Drinking alcohol with Bacrim DS (kidney infection)

Hazle_Weatherfield · November 20, 2009, 3:45am

Awful! Do not do it!

It’s probably ok to do it!

No effect whatsover!

I tend to take these warnings with grains of salt because I take Lexapro daily and Xanax as needed and have never lessened my alcohol consumption. I’m finding different reports. What’s the real story?

Hirka_T_Bawa · November 20, 2009, 4:11am

There are no interactions between Sulfamethoxazole & Trimethoprim and ethyl alcohol. It would be totally fine to drink while taking Bactrim DS during a normal 10-14 day course of treatment. Now, if you are taking Bactrim DS every day for prophylaxis then I would recommend taking a multi-vitamin with it if you drink every day (Mainly for B-12 and Folic Acid).

Qadgop_the_Mercotan · November 20, 2009, 1:27pm

I must dissent, Hirka.

from the Micromedex on Bactrim:

Drug-Food Combinations

3.5.2.A Ethanol

Interaction Effect: a disulfiram-like reaction (flushing, sweating, palpitations, drowsiness)

Summary: Two patients receiving cotrimoxazole double-strength experienced a disulfiram-type reaction after the ingestion of 24 to 36 ounces of beer. One of the patients had a similar reaction on rechallenge the next day after the ingestion of 6 ounces of beer. Although the exact mechanism of this interaction is not known, it is possible that cotrimoxazole may inhibit aldehyde dehydrogenase or may inhibit the elimination of acetaldehyde via the cytochrome P450 hepatic pathway (Heelon & White, 1998a).

Severity: major

Onset: rapid

Substantiation: probable

Clinical Management: Patients receiving sulfamethoxazole/trimethoprim should be warned that a disulfiram-type reaction may occur if ethanol is ingested.

Probable Mechanism: unknown

Literature Reports

a) Two health care professionals receiving cotrimoxazole double-strength twice daily for three days as pertussis prophylaxis experienced a disulfiram-like reaction after the ingestion of ethanol. The first patient, a 31-year-old male, drank 24 ounces of beer and 10-20 minutes elapsed before symptoms of flushing, heart palpitations, dyspnea, nausea, and headache occurred. He became drowsy and fell asleep, and woke the next morning with no symptoms. When he consumed 6 ounces of beer the next day, the same type of symptoms reoccurred. His average ethanol intake was 36 to 48 ounces of beer a week. The second patient, a 39-year-old male, also experienced heart palpitations, flushing, dyspnea, nausea, and headache after the consumption of 36 ounces of beer. He also fell asleep and woke the next morning with no symptoms. His average beer consumption was 24 to 36 ounces daily. Neither of these patients had medical conditions before or after the disulfiram-like reaction, and neither was receiving any prescription or nonprescription products (Heelon & White, 1998).

So, in some individuals, Bactrim (and other sulfa-type drugs) can act like antabuse, causing some really nasty symptoms. I’ve had a few patients comment on the effect when prescribed sulfa over the years.

YMMV.

Qadgop_the_Mercotan · November 20, 2009, 1:37pm

I should also note that this reaction is fairly uncommon, and not life-threatening.

Hirka_T_Bawa · November 20, 2009, 2:37pm

I got my information from Clinical Pharmacology, and they don’t have any interactions listed between SMZ-TMP and Ethanol. I haven’t heard of the disulfiram-like reaction with Sulfa drugs before, but you do have much more clinical experience then I do (as in you have a lot, and I have almost none), so can see you seeing more of the rare reactions.

If you do get a disulfiram-like reaction, you’ll know it really quick. You’ll start to feel like you have a hang over within about 20 minutes after drinking. But, as Qadgop said, it is normally not life-threatening. If you drink on the medication, and start getting nausea or vomiting, as long as you stop drinking then, you’ll be fine, and know you’re one of the rare people with the interaction.