{"id":61789,"date":"2023-11-30T21:03:16","date_gmt":"2023-12-01T02:03:16","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=61789"},"modified":"2024-10-25T10:24:29","modified_gmt":"2024-10-25T14:24:29","slug":"metformin-interactions","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/metformin-interactions\/","title":{"rendered":"Metformin interactions to avoid"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/metformin-hcl\/what-is\"><span style=\"font-weight: 400;\">Metformin<\/span><\/a><span style=\"font-weight: 400;\"> is the <\/span><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/type-2-diabetes\/diagnosis-treatment\/drc-20351199#:~:text=Metformin%20(Fortamet%2C%20Glumetza%2C%20others,may%20need%20to%20take%20supplements.\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">first-line drug<\/span><\/a><span style=\"font-weight: 400;\"> of choice prescribed by medical professionals for Type 2 diabetes treatment. It is also used <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/off-label-prescription-drugs\/\"><span style=\"font-weight: 400;\">off-label<\/span><\/a><span style=\"font-weight: 400;\"> for insulin resistance in polycystic ovary syndrome (<\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-pcos\/\"><span style=\"font-weight: 400;\">PCOS<\/span><\/a><span style=\"font-weight: 400;\">). A pill with a long history of use, metformin has stood the test of time by effectively lowering blood glucose levels and the risk of diabetic complications while not leading to weight gain. Metformin&rsquo;s side effects are not trivial. However, drug interactions or certain coinciding health conditions can magnify their risk. Knowing these details could help keep a person safe while managing their diabetes.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/signs-metformin-is-not-working\/\"><b>Signs metformin is not working<\/b><\/a><\/p>\n<h2 id=\"key-takeaways\"><span style=\"font-weight: 400;\">Key takeaways:<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Two of the most dangerous drug interactions with metformin do not involve traditional medications; they are alcohol and intravenous contrast dye for CT scans.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Several prescription drugs that interact with metformin are prescribed to treat conditions commonly comorbid with diabetes, setting up a fairly frequent interaction scenario.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The most concerning reaction resulting from metformin drug interactions is <\/span><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/25066-lactic-acidosis\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">lactic acidosis<\/span><\/a><span style=\"font-weight: 400;\">, a life-threatening change in our body&rsquo;s chemical balance that can be heightened by kidney, liver, or heart disease.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combining some medications with metformin can lead to lowering blood sugar levels too much, even into a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/hypoglycemia-without-diabetes\/\"><span style=\"font-weight: 400;\">hypoglycemic<\/span><\/a><span style=\"font-weight: 400;\"> range.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypoglycemia necessitates immediate action at home or, if necessary, with emergent care, and symptoms of lactic acidosis should also call for immediate emergency medical attention.<\/span><\/li>\n<\/ul>\n<h2 id=\"metformin-drug-interactions\"><span style=\"font-weight: 400;\">Metformin-drug interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Metformin and its brand name forms, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/riomet\"><span style=\"font-weight: 400;\">Riomet<\/span><\/a><span style=\"font-weight: 400;\"> and extended-release <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/glumetza\"><span style=\"font-weight: 400;\">Glumetza<\/span><\/a><span style=\"font-weight: 400;\">, touch all the bases with their drug interactions. Members of several popular medication classes, such as antihypertensives and antibiotics, have significant metformin interaction potential.<\/span><\/p>\n<h3 id=\"iodinated-radiologic-contrast\"><span style=\"font-weight: 400;\">Iodinated radiologic contrast<\/span><\/h3>\n<p><a href=\"https:\/\/www.mayoclinic.org\/drugs-supplements\/iodixanol-injection-route\/precautions\/drg-20150989\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Intravenous iodine-based dye<\/span><\/a><span style=\"font-weight: 400;\"> is often administered during CT scans to improve tissue differentiation on images, which helps radiologists determine what disease may be present. This radiologic contrast can result in impaired kidney function, known as renal insufficiency. Secondarily, renal insufficiency is a setup for lactic acidosis during metformin therapy, and some experts recommend not taking metformin for 48 hours after receiving iodinated radiologic contrast.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">High levels of lactic acid in the bloodstream can be extremely dangerous. Confusion and shortness of breath accompany early metformin symptoms of nausea, vomiting, and diarrhea, which mimic common side effects. Ultimately, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/low-blood-pressure\/\"><span style=\"font-weight: 400;\">hypotension<\/span><\/a><span style=\"font-weight: 400;\"> (low blood pressure) can develop at the critical stage of lactic acidosis, putting one&rsquo;s life at risk. If these symptoms are noticed, seek emergency care immediately.