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Probe · metronidazole · 3 min read

How long after disulfiram before Flagyl 250 mg?

Two weeks. Do not give metronidazole to someone who has taken disulfiram within the last two weeks. Psychotic reactions have been reported in alcoholic patients who used both drugs at once. That gap is a contraindication, not the three-day alcohol hold after Flagyl. Tell the writer the last disulfiram date before anyone starts a 250 mg pack. The drink calendar after Flagyl is three days after the last tablet.

Medically reviewed by Dr. Mateo Ruiz, MD - Clinical pharmacology, Barcelona

Last reviewed

Updated

01What not to do with the two bottles

Forest-green still life: two-week gap after a stoppered bottle

Do not keep disulfiram in the cabinet 'for weekends' while a Flagyl pack is open. Do not start Flagyl to punish a planned drink. Neither label is written that way.

If psychosis, severe confusion, or a sudden behavior change starts after the two names overlap, that is urgent care, not a taste complaint.

02How long disulfiram must be off

Metronidazole should not be given to patients who have taken disulfiram within the last two weeks. That sentence sits in Contraindications and again under Drug Interactions.

Count two weeks from the last disulfiram swallow, then the writer can revisit Flagyl. Do not stack the two drugs to 'cover' a party.

03How this differs from the alcohol hold

After Flagyl, alcohol and propylene-glycol products wait at least three days. Before Flagyl, disulfiram waits two weeks. Mixing those clocks is how people drink on day four and still have disulfiram on board.

The glow list after ethanol-plus-metronidazole is the alcohol pulse. Psychosis from the two drugs together belongs with the two-week gap.

04What the overlap reports were

Psychotic reactions showed up in alcoholic patients using metronidazole and disulfiram concurrently. The insert does not give you a home test for who will be the next case.

If both names are already on the med list, stop and call before the next 250 mg tablet. This is not a 'take them at opposite ends of the day' problem.

05What to say before the 250 mg pack is written

Bring the last disulfiram date to the visit that starts metronidazole. A dental 250 mg course still needs that date. 'I stopped last month' is only useful if the day is known.

If you cannot remember the day, say so. Guessing 'about two weeks' is how overlap happens.

06What remains after the two weeks

Clearing the disulfiram gap does not open drinks on Flagyl. Once 250 mg starts, the three-day-after hold still applies. Two clocks, one INN.

Cockayne syndrome is a separate hard stop. Warfarin still needs INR. Those rooms are not solved by waiting out disulfiram.

Sources

  1. Pfizer FLAGYL (metronidazole) tablets prescribing information, LAB-0162-20.0, revised July 2024.

Checked against the current label and reviewed by Dr. Mateo Ruiz. See Probe, Assay, Glow-check, Seal.

Vault consult

Answers follow the U.S. Flagyl label.

Hector S. Last disulfiram was ten days ago. Start Flagyl 250 mg for a dental pack?

Vault reply

No. Wait until two weeks have passed since the last disulfiram dose. Ten days is still inside the contraindication.

Yael N. Is the two-week gap the same as the three-day drink wait?

Vault reply

No. Two weeks is disulfiram before Flagyl. Three days is alcohol after the last Flagyl tablet.

Bruno M. Can I take both if I do not drink?

Vault reply

The psychosis reports were in alcoholic patients using both drugs. The contraindication is still two weeks off disulfiram. Do not stack them.

Before you start, stop, or change any medicine, speak with your prescriber or pharmacist - they hold your chart, this vault card does not. Open the vault disclaimer.