Customer (name blocked for privacy),
There is an absolute contraindication between metronidazole and alcohol. The reaction is extreme nausea with vomiting, there may also be an increase in alcohol toxicity prodced by metronidazole. Please see the monograph below.
thanks
Title Alcohol (Ethyl) / Metronidazole
Risk Rating C: Monitor therapy
Summary Metronidazole may enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.
Severity Moderate
Reliability Rating Excellent
Patient Management Monitor for signs and symptoms of a disulfiram-like reaction during coadministration of alcohol and metronidazole (although evidence currently stands against the development of a true disulfiram-like reaction). Alcohol may be contained in beverages and pharmaceutical products (eg, elixirs).
Discussion Several case reports describe signs and symptoms of a disulfiram-like reaction during coadministration of alcohol and metronidazole.
1,2,3,4,5,6 Reported reactions have ranged from mild cardiovascular effects to death. Randomized, double-blind, placebo-controlled trials, however, have failed to demonstrate the value of metronidazole as an alcohol aversive agent.
7,8,9,10,11,12 The results of these trials suggest that if a reaction does occur, it does so in an unpredictable and relatively mild fashion. The mechanism of a metronidazole-alcohol interaction, if one does occur, is unclear. A disulfiram-like reaction presumes that metronidazole increases acetaldehyde concentrations by inhibiting acetaldehyde dehydrogenase, thereby inhibiting the metabolism of acetaldehyde to acetic acid. A double-blind study involving 12 normal subjects demonstrated no effect of metronidazole on acetaldehyde concentrations.
13 Footnotes 1. Taylor JAT, "Metronidazole - A New Agent for Combined Somatic and Psychic Therapy for Alcoholism: A Case Study and Preliminary Report,"
Bull Los Angeles Neurol Soc, 1964, 29:58-62. 2. Sansoy OM and Vegas L, " Evaluation of Metronidazole in the Treatment of Alcoholism,"
J Indian Med Assoc, 1970, 55:29. 3. De Mattos H, "Relationship Between Alcoholism and the Digestive System,"
Hospital, 1968, 74:281. 4. Edwards DL, Fink PC, and Van Dyke PO, " Dislufiram-like Reaction Associated With Intravenous Trimethoprim-Sulfamethoxazole and Metronidazole,"
Clin Pharm, 1986, 5(12):999-1000. 5. Plosker GL, "Possible Interaction Between Ethanol and Vaginally Administered Metronidazole,"
Clin Pharm, 1987, 6(3):189,192-3. 6. Cina SJ, Russell RA, and Conradi SE, "Sudden Death Due to Metronidazole/Ethanol Interaction,"
Am J Forensic Med Pathol, 1996, 17(4):343-6. 7. Linton PH and Hain JD, "Metronidazole in the Treatment of Alcoholism,"
Quarterly J Stud Alcohol, 1967, 28(3):544-6. 8. Egan WP and Goetz R, "Effect of Metronidazole on Drinking by Alcoholics,"
Quarterly J Stud Alcohol, 1968, 29(4):899-902. 9. Penick SB, Carrier RN, and Sheldon JB, "Metronidazole in the Treatment of Alcoholism,"
Am J Psychiatry, 1969, 125(8):1063-6. 10. Strassman HD, Adams B, and Pearson AW, "Metronidazole Effect on Social Drinkers,"
Quarterly J Stud Alcohol, 1970, 31(2):394-8. 11. Platz A, Panepinto WC, Kissin B, et al, "Metronidazole and Alcoholism,"
Dis Nerv Syst, 1970, 31(9):631-6. 12. Kaplan R, Blume S, Rosenberg S, et al, "Phenytoin, Metronidazole and Multivitamins in the Treatment of Alcoholism,"
Quarterly J Stud Alcohol, 1972, 33(1):94-104. 13. Visapaa JP, Tillonen JS, Kaihovaara PS, et al, "Lack of Disulfiram-like Reaction With Metronidazole and Ethanol,"
Ann Pharmacother, 2002, 36(6):971-4.
