Sudden death due to metronidazole/ethanol interaction

Am J Forensic Med Pathol. 1996 Dec;17(4):343-6. doi: 10.1097/00000433-199612000-00013.


Metronidazole (Flagyl), a commonly prescribed antimicrobial agent, can produce a reaction similar to that of disulfiram (Antabuse) when administered to patients drinking ethanol. This drug/chemical interaction results in accumulation of acetaldehyde in the blood. Acetaldehyde is hepatotoxic, cardiotoxic, and arrythmogenic; no lethal serum acetaldehyde level has been established. Sudden death has been reported in patients taking disulfiram while using ethanol; no fatalities have been reported due to ethanol/ metronidazole interactions. Described is a case of a 31-year-old woman who died moments after an assault by a male companion, during which he inflicted minor physical trauma to her upper arm. Toxicologic analysis yielded elevated concentrations of serum ethanol (162 mg/d), acetaldehyde (4.6 mg/d), and metronidazole (0.42 mg/L). The cause of death was reported to be cardiac dysrhythmia due to acetaldehyde toxicity due to an ethanol/ metronidazole interaction. Autonomic stress associated with the assault is likely to have contributed to this woman's death. The mechanism of death is examined.

Publication types

  • Case Reports

MeSH terms

  • Acetaldehyde / blood
  • Adult
  • Antitrichomonal Agents / adverse effects*
  • Death, Sudden / etiology*
  • Drug Interactions
  • Ethanol / adverse effects*
  • Female
  • Humans
  • Male
  • Metronidazole / adverse effects*


  • Antitrichomonal Agents
  • Metronidazole
  • Ethanol
  • Acetaldehyde