<\/span><\/p>\n<h3 id=\"oct-inhibitors\"><span style=\"font-weight: 400;\">OCT inhibitors<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">One of the major cardiovascular complications of diabetes is coronary artery disease (CAD), so the two diseases often co-exist. If one has both conditions and is experiencing angina from heart disease, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/ranolazine-er\"><span style=\"font-weight: 400;\">ranolazine<\/span><\/a><span style=\"font-weight: 400;\"> may seem like a good option to reduce the frequency of chest pain. However, one needs to be aware of ranolazine&rsquo;s interaction with metformin. By inhibiting the OCT2 transporter, it can raise metformin levels, leading to an increased risk of lactic acidosis. If prescribed ranolazine while taking metformin, ask for medical advice from a healthcare provider. They might recommend a lower dose of metformin as a safer option.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The over-the-counter antacid medication <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/tagamet-hb\"><span style=\"font-weight: 400;\">Tagamet<\/span><\/a><span style=\"font-weight: 400;\"> (cimetidine) can also inhibit OCT2, causing metformin concentrations and risks to rise. A doctor may advise a different therapy for heartburn.&nbsp;<\/span><\/p>\n<h3 id=\"angiotensin-converting-enzyme-inhibitors\"><span style=\"font-weight: 400;\">Angiotensin-converting enzyme inhibitors<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Preferred agents for <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/hypertension-treatments-and-medications\"><span style=\"font-weight: 400;\">hypertension<\/span><\/a><span style=\"font-weight: 400;\"> in the setting of diabetes, angiotensin-converting enzyme inhibitors (<\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/ace-inhibitors\"><span style=\"font-weight: 400;\">ACE inhibitors<\/span><\/a><span style=\"font-weight: 400;\">), are frequently given alongside metformin. This practice can be appropriate, but be aware that the likelihood of <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/low-blood-sugar-symptoms\"><span style=\"font-weight: 400;\">hypoglycemia<\/span><\/a><span style=\"font-weight: 400;\"> and lactic acidosis may be higher. Small studies and case reports suggest an association between concurrent use of an ACE inhibitor and metformin and these negative effects. Common ACE inhibitors include the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/zestril\"><span style=\"font-weight: 400;\">Zestril<\/span><\/a><span style=\"font-weight: 400;\"> (lisinopril)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/enalapril-maleate\"><span style=\"font-weight: 400;\">Enalapril<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/lotensin\"><span style=\"font-weight: 400;\">Lotensin<\/span><\/a><span style=\"font-weight: 400;\"> (benazepril)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/accupril\"><span style=\"font-weight: 400;\">Accupril<\/span><\/a><span style=\"font-weight: 400;\"> (quinapril)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Taking metformin together with an ACE inhibitor may continue to be recommended by a medical team. Close monitoring of glucose levels and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/blood-tests-for-diabetes\/\"><span style=\"font-weight: 400;\">blood tests<\/span><\/a><span style=\"font-weight: 400;\"> may be recommended to look for hypoglycemia and early signs of lactic acidosis with this drug combination.<\/span><\/p>\n<h3 id=\"nonsteroidal-anti-inflammatory-agents\"><span style=\"font-weight: 400;\">Nonsteroidal anti-inflammatory agents<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Nonsteroidal anti-inflammatory agents, better known as <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/nsaids\"><span style=\"font-weight: 400;\">NSAIDs<\/span><\/a><span style=\"font-weight: 400;\">, are extraordinarily common treatments for pain, inflammation, and fever. Members of the category include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/motrin-ib\"><span style=\"font-weight: 400;\">Motrin<\/span><\/a><span style=\"font-weight: 400;\"> (ibuprofen)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/naprosyn\"><span style=\"font-weight: 400;\">Naprosyn<\/span><\/a><span style=\"font-weight: 400;\"> (naproxen)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/meloxicam\"><span style=\"font-weight: 400;\">Meloxicam<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/celebrex\"><span style=\"font-weight: 400;\">Celebrex<\/span><\/a><span style=\"font-weight: 400;\"> (celecoxib)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/lodine\"><span style=\"font-weight: 400;\">Lodine<\/span><\/a><span style=\"font-weight: 400;\"> (etodolac)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">NSAIDs pose a risk to kidney function, and it is not uncommon to see a reduction in renal function during treatment. Accordingly, coupling NSAIDs with metformin could create a perfect storm. If an NSAID makes mildly diminished renal function much worse, the risk of lactic acidosis from metformin could escalate. A doctor may want to check blood tests for kidney function before and during treatment.