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| Copyright © 1978-2008 |
Title Alcohol (Ethyl) / Metronidazole
Risk Rating C: Monitor therapy
Summary Metronidazole may enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.
Severity Moderate
Reliability Rating Excellent
Patient Management Monitor for signs and symptoms of a disulfiram-like reaction during coadministration of alcohol and metronidazole (although evidence currently stands against the development of a true disulfiram-like reaction). Alcohol may be contained in beverages and pharmaceutical products (eg, elixirs).
Discussion Several case reports describe signs and symptoms of a disulfiram-like reaction during coadministration of alcohol and metronidazole.
1,2,3,4,5,6 Reported reactions have ranged from mild cardiovascular effects to death. Randomized, double-blind, placebo-controlled trials, however, have failed to demonstrate the value of metronidazole as an alcohol aversive agent.
7,8,9,10,11,12 The results of these trials suggest that if a reaction does occur, it does so in an unpredictable and relatively mild fashion. The mechanism of a metronidazole-alcohol interaction, if one does occur, is unclear. A disulfiram-like reaction presumes that metronidazole increases acetaldehyde concentrations by inhibiting acetaldehyde dehydrogenase, thereby inhibiting the metabolism of acetaldehyde to acetic acid. A double-blind study involving 12 normal subjects demonstrated no effect of metronidazole on acetaldehyde concentrations.
13 Footnotes 1. Taylor JAT, "Metronidazole - A New Agent for Combined Somatic and Psychic Therapy for Alcoholism: A Case Study and Preliminary Report,"
Bull Los Angeles Neurol Soc, 1964, 29:58-62. 2. Sansoy OM and Vegas L, " Evaluation of Metronidazole in the Treatment of Alcoholism,"
J Indian Med Assoc, 1970, 55:29. 3. De Mattos H, "Relationship Between Alcoholism and the Digestive System,"
Hospital, 1968, 74:281. 4. Edwards DL, Fink PC, and Van Dyke PO, " Dislufiram-like Reaction Associated With Intravenous Trimethoprim-Sulfamethoxazole and Metronidazole,"
Clin Pharm, 1986, 5(12):999-1000. 5. Plosker GL, "Possible Interaction Between Ethanol and Vaginally Administered Metronidazole,"
Clin Pharm, 1987, 6(3):189,192-3. 6. Cina SJ, Russell RA, and Conradi SE, "Sudden Death Due to Metronidazole/Ethanol Interaction,"
Am J Forensic Med Pathol, 1996, 17(4):343-6. 7. Linton PH and Hain JD, "Metronidazole in the Treatment of Alcoholism,"
Quarterly J Stud Alcohol, 1967, 28(3):544-6. 8. Egan WP and Goetz R, "Effect of Metronidazole on Drinking by Alcoholics,"
Quarterly J Stud Alcohol, 1968, 29(4):899-902. 9. Penick SB, Carrier RN, and Sheldon JB, "Metronidazole in the Treatment of Alcoholism,"
Am J Psychiatry, 1969, 125(8):1063-6. 10. Strassman HD, Adams B, and Pearson AW, "Metronidazole Effect on Social Drinkers,"
Quarterly J Stud Alcohol, 1970, 31(2):394-8. 11. Platz A, Panepinto WC, Kissin B, et al, "Metronidazole and Alcoholism,"
Dis Nerv Syst, 1970, 31(9):631-6. 12. Kaplan R, Blume S, Rosenberg S, et al, "Phenytoin, Metronidazole and Multivitamins in the Treatment of Alcoholism,"
Quarterly J Stud Alcohol, 1972, 33(1):94-104. 13. Visapaa JP, Tillonen JS, Kaihovaara PS, et al, "Lack of Disulfiram-like Reaction With Metronidazole and Ethanol,"
Ann Pharmacother, 2002, 36(6):971-4.
Images available only to Customers.
| Copyright © 1978-2008 |
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