Flagyl Side Effects & What You Can Do About Them
Medically reviewed on May 18, 2017 by L. Anderson, PharmD.
Flagyl: Decades of Bad Side Effects
The US Food and Drug Administration (FDA) first approved Flagyl (generic name: metronidazole) way back in the 1960's, so you've probably taken it, or know someone who has. It's a potent drug in the nitroimidazole class used to treat bacterial infections of the stomach and intestine, skin, joints, vagina, and respiratory tract. It's bactericidal (kills bacteria) and is used to treat ominous sounding organisms such as Bacteriodes fragilis, Helicobacter pylori, and Giardia lamblia.
Flagyl is an important drug, but is linked with many difficult side effects. So how can you better tolerate this medicine to cure what is most likely a serious bacterial infection?
Strengths and Uses: Metronidazole
Your metronidazole (Flagyl) dose and length of therapy will depend upon your infection. It's often prescribed to be taken by mouth two or three times a day for 7 to 14 days; it depends upon your infection. Metronidazole (Flagyl) comes in four oral strengths:
- 250 and 500 mg strength, regular-release tablets
- 375 mg regular release capsules
- 750 mg extended-release tablets
Metronidazole is used to treat some common infections like: Bacterial vaginosis, Bacterial stomach or intestinal infections, Pelvic Inflammatory diseases, Trichomoniasis (sexually transmitted infection due to a parasite), and many other types of bacterial infections. It's also available in an intravenous formulation, and as a cream or gel for topical acne treatment and vaginal infections.
How to Handle the Stomach Side Effects of Flagyl
Metronidazole side effects are notorious for causing an upset stomach and killing your appetite. For many people, the nausea -- and even flat out vomiting -- can occur just from the bad taste. Heartburn, constipation, and diarrhea can occur, too. It's enough to make some people abandon therapy altogether, but don't -- call your doctor before you stop any antibiotic.
The regular release tablets can be taken with a meal, a snack or a glass of milk to help prevent upset stomach. If heartburn is an issue, ask your doc if you can take an over-the-counter acid blocker like famotidine (Pepcid AC). If you are taking the extended-release metronidazole tablet (Flagyl ER) you must take it on an empty stomach, at least 1 hour before or 2 hours after eating a meal. If your gut can't tolerate metronidazole, you might be better off using the regular-release tablets so you can take it with food. Ask your doctor about this option.
What Can I Do About the Flagyl Taste?
Metronidazole (Flagyl) leaves a bitter, metallic taste in your mouth. This is a well-known side effect. For many, the bad taste lasts throughout treatment, too, not just when you're swallowing the medicine.
What can be done? During treatment, have a supply of sweet hard candies (sugar-free, if preferred) or mints to help mask the taste. If the taste is only difficult when you're swallowing, try masking with chocolate, like chocolate pudding or chocolate milk. If you can't tolerate the taste at all, or if you have nausea or vomiting, ask your doctor if there are other options to treat your infection.
Flagyl and Alcohol: Never Shaken or Stirred
The pharmacy bottle sticker says "Avoid Alcohol", but how strict is this? In fact, you should not have ANY alcohol with metronidazole, and that includes, beer, wine, spirits and liquors in mixed drinks. You should even avoid alcohol in medicines or mouthwash while you are taking metronidazole and for at least 3 days after you stop taking it. What are the effects if you don't follow this rule? Unpleasant side effects such as a fast heartbeat, warmth or redness (flushing) under your skin, a tingly feeling, or nausea and vomiting reportedly may occur. Although there are only a few case reports, the manufacturer still recommends alcohol avoidance with both oral and vaginal forms of metronidazole. And let's face it -- metronidazole is hard enough on its own without compounding the side effects with alcohol, don't you agree?
Antibiotic-Induced Diarrhea: It's Unfair
It's bad enough you have an infection. But now your treatment has caused antibiotic-associated diarrhea. This happens because the population of "good" bacteria in your intestine are altered due to your antibiotic. Symptoms can range from soft stools to frequent and explosive watery diarrhea.
