metronidazole for an awful infection in my tooth

[Mezzo]

i took my first dose of metronidazole about 5 hours ago... doyou think i'd know by now if i was going to react really badly to it? i feel OK?

please no horror stories about this antibiotic i'm already very worried

[nomorepanic]

You would have reacted within 30 mins at the most.

Just avoid alcohol completely.

[Mezzo]

thanks! yes that's the plan - have got alcohol free mouthwash even

[hanshan]

There is actually NO solid evidence for a strong adverse reaction between metronidazole and alcohol:

http://aop.sagepub.com/content/36/6/971.abstract

I would put it down as the pharmaceutical equivalent of an urban myth.

[Mezzo]

that's interesting hanshan! regardless i don't drink though so not much of a problem

[MyNameIsTerry]

I won't post in the interaction info just in case but there is conflicting data because some studies have shown no reaction. However, Drugs.com have it as a Moderate interaction and recommend the following to medical professionals:

MANAGEMENT: Because clear evidence is lacking concerning the safety of ethanol use during nitroimidazole therapy, patients should be apprised of the potential for interaction and instructed to avoid alcoholic beverages and products containing alcohol or propylene glycol while using oral, intravenous, or vaginal preparations of a nitroimidazole. Alcoholic beverages should not be consumed for at least one day after completion of metronidazole therapy and for 3 days after completion of tinidazole therapy.

That puts it on the same level as many antidepressants and alcohol, which doctors are often fine with. But it's a different type of interaction and rather than recommend limiting or avoiding, they give specific advice to avoid.

[nomorepanic]

I know otherwise and of other people that have thought it would be ok and it really wasn't.

It is also prescribed to alcoholics as it makes people really sick so it is to try and deter them from drinking.

[Beachlady]

My dog is currently on that med, true story. And he’s just fine. :)

[hanshan]

The report above is a double-blind scientific study, as opposed to hearsay and anecdotal reports.

If you look carefully at the reported evidence for a negative alcohol-metronidazole reaction, there is not one actual drug trial. There are ten single case reports (ie ten people), and those people had multiple reasons for feeling sick, eg their infection was severe or they overdosed on alcohol.

It's just an old story from the days before we had the kind of testing available today. But metronidazole doesn't get scientifically tested in a drug trial because it's an old drug, and drug trials are time-consuming and expensive, so are usually reserved for new drugs (with funding from the drug companies). So the old story endures.

Generally speaking, antibiotics and alcohol aren't a good mix. The antibiotic upsets the balance of the gut flora, and the the resulting digestive upset may not sit well with alcohol. But that is not the same as an immediate disulfiram-like reaction.

(Actually, if can add my own hearsay evidence, I was prescribed metronidazole for a tooth abscess, no alcohol, and it made my tummy upset and gave me an unpleasant metallic taste in my mouth. I dared to try a little alcohol, and I can assure you it made me feel much better).

[MyNameIsTerry]

My dog is currently on that med, true story. And he’s just fine. :)

It's he having a "doggie beer" though? :D

Glad to hear he is fine and I hope he gets over what it is treating him for.

[flipp]

One of my dogs was on this drug,also known as Flagyl.She had pups and had an infection in her vjaja, I also have taken it for a tooth abscess had no problem with it.

[MyNameIsTerry]

The report above is a double-blind scientific study, as opposed to hearsay and anecdotal reports.

If you look carefully at the reported evidence for a negative alcohol-metronidazole reaction, there is not one actual drug trial. There are ten single case reports (ie ten people), and those people had multiple reasons for feeling sick, eg their infection was severe or they overdosed on alcohol.

It's just an old story from the days before we had the kind of testing available today. But metronidazole doesn't get scientifically tested in a drug trial because it's an old drug, and drug trials are time-consuming and expensive, so are usually reserved for new drugs (with funding from the drug companies). So the old story endures.

Generally speaking, antibiotics and alcohol aren't a good mix. The antibiotic upsets the balance of the gut flora, and the the resulting digestive upset may not sit well with alcohol. But that is not the same as an immediate disulfiram-like reaction.

(Actually, if can add my own hearsay evidence, I was prescribed metronidazole for a tooth abscess, no alcohol, and it made my tummy upset and gave me an unpleasant metallic taste in my mouth. I dared to try a little alcohol, and I can assure you it made me feel much better).

About the disulfiram reaction, the professional section on Drugs.com said this:

There have been a few case reports involving metronidazole but data are not convincing.

And then followed up with this:

However, some investigators have questioned the disulfiram-like properties of metronidazole. One study found neither elevations in blood acetaldehyde nor objective or subjective signs of a disulfiram-like reaction to ethanol in six subjects treated with metronidazole (200 mg three times a day for 5 days) compared to six subjects who received placebo

They still advise abstinence but I've always found GP's say that with all antibiotics anyway. It's no headache to give the booze a miss for a week, the issue with long term treatment like with antidepressants brings in the quality of life issue so it's very relevant for a lot of people then. I guess they are just playing safe because as usual there are severity levels with that reaction and the rare cases are their legal worry?

[hanshan]

Basically, there are three types of evidence:

1. Case reports
2. Pharmacological studies
3. Double-blind randomized control drug trials

1. Case reports - For the metronidazole-ethanol interaction, there are about ten published case reports over forty or fifty years. Most of those look a bit shaky today, as they automatically assumed that someone presenting with a flushed face in distress who had taken both metronidazole and drunk alcohol was a result of a combination of the two. In fact, the person could have overdosed on alcohol, or could be still suffering from their original infection, or some other problem.

2. Pharmacological studies - These are usually carried out on the tissue of rats and the like, and have never shown a disulfiram-like reaction from the combination of metronidazole and ethanol.

3. Double-blind randomized control drug trials - There has only been one small-scale double--blind randomized control trial. This is because they are expensive and time-consuming to mount. This one trial showed neither pharmacological nor perceived ill-effects from combining metronidazole and ethanol.

Okay, so that's the evidence, but entrenched beliefs die hard.

[nomorepanic]

Well I was only speaking from my experience and that of others I know that have taken it and it was a definite real reaction.

[anxious848]

Hi! I recently took metronidazole for 10 days to treat an infection (it didn't work for me - its for a parasite called b.hominis that is apparently difficult to get rid of). I had absolutely no issues with the medication. Definitely wait enough hours inbetween...I forgot to take mine first thing in the morning so it ended up being closer to the afternoon when I took it. Felt fine in the afternoon but after the second pill I felt a little acid refluxy / nauseous.

Definitely will reiterate to avoid alcohol at all costs. My pharmacist told me not to have a drink within 24 hours of starting the medication and then to wait 72 hours after my final pill just to be safe.

[hanshan]

Lots of people have a negative reaction if they mix alcohol with an antibiotic, but that's not what we are talking about here. Metronidazole was initially postulated to have a disulfiram-like reaction due to a rapid build-up of acetaldehyde in the body. However, pharmacological tissue studies since have never found any evidence of that. Doctors and pharmacists still repeat the mantra, however.