RE: Educating Steem: Explaining the Physiology of “The Hangover”
I was put on Metronidazole quite a few times for an antibiotic reistent super-big C.Diff infection that ruined my life over the 18 months that it ran its course. I drank without issue.
This contraindication appears to be be a myth. It always disturbs me that both doctors and pharmacists continue to push this myth, even with warning labels, yet there is no evidence. I have consistently been stunned at how rarely men and women of medicine are scientific at heart.
https://www.ncbi.nlm.nih.gov/pubmed/25223673
"It is common practice to warn against intake of alcohol (ethanol) when taking metronidazole because of the risk of an effect similar to disulfiram (Antabuse)."
"No in-vitro studies, animal models, reports of adverse effects or clinical studies provide any convincing evidence of a disulfiram-like interaction between ethanol and metronidazole."
"The warning against simultaneous use of alcohol and metronidazole appear to be based on laboratory experiments and individual case histories in which the reported reactions are equally likely to have been caused by ethanol alone or by adverse effects of metronidazole. Recent research does not confirm a clinically relevant interaction between ethanol and metronidazole."
https://www.ncbi.nlm.nih.gov/pubmed/12022894
"Metronidazole did not raise blood acetaldehyde or have any objective or subjective adverse effects when used together with ethanol." ... "This study shows that metronidazole does not have an effect on blood acetaldehyde concentrations when ingested with ethanol and does not have any objective or subjective disulfiram-like properties."
Disulfiram doesn't interact with ethanol. It inhibits acetaldehyde dehydrogenase.
The studies still show no deleterious link between alcohol consumption and metronidazole, no matter how far along their metabolism you want to go.
I don't know anything about metronidazole (other than it being an antibiotic). So okay. I was just clarifying the statement above. Cheers.
I will have to look more into that. Thank you for providing a pubmed article as well.
As far as my article, the point is that if drugs (whether metronidazole is included or not) raise acetaldehyde, then they will get a hangover feeling. Disulfiram itself is a great example of that.
As a biology major in college and taking many science courses in medical school, I feel my heart has plenty of science in it. I would also add that medical doctors have to also have many other qualities. Medicine in my eyes is also an art. I wrote an article on "The Art of the Physical Exam." You also have to be a good listener/detective to discover things.
Glad you are C-diff free.
Studies will always change our perspectives in medicine, and when we have to learn hundreds of thousands of facts, it is impossible to look up all the studies on each of those facts.
Since you had a personal experience with this drug, you took a lot of time to research it. You are a mini-expert now on metronidazole (a good thing) because it can shape my perspective as well by reading more. Medicine is a life-long learning process.
I would only ask that you don't hold physicians to a standard where if you find one thing that you disagree with in the article that it shapes your perspective about us. I may be a doctor, but I also can't be perfectly knowledgable about every study presented on every medication.
Cheers.
***I also changed that section of the article to reflect some research I just did. I now agree that evidence does not support an increase in acetaldehyde with metronidazole (although it was classically taught that way in medical school). However, in some individuals it does cause a "like" reaction due to the fact that metronidazole increases nausea and vomiting in some patients independently of alcohol. The combination can cause a disulfiram-like reaction....but not due to acetaldehyde build up.
I would also strongly advise patients to not drink while having C-Diff. Combining a diuretic with severe diarrhea is a very poor choice and can easily lead to severe dehydration.
Of course, I don't think my Dr will ever advise me to drink =P no matter the situation. Maybe if him and I were in a bunker together at the end of the world. I've just met too many nurses and doctors who lack a basic grasp of even what science is, and some are very behind the research even in their specialist field. My GP believes in the great flood, and that's fine, but he denies me when I tell him there's no evidence for it in the strata. Instead he says, "Hmm, I think there is..." He sent me bible-camp videos to watch so I thought would send him a few science videos to watch. But he would not watch them.
I don't care, he's a compassionate man who listens and cares. That is far more important than off-the-cuff knowledge. These days, with the democratization of information, we should all be experts in our own medical conditions. Like a true mind of science you've altered your position now that new information has come to light. That is science.