Do ethanol and metronidazole interact to produce a disulfiram-like reaction?

OBJECTIVE

To obtain and evaluate evidence about the supposed disulfiram-like interaction between metronidazole and ethanol.

DATA SOURCES

MEDLINE search from January 1964 to June 1999, using the terms metronidazole, ethanol, and drug reaction.

DATA SYNTHESIS

The manufacturer's warnings include a disulfiram-like reaction between metronidazole and ethanol. However, review of reports published between 1969 and 1982 produced no convincing evidence that this reaction exists. Six case reports involving eight patients were evaluated.

CONCLUSIONS

Four of the eight cases were serious, including one death, but the authors of all the reports presumed the metronidazole-ethanol reaction to be an established pharmacologic fact. None provided evidence that could justify their conclusions.