<\/span><\/p>\n<h3 id=\"beta-blockers\"><span style=\"font-weight: 400;\">Beta-blockers<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Heart disease and hypertension frequently coincide with diabetes. Therefore, <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/beta-blockers\"><span style=\"font-weight: 400;\">beta-blockers<\/span><\/a><span style=\"font-weight: 400;\"> are utilized frequently with metformin. Beta-blockers are helpful agents to control heart rates and lower blood pressure in CAD and congestive heart failure (CHF). Unfortunately, they can mask the symptoms of hypoglycemia, one of metformin&rsquo;s adverse effects.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin and other <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/biguanides\"><span style=\"font-weight: 400;\">biguanides<\/span><\/a><span style=\"font-weight: 400;\">, by themselves, do not cause much hypoglycemia, but when used with other antidiabetic treatments, such as insulin and sulfonylureas, hypoglycemia risk is heightened. If taking a beta-blocker, early signs of low blood sugar, such as sweating, dizziness, and tachycardia (fast heartbeat), may not be experienced as reliably. Common beta-blockers include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/toprol-xl\"><span style=\"font-weight: 400;\">Toprol XL<\/span><\/a><span style=\"font-weight: 400;\"> (extended-release metoprolol)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/coreg\"><span style=\"font-weight: 400;\">Coreg<\/span><\/a><span style=\"font-weight: 400;\"> (carvedilol)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/inderal-la\"><span style=\"font-weight: 400;\">Inderal LA<\/span><\/a><span style=\"font-weight: 400;\"> (extended-release propranolol)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/labetalol-hcl\"><span style=\"font-weight: 400;\">Labetalol<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/tenormin\"><span style=\"font-weight: 400;\">Tenormin<\/span><\/a><span style=\"font-weight: 400;\"> (atenolol)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">With this drug combination, closer blood sugar monitoring may be advised by a doctor. If hypoglycemia develops, fast-acting <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/glucose\"><span style=\"font-weight: 400;\">sugar pills<\/span><\/a><span style=\"font-weight: 400;\">, food, or drink should be taken. If unable to take anything orally, an emergency <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/news\/fda-approves-glucagon-generic\/\"><span style=\"font-weight: 400;\">glucagon<\/span><\/a><span style=\"font-weight: 400;\"> dose can be given by injection or nasally to raise glucose levels temporarily until an ambulance arrives. The convenience of brand-name nasal glucagon, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/baqsimi-one-pack\"><span style=\"font-weight: 400;\">Baqsimi<\/span><\/a><span style=\"font-weight: 400;\">, comes at a price, but try a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">SingleCare discount card<\/span><\/a><span style=\"font-weight: 400;\"> for assistance.<\/span><\/p>\n<h3 id=\"carbonic-anhydrase-inhibitors\"><span style=\"font-weight: 400;\">Carbonic anhydrase inhibitors<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">This drug category probably does not sound familiar, but <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/carbonic-anhydrase-inhibitors\"><span style=\"font-weight: 400;\">carbonic anhydrase inhibitors<\/span><\/a><span style=\"font-weight: 400;\"> include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/topamax\"><span style=\"font-weight: 400;\">Topamax<\/span><\/a><span style=\"font-weight: 400;\"> (topiramate), a popular medicine for preventing migraines and seizures, and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/acetazolamide\"><span style=\"font-weight: 400;\">acetazolamide<\/span><\/a><span style=\"font-weight: 400;\">, one of the few drugs used for altitude sickness and off-label for <\/span><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/pseudotumor-cerebri\/symptoms-causes\/syc-20354031\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pseudotumor cerebri<\/span><\/a><span style=\"font-weight: 400;\"> (idiopathic intracranial hypertension). These agents reduce serum bicarbonate levels in the bloodstream. They can increase metformin levels, thereby potentially having two effects that elevate the risk of lactic acidosis in the setting of metformin therapy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A healthcare provider may or may not advise continuing Topamax along with metformin. Additional lab monitoring for lactic acidosis development could be a reasonable strategy to enhance safety and peace of mind.