What’s the Buzz

The Bee Healthy Blog

2 Foods You Should Avoid While Taking Flagyl

A pill bottle of metronidazole (flagyl).

If you have been prescribed Flagyl (metronidazole), you will need to take certain precautions during treatment with this antibiotic, including avoiding certain foods. Please continue reading to find out which foods to avoid while on Flagyl.

What is Flagyl?

Flagyl is a brand name product that contains metronidazole as the active ingredient. Metronidazole is a nitroimidazole antibiotic. It is used to treat bacterial infections caused by anaerobic bacteria, including stomach, skin, gynecological, bone, joint, lower respiratory tract, brain, and heart infections. 

Flagyl is commonly used to treat bacterial vaginosis. However, since this medication is an antibiotic, metronidazole will not resolve a vaginal yeast infection in women

Additional uses of Flagyl include treating protozoal and parasitic infections such as trichomoniasis infections (common sexually transmitted infections caused by parasites), amoebiasis (intestinal illness caused by parasites), and giardiasis (traveler’s diarrhea). 

Can you eat anything while taking metronidazole?

You can eat a normal diet while taking metronidazole unless your healthcare provider tells you otherwise. 

Should I take Flagyl with or without food?

The extended-release tablets of metronidazole should be taken 1-2 hours after meals. The regular tablets and capsules can be taken with or without food. However, if metronidazole causes unpleasant effects such as an upset stomach or stomach pain, taking it with meals or snacks may help. However, if you are taking flagyl with food and still having stomach cramps or feeling nauseous, you should be aware of the following foods and beverages that can interact with the drug.

What can you not eat when taking Flagyl?

You should avoid the following foods and beverages while taking Flagyl:

Alcoholic beverages

Taking oral metronidazole (Flagyl) with alcohol can cause nausea, vomiting, abdominal cramps, flushing, and throbbing headaches. Do not drink alcohol during treatment with Flagyl. Wait at least 3 days after your last dose of metronidazole before consuming alcoholic beverages, including tap beer and red wine.

Propylene glycol

Avoid products that contain a food additive called propylene glycol when taking Flagyl and for 3 days after finishing your antibiotic course. Propylene glycol is present in many common foods such as salad dressings, seasoning blends, dried soups, baking mixes, soft drinks, iced teas, powdered drink mixes, food coloring, flavorings, frostings, and other foods like processed snacks. Taking Flagyl with products that contain propylene glycol can cause stomach cramping, nausea, vomiting, headaches, and flushing.

Can you eat dairy with Flagyl?

You can eat dairy with Flagyl (metronidazole). However, metronidazole can be present in certain combination products, such as Helidac and Pylera, which are made with two other medications: tetracycline and bismuth. These combination drugs are used to treat Helicobacter pylori infections and ulcers. You should take these medications at least 1 hour before or 2 hours after consuming dairy products, calcium-containing foods like fortified orange juice, or calcium supplements.

What should I avoid while taking metronidazole?

You should avoid taking certain medications with which metronidazole can have drug interactions or discuss with your primary care provider if the dose of metronidazole needs to be altered. There are also different alternatives depending on how long you will be taking the medication. The medications to be wary of include anticoagulants/blood thinners like warfarin, stomach acid reducers like cimetidine, anti-seizure medications like phenytoin and phenobarbital, mood stabilizers like lithium, and cancer medications like busulfan.

It is strongly suggested you talk to your doctor before taking disulfiram (Antabuse) during treatment with metronidazole. Disulfiram is used to treat chronic alcoholism. Taking disulfiram and metronidazole together can cause throbbing headaches, flushing, thirst, sweating, difficulty breathing, chest pain, heart palpitations, rapid or irregular heartbeat, low blood pressure, lightheadedness, dizziness, blurred vision, nausea, vomiting, and confusion. Rarely, more severe adverse reactions can occur, including abnormal heart rhythms, heart failure, heart attack, loss of consciousness, seizures, and even death. Disulfiram has also been linked to psychotic reactions in some cases. 

Who should not take Flagyl?

People who have had allergic reactions to metronidazole in the past should not take Flagyl. Also, this medication may not be safe for people with Crohn’s disease, liver disease, kidney disease, heart disease, and blood dyscrasias. People with a rare disorder called Cockayne syndrome can have a serious reaction to metronidazole and develop life-threatening liver failure.

What are common Flagyl side effects?

Common side effects of Flagyl (metronidazole) include nausea, vomiting, diarrhea, stomach cramps, upset stomach, loss of appetite, constipation, dry mouth, headache, unpleasant metallic taste, and furry tongue or tongue irritation. Tell your doctor if these side effects are severe or do not improve after a few days.

Rarely, Flagyl can cause more serious side effects or an allergic reaction. Seek immediate medical attention if you develop any of the following signs and symptoms:

  • Skin rash, hives, itching, blistering, peeling
  • Numbness, tingling, burning, or pain in the hands or feet
  • Flushing
  • Dizziness
  • Signs of infection such as fever, sore throat, stuffy nose
  • Joint pain
  • Trouble speaking
  • Coordination problems
  • Agitation
  • Confusion 
  • Seizures

What else should I know about metronidazole (Flagyl)?

  • You should not stop taking metronidazole before completing the prescribed course, even if you feel well. This can lead to incomplete treatment of your bacterial infection, which can make it come back and become harder to treat. Meaning you may not be able to be fully treated with metronidazole after stopping your medication early because it will no longer affect the bacteria.
  • Do not split, chew, or crush an extended-release tablet. Swallow it whole.
  • In case of a missed dose, take metronidazole as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your prescribed dosing schedule. Do not take two doses together. 
  • If you are taking metronidazole to treat a sexually transmitted disease such as bacterial vaginosis, talk to your doctor about treating your sexual partner at the same time.
  • It is generally safe to take most blood pressure drugs orally to lower blood pressure while on metronidazole. However, metronidazole injection contains a large amount of sodium per dose. This can suddenly overload the body and raise blood pressure. Tell your doctor if you have hypertension or take blood pressure drugs to treat high blood pressure. Your doctor may decide not to use IV metronidazole if you have uncontrollable high blood pressure (resistant hypertension), congestive heart failure, or significant fluid retention.
  • Metronidazole may cause harm to an unborn baby. Tell your doctor if you are pregnant or breastfeeding.
     

References:

  1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020334s008lbl.pdf
  2. https://labeling.pfizer.com/showlabeling.aspx?id=572
  3. http://acdscamp.org/Narratives/20110103152837_~_ZZ%20PROPYLENE%20GLYCOL.pdf
  4. https://medlineplus.gov/druginfo/meds/a601028.html#
  5. https://medlineplus.gov/genetics/condition/cockayne-syndrome/#
  6. https://www.dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=d2112f37-5080-4a19-bcc3-6386b49abe1d&type=display