Flagyl + Alcohol causes a Disulfiram-like reaction.. Is it a myth?

My name is URL

I was prescribed Flagyl (400mg x 3 daily) last Wednesday for a minor gum infection. Last night I was at a friend's going away party and perhaps stupidly made the decision to have a drink. I had 4 pints of stout in total and suffered no ill effects whatsoever. I felt perfectly fine then and had no hangover this morning either. I only weigh 70 Kilos so it's not as if I'm built to handle it.

This really surprises me actually, considering the grave warnings that docs & pharmacists give to people when dispensing the drug. I expected to at least feel a bit ropey if not nauseous.

Of course I am not, and would not recommend that anyone else does this, and know full well that I was an idiot to do so.

After some searching today I found this - http://onthepharm.net/2007/08/flagyl-alcohol-reaction.html

What's your opinion on this? Is the risk of combining alcohol with metronidazole overplayed, or was I just lucky? Is it possible that some conflation exists here? I mean Flagyl can be a harsh drug and have many nasty side effects before alcohol is even brought into the equation.

Dr Galen

I can see why this thread was closed, but I'm going to reopen it, on the strict instruction, that it's for a discussion around the theory and evidence on the topic at hand. I do think that we should be examining the "accepted notions" that exist in Healthcare, and always be looking at the evidence for choices.

Anything that strays from this, into the territory of Medical Advice or similar is going to earn a ban.

bleg

From what I remember the only reason that the warning was included was because metronidazole and disulfuram had a similar chemical structure and thus were presumed to have the same effect on the enzyme.

anotherlostie

It's a lot more than a presumption. I twice remember old dears calling the pharmacy I worked in feeling deeply unwell after starting a course of Flagyl and going home and having a swift gin to help numb the pain.

Perhaps, and purely speculative here, there is a genetic component to the disulfiram reaction and the OP avoids it.

I do think it is important to highlight to anyone reading this thread and taking Flagyl not to go away with the impression that a few pints will have no effect on them if they take it - it most likely will and the OP was lucky (and a little reckless if he knew the risk IMHO), and I'm glad the topic was reopened to be able to make that point.

palmcut

A paper published in the American journal of forensic Medicine in1996 by Russell, Cina and Conradi quotes a fatality due to the metronidazole/alcohol interaction.

Stockley's drug Interactions claims that this interaction is well studied but remains controversial. It appears that the interaction either does happen or does not happen. Some people can be fortunate and not experience any interaction.
The manufacturer recommends avoidance of alcohol when metronidazole is taken, and for at least 48 hours after it has been stopped.

It is impossible to know beforehand if a patient is going to experience the interaction. For these reasons most GPs and Pharmacists recommend that the patient does not take alcohol whilst taking Metronidazole.

Nonoperational

It's a funny one... It's taken as red but I've never heard first hand of someone suffering it. I had a few drinks on metronidazole before with no ill effects.