<\/span><\/p>\n<h3 id=\"lamictal\"><span style=\"font-weight: 400;\">Lamictal<\/span><\/h3>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/lamictal\"><span style=\"font-weight: 400;\">Lamictal<\/span><\/a><span style=\"font-weight: 400;\"> (lamotrigine) is another anti-epileptic to watch out for in the setting of metformin therapy. It raises metformin concentrations, which can potentiate the diabetic drug&rsquo;s adverse effects, including diarrhea, hypoglycemia, and lactic acidosis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Talk to a healthcare provider if prescribed Lamictal or metformin. The medical advice could be to seek other drug treatment options for diabetes. These options may include glucagon-like peptide 1 (<\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/glp-1-agonists\"><span style=\"font-weight: 400;\">GLP1<\/span><\/a><span style=\"font-weight: 400;\">) receptor agonists, sodium-glucose cotransporter 2 (<\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/sglt2-inhibitors\"><span style=\"font-weight: 400;\">SGLT2<\/span><\/a><span style=\"font-weight: 400;\">) inhibitors, dipeptidyl peptidase 4 (DPP4) inhibitors, <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/sulfonylureas\"><span style=\"font-weight: 400;\">sulfonylureas<\/span><\/a><span style=\"font-weight: 400;\">, or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/insulin-glargine\"><span style=\"font-weight: 400;\">glargine insulin<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"antibiotics\"><span style=\"font-weight: 400;\">Antibiotics<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/cephalosporins\"><span style=\"font-weight: 400;\">cephalosporin<\/span><\/a><span style=\"font-weight: 400;\"> antibiotic <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/cephalexin\"><span style=\"font-weight: 400;\">cephalexin<\/span><\/a><span style=\"font-weight: 400;\"> similarly raises blood metformin concentrations, although the level of danger is not as great. As a result, side effects of metformin may be more likely, especially if one has reduced kidney function. Ask the prescribing provider if the dose of either medication should be adjusted or seek an alternative to cephalexin.<\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/drug-classes\/quinolones\"><span style=\"font-weight: 400;\">Quinolone<\/span><\/a><span style=\"font-weight: 400;\"> antibiotics may be necessary for certain infections due to diabetes, but they can pose a challenge. At times, they increase the risk factors for hypoglycemia when used with metformin or other diabetic drugs. Still, in other instances, they can reduce the medication&rsquo;s effectiveness, thereby promoting hyperglycemia (<\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/high-blood-sugar-symptoms\"><span style=\"font-weight: 400;\">high blood sugar<\/span><\/a><span style=\"font-weight: 400;\">). A healthcare professional may recommend more frequent blood glucose checks when metformin is used with quinolones like <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/cipro\"><span style=\"font-weight: 400;\">Cipro<\/span><\/a><span style=\"font-weight: 400;\"> (ciprofloxacin) and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/levofloxacin\"><span style=\"font-weight: 400;\">levofloxacin<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"selective-serotonin-reuptake-inhibitors\"><span style=\"font-weight: 400;\">Selective serotonin reuptake inhibitors<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">First-line <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/antidepressants\"><span style=\"font-weight: 400;\">antidepressants<\/span><\/a><span style=\"font-weight: 400;\">, selective serotonin reuptake inhibitors (<\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/ssris\"><span style=\"font-weight: 400;\">SSRIs<\/span><\/a><span style=\"font-weight: 400;\">), are frequently taken together with metformin in those with depression and Type 2 diabetes mellitus. SSRIs can magnify the hypoglycemia risk in this situation, but again, this is more likely to be an issue if other diabetes medications are being used in conjunction with metformin. For example, common SSRIs include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/celexa\"><span style=\"font-weight: 400;\">Celexa<\/span><\/a><span style=\"font-weight: 400;\"> (citalopram)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/zoloft\"><span style=\"font-weight: 400;\">Zoloft<\/span><\/a><span style=\"font-weight: 400;\"> (sertraline)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/lexapro\"><span style=\"font-weight: 400;\">Lexapro<\/span><\/a><span style=\"font-weight: 400;\"> (escitalopram)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/prozac\"><span style=\"font-weight: 400;\">Prozac<\/span><\/a><span style=\"font-weight: 400;\"> (fluoxetine)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/paxil\"><span style=\"font-weight: 400;\">Paxil<\/span><\/a><span style=\"font-weight: 400;\"> (paroxetine)<\/span><\/li>\n<\/ul>\n<h3 id=\"warfarin\"><span style=\"font-weight: 400;\">Warfarin<\/span><\/h3>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/warfarin-sodium\"><span style=\"font-weight: 400;\">Warfarin<\/span><\/a><span style=\"font-weight: 400;\"> is a long-standing member of the <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/anticoagulants\"><span style=\"font-weight: 400;\">anticoagulant<\/span><\/a><span style=\"font-weight: 400;\"> class of drugs. Its blood-thinning effects can be diminished by metformin, putting users at risk for blood clots. A doctor may still want both medications to be taken and will closely monitor the international normalized ratio (INR) to watch the effectiveness of warfarin. The dosing of warfarin can be adjusted if necessary.<\/span><\/p>\n<h2 id=\"metformin-food-interactions\"><span style=\"font-weight: 400;\">Metformin-food interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Taken at mealtime, metformin absorption, and effects are slowed. For this reason, the prescriber may want it taken with meals. One will still want to limit their carbohydrate intake by restricting bread, white potatoes, pasta, and sugars to help metformin achieve its mission of diabetes control.