Is there anything you can do? Many people eat yogurt with live, active cultures or take a probiotic to help prevent this problem while taking antibiotics. Be sure to stay hydrated, replace electrolytes, and eat a bland diet like bananas, rice, applesauce, and toast (BRAT diet) to help recover from a bout of diarrhea. Antibiotic-associated diarrhea, while unpleasant, is usually a short-lived side effect and will usually clear up a few days after antibiotics are stopped. But see the next slide for a warning.
Clostridium Difficile: A More Severe Form of Diarrhea
A more severe case of infectious diarrhea called Clostridium difficile (C. difficile) can happen with almost any antibiotic, and is more common when hospitalized. Serious complications can include inflammation of the intestine known as pseudomembranous colitis. However, the good news is that metronidazole is used to treat C. difficile, so you should have some coverage for this bacteria.
For prevention of antibiotic-induced diarrhea and C. difficile infection, some studies suggest the probiotics Saccharomyces boulardii (Florastor) and Lactobacillus GG can be helpful. If you have severe diarrhea that is watery, bloody, or contains mucus, stomach cramping, or fever, call your doctor right away. Avoid any over-the-counter antidiarrheal medicine unless your doctor recommends it.
Your Brain On Flagyl
Feel like your world is spinning? Having trouble focusing? Your metronidazole treatment might be to blame. Flagyl can penetrate the blood-brain barrier and is known to cause central nervous system (CNS) side effects that can worsen with high doses. Common ones include:
- Irritability, dizziness, or confusion
- Difficulty sleeping
- Tremors or shakiness
- Peripheral neuropathy (tingling or painful sensations in the hands or feet)
Kill the Bacterial: Get a Yeast Infection
Antibiotics can frequently lead to unpleasant yeast (candida) infections. Women may get an itchy, vaginal yeast infection. Antibiotics kill off the “good” bacteria as well as bacteria causing your infection, which alters the balance of yeast in the vagina. Although a yeast infection is annoying and can be uncomfortable, it's easy to treat. Visit your pharmacy for 7-day, 3-day or even 1-day vaginal suppository or cream treatment options.
Common brands include Monistat (miconazole) or Gyne-Lotrimin (clotrimazole). If these treatments aren't effective, see your doctor for a higher prescription strength. Plus, if this is your first yeast infection after a course of antibiotics, check with your doctor to be sure it's not a more serious problem. And don't get confused; even though metronidazole ends in "azole", it will not treat any fungal or yeast infection.
Changes in Urine Color
It can be shocking to see your urine color change to a dark or reddish-brown color when taking metronidazole (Flagyl).
But never fear, this pigment change is due to a metabolite of metronidazole that occurs when it's broken down in your body for elimination through your kidneys, so it's nothing to be concerned about.
In fact, many other medications -- including rifampin, sulfasalazine, and propofol -- can change the color of urine; it's not uncommon. Your urine should change back to it's normal color a day or two after you stop treatment.
Flagyl's Too Hard to Tolerate: Can't I Just Stop It?
Be sure to take metronidazole for the full course of antibiotic treatment that your doctor prescribes. The side effects may be somewhat difficult, but a recurring infection if you stop therapy can be serious. If you simply cannot tolerate the side effects, speak with your health care provider about what other options you might have. Also, don't ever share this medication with anyone - it's very specific for the types of infections it treats and may be harmful if taken by someone else without a doctor's okay. It has no action on viral infections like a cough, cold, or the flu.
What are your thoughts on metronidazole?
- If you took metronidazole (Flagyl), were you able to tolerate it?
- Which side effects did you experience?
- Would you take metronidazole again, if recommended by your doctor?
Finished: Flagyl Side Effects and What You Can Do About Them
- Johnson M. Metronidazole: An Overview. May 31, 2016. Accessed May 18, 2017 at https://www.uptodate.com/contents/metronidazole-an-overview
- Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA 2012; 307:1959–1669.
- PubMed Health. Metronidazole. Accessed May 17, 2017 at https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0001181/
- Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ. Central nervous system toxicity associated with metronidazole therapy. Ann Intern Med 1980; 93:59.