, hepatotoxic, and arrhythmogenic substances in the body due to the presence of blockers in the metabolism of ethanol.

Another research reported by the WHO on in-vitro studies utilizing animal models revealed that no convincing evidence was found as to the possibilities of Metronidazole and alcohol interaction. It was explained that the history of Flagyl and alcohol reaction might have been strictly from the excessiveness of ethanol and its side effects.

Antidipsotropic Properties of Metronidazole

The category of drugs known as antidipsotropic are medications administered to help an alcoholic abstain from drinking. When taken with ethanol, the combination creates very unpleasant interactions, which can help individuals with chronic drinking problems to quit.

Does Flagyl have antidipsotropic properties? Yes, it does. The Flagyl-alcohol interaction may cause antidipsotropic effects such as increased heart rate, nausea, vomiting, and other side effects.

However, only a medical professional shall decide upon the ways to treat alcoholism. Do not self-medicate with Metronidazole or any other medications – ask a doctor or addiction specialist from a drug rehab first.

Metronidazole with alcohol may present with numerous health conditions due to toxicity. Talk to a medical professional about the medication and the risks of reaction with ethanol, as well as to get additional information on alcohol. In cases where both substances are erroneously taken together, consult a doctor immediately.

How Long After Metronidazole One Can Drink Alcohol?

To avoid Metronidazole-alcohol interaction, it is best to ensure that the system is clear of one of both substances before taking the other. So, how long after taking Metronidazole, can one drink liquor?

During the Metronidazole and alcohol reaction, Flagyl may continue to inhibit the activities of the enzyme aldehyde dehydrogenase for up to 3 days after the individual had stopped the medication. This suggests that one may need to stay off ethanol for three days after the last dose. The metronidazole-alcohol 24-hour mark is typical for creams. When using Metronidazole cream and alcohol, it is recommended to avoid drinking for at least 24 hours before considering taking the medication.

Individuals with a high tolerance for ethanol will need to wait a bit longer than average to ensure that alcohol deposits are entirely broken down before indulging in the medication.

Doctor showing medical test result .

Why Can’t One Drink Alcohol with Amoxicillin?

Amoxicillin is an antibiotic in the penicillin group used for infections in areas such as the sinuses, ears, skin, and many other bacterial infections. It is also used before dental procedures to prevent certain types of infections from occurring in the first place.

Side Effects of Mixing Amoxicillin With Alcohol Include:

  • Amplified dizziness
  • Reduced effectiveness of the drug
  • Extended treatment duration
  • Boost of bacterial growth in the infected area

Combining ethanol with this medication can also lead to side effects, including shortness of breath, headaches, chest pain, irregular heartbeat, nausea, and vomiting. Due to these associated risks, it is required for the patient to stay away from drinking for at least 72 hours after the medication was taken.

Effects of Combining Alcohol with Doxycycline

Doxycycline is an antibacterial medicine. It targets infections most commonly affecting urinary tract infections, such as Gonorrhea, Chlamydia, eye infections, gum disease, Malaria, Lyme disease, etc. This is an extremely strong medication.

One thing antibiotics and alcoholic drinks have in common is that they both destroy the healthy bacteria in one’s stomach. If taken simultaneously, the effects are even more harmful. Taking Doxycycline and alcohol together can, therefore, cause stomach pain, cramps, diarrhea, and vomiting.

Drinking neutralizes the effects of many medicine types on the market. Drinking while on Doxycycline is no exception. However, this counterproductive combination can never be precisely predicted as it’s difficult to determine what a safe amount of alcohol is. No two people have the same reaction to alcohol.

Some of the Factors that Play Into One’s Alcohol Retention Are:

  • Gender
  • Age
  • Height
  • Weight

It is common advice among health professionals not to drink at all while taking this antibiotic.

Managing Effects of Mixing Antibiotics with Alcohol

Call 911. This is the right action one should take should he or she suspect someone is exhibiting the adverse symptoms of mixing antibiotics with alcohol.

Why can’t one drink alcohol and antibiotics? The common adverse symptoms of antibiotics and alcohol interaction are breathlessness, headache, chest pain, irregular heartbeat, dizziness, and nausea and vomiting. But, not everybody exhibits all the symptoms. The symptoms may also vary in degree from person to person. Also important is how effectively the liver can metabolize the substances.

While it is unlikely that antibiotics and alcohol interactions can lead to death, some symptoms like an irregular heartbeat, breathlessness, nausea, and vomiting call for immediate medical intervention. These symptoms, if left untreated, can be fatal. For instance, an irregular heartbeat can trigger a cardiac arrest, while dehydration caused by vomiting can cause blood pressure to drop to dangerously low levels.

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Page Sources

  1. National Institute on Drug Abuse and Alcoholism, Alcohol's Effects on the Body, https://www.niaaa.nih.gov/alcohols-effects-body
  2. National Institute on Drug Abuse and Alcoholism Harmful Interactions https://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm
  3. Netdoctor, Antabuse (disulfiram), https://www.netdoctor.co.uk/medicines/brain-nervous-system/a6217/antabuse-disulfiram/
  4. BBC, Can you mix antibiotics and alcohol? http://www.bbc.com/future/story/20130917-truth-about-drink-and-antibiotics
  5. Cina, S. J., Russell, R. A., & Conradi, S. E. (1996). Sudden death due to metronidazole/ethanol interaction. The American journal of forensic medicine and pathology, 17(4), 343–346. https://doi.org/10.1097/00000433-199612000-00013
  6. Williams, C. S., & Woodcock, K. R. (2000). Do Ethanol and Metronidazole Interact to Produce a Disulfiram-Like Reaction? Annals of Pharmacotherapy, 34(2), 255–257. https://doi.org/10.1345/aph.19118
  7. Visapää, J. P., Tillonen, J. S., Kaihovaara, P. S., & Salaspuro, M. P. (2002). Lack of disulfiram-like reaction with Metronidazole and ethanol. The Annals of pharmacotherapy, 36(6), 971–974. https://doi.org/10.1345/aph.1A066

Published on: March 9th, 2018

Updated on: April 5th, 2021

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.