<\/span><\/p>\n<h2 id=\"other-metformin-interactions\"><span style=\"font-weight: 400;\">Other metformin interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Clearly, there are a number of drugs that interact with metformin. The potential hazards do not end there. Heavy alcohol consumption and renal insufficiency pose risks with the drug as well.<\/span><\/p>\n<h3 id=\"metformin-and-alcohol\"><span style=\"font-weight: 400;\">Metformin and alcohol<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Drinking an excessive amount of alcohol, either in the short-term or long-term, can raise lactic acid levels. Taken along with metformin, high levels of alcohol intake could elevate the risk of lactic acidosis. The risk warrants limiting or avoiding alcohol as determined by a doctor.<\/span><\/p>\n<h3 id=\"metformin-and-kidney-disease\"><span style=\"font-weight: 400;\">Metformin and kidney disease<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Metformin is excreted by the kidney. If the kidneys are not working well, it makes sense that metformin levels will rise, along with the risk of adverse effects. Depending on the level of <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/chronic-kidney-disease\/\"><span style=\"font-weight: 400;\">renal impairment<\/span><\/a><span style=\"font-weight: 400;\">, the metformin dose may need to be limited, or the drug could have to be avoided altogether.<\/span><\/p>\n<h3 id=\"metformin-and-liver-disease\"><span style=\"font-weight: 400;\">Metformin and liver disease<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Metformin reduces lactate absorption in the liver, raising lactate blood levels and thus increasing the risk of lactic acidosis for those with advanced stages of liver dysfunction. A doctor will determine if it is best to avoid metformin if advanced hepatic impairment is a concern.<\/span><\/p>\n<h3 id=\"metformin-and-heart-disease\"><span style=\"font-weight: 400;\">Metformin and heart disease<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Severe degrees of congestive heart failure are associated with poor tissue perfusion from reduced circulation. As a result, more lactic acid may be produced. This can be particularly bad news if coupled with metformin. However, if heart failure is stable and controlled, a medical provider may keep one on a dose of metformin.<\/span><\/p>\n<h3 id=\"metformin-and-vitamin-b12\"><span style=\"font-weight: 400;\">Metformin and vitamin B12<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Vitamin B12 absorption is inhibited by metformin. As a result, levels of this nutrient can drop, causing one to develop a vitamin B12 deficiency, putting one at risk of anemia and neurologic symptoms like tingling and memory loss. Typically, a daily <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/vitamin-b12\"><span style=\"font-weight: 400;\">vitamin B12 supplement<\/span><\/a><span style=\"font-weight: 400;\"> or regular monitoring of vitamin B12 levels is recommended during metformin therapy.<\/span><\/p>\n<h2 id=\"how-to-minimize-metformin-interactions\"><span style=\"font-weight: 400;\">How to minimize metformin interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Get on the same page as your healthcare provider to minimize metformin interactions. Make sure to review with them a list of prescription drugs, supplements, and over-the-counter medications currently being taken. Report alcohol consumption habits. Ensure that kidney, liver, and heart function have been monitored. If a CT scan is needed, check if iodinated contrast will be given and if a metformin dose needs to be altered. Most importantly, be willing to raise any concerns with the provider and then follow instructions on how to monitor or adjust a treatment plan.<\/span><\/p>\n<h2 id=\"when-to-talk-to-a-healthcare-provider-about-metformin-interactions\"><span style=\"font-weight: 400;\">When to talk to a healthcare provider about metformin interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As soon as one is prescribed metformin, ask about interactions with drugs, food, and other medical conditions. Likewise, during metformin therapy, ask about interactions again if a new medicine is prescribed or if habits or health conditions change. One can be their best advocate, and the healthcare team will always welcome active participation in diabetes care.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Metformin is the first-line drug of choice prescribed by medical professionals for Type 2 diabetes treatment. It is also used off-label for insulin resistance in polycystic ovary syndrome (PCOS). A pill with a long history of use, metformin has stood the test of time by effectively lowering blood glucose levels and the risk of diabetic [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":61790,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[10298,814],"coauthors":[20732],"class_list":["post-61789","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-diabetes","tag-drug-interactions","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Metformin interactions to avoid | SingleCare<\/title>\n<meta name=\"description\" content=\"Metformin (Riomet) interacts with iodinated radiologic contrast, OCT and ACE inhibitors, NSAIDs, and alcohol. 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