{"id":8750,"date":"2020-02-06T13:00:29","date_gmt":"2020-02-06T18:00:29","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=8750"},"modified":"2025-01-15T15:36:35","modified_gmt":"2025-01-15T20:36:35","slug":"metformin-side-effects","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/metformin-side-effects\/","title":{"rendered":"Metformin side effects and how to avoid them"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/metformin-hcl\"><span style=\"font-weight: 400;\">Metformin<\/span><\/a><span style=\"font-weight: 400;\"> is an oral medication commonly prescribed to treat Type 2 diabetes and prediabetes. It helps to control blood glucose levels and restore the body&#8217;s response to insulin. When someone is first diagnosed with Type 2 diabetes, metformin is one medication that is often recommended along with diet and exercise. However, it can cause side effects, especially in the stomach and bowels. Here, we\u2019ll look at possible common and more serious side effects of metformin and discuss how some of them can be managed.\u00a0<\/span><\/p>\n<h2 id=\"common-side-effects-of-metformin\"><span style=\"font-weight: 400;\">Common side effects of metformin<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Metformin lowers blood sugar by slowing down the release of glucose from the liver into the bloodstream. It also slows glucose absorption and helps the body use insulin more effectively.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As with any medication, metformin has the potential for side effects. Taking metformin with food can help to reduce some of them. Common side effects of metformin <\/span><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=56d13a1c-b289-4528-b23c-60f5427b4552\"><span style=\"font-weight: 400;\">include<\/span><\/a><span style=\"font-weight: 400;\">:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diarrhea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nausea or vomiting<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Upset stomach<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gas<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Low energy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headache<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Low vitamin B12 levels<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Less commonly, people may also experience:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Metallic taste in the mouth<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Weight loss<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Loss of appetite<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Low blood sugar, especially when taken together with other diabetes medications or insulin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dizziness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shortness of breath or chest pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Skin or nail problems<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Body aches<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sweating or chills<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heart racing\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Many of metformin\u2019s side effects are more common when someone first starts taking it. For some people, these side effects go away after their body adjusts to the medication. For others, side effects may continue or become worse. Some metformin side effects, like low vitamin B12 levels, don\u2019t always have symptoms, so regular checkups are essential.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Most people who take metformin alone don\u2019t have trouble with low blood sugar. It\u2019s one of the advantages of metformin. But, people who take it with <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/insulins\"><span style=\"font-weight: 400;\">insulin<\/span><\/a><span style=\"font-weight: 400;\"> or other diabetes drugs, like <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/sulfonylureas\"><span style=\"font-weight: 400;\">sulfonylureas<\/span><\/a><span style=\"font-weight: 400;\">, may have a higher risk of low blood sugar. Signs of hypoglycemia include dizziness, shaking, confusion, fatigue, and fainting.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin is sometimes prescribed off-label to women with polycystic ovary syndrome (<\/span><a href=\"https:\/\/www.singlecare.com\/blog\/metformin-for-pcos\/\"><span style=\"font-weight: 400;\">PCOS<\/span><\/a><span style=\"font-weight: 400;\">), a condition that can cause hormone imbalance, higher blood sugar levels, and irregular periods. Metformin may lead to more <\/span><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8995234\/\"><span style=\"font-weight: 400;\">regular ovulation<\/span><\/a><span style=\"font-weight: 400;\"> for women with PCOS. This is a benefit for people who are being treated for infertility. But those who choose not to become pregnant should also be aware of this as a side effect.<\/span><\/p>\n<h2 id=\"serious-side-effects-of-metformin\"><span style=\"font-weight: 400;\">Serious side effects of metformin\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Lactic acidosis is a very rare but serious side effect of metformin that requires emergency medical attention. It almost never occurs when metformin is taken as directed under the care of a healthcare professional. The risk factors for lactic acidosis with metformin include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Advanced kidney disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Liver disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drinking excessive amounts of alcohol<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In certain medical or surgical settings, such as not eating before or after surgery or getting IV contrast for radiology studies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Taking large amounts of metformin<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Signs and symptoms of lactic acidosis include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dizziness or lightheadedness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Muscle pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Extreme weakness or tiredness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Trouble breathing\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A fast or slow heart rate<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Flushing of the skin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Decreased appetite<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severe stomach pain<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Although it&#8217;s rare, metformin may cause allergic reactions. Signs of an allergic reaction include difficulty breathing, swelling of the face or hands, and a skin rash. Seek immediate medical attention if you believe you&#8217;re experiencing an allergic reaction.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Taking metformin for extended amounts of time may lead to a vitamin B12 deficiency. Over time, this can lead to anemia and other health problems. People taking metformin should have regular blood tests that include vitamin B12 levels.\u00a0<\/span><\/p>\n<h2 id=\"metformin-warnings\"><span style=\"font-weight: 400;\">Metformin warnings\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">Metformin is FDA-approved for adults and children 10 and older. Adults over 65 may need more frequent checks for conditions that could increase the risk of side effects.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin should not be used or used with caution in people who:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have liver or kidney disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have heart failure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are not able to eat for a period of time<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are getting ready for surgery or just after surgery<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drink a lot of alcohol<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Will be having a CT scan or other study that uses IV contrast solution<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">People with diabetes should have regular checkups and lab tests as directed by their doctor. This can prevent the most serious side effects of metformin.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin is not used to treat Type 1 diabetes. Only insulin treats Type 1 diabetes.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin is considered generally safe to use during pregnancy and breastfeeding. However, a doctor will reassess the best treatment plan for safety and effectiveness during pregnancy.<\/span><\/p>\n<h2 id=\"metformin-interactions\"><span style=\"font-weight: 400;\">Metformin interactions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">People who use insulin or other diabetes medications together with metformin may be at higher risk of low blood sugar.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some medications can increase the risk of side effects. Others can make metformin less effective.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8220;Metformin can <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/metformin-interactions\/\"><span style=\"font-weight: 400;\">interact with other medications<\/span><\/a><span style=\"font-weight: 400;\">, including diuretic medications, steroid medications, certain thyroid drugs, oral contraceptives, and calcium channel blocking drugs like nifedipine,&#8221; says Chirag Shah, MD, and co-founder of <\/span><a href=\"https:\/\/www.pushhealth.com\/\"><span style=\"font-weight: 400;\">Push Health<\/span><\/a><span style=\"font-weight: 400;\">, an online healthcare platform. &#8220;Due to a wide range of medication interactions, it is important to review a patient&#8217;s current medications before prescribing metformin.&#8221;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medications that may decrease the effectiveness of metformin include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/quinolones\"><span style=\"font-weight: 400;\">Quinolone antibiotics<\/span><\/a><span style=\"font-weight: 400;\"> such as ciprofloxacin and levofloxacin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/thiazide-diuretics\"><span style=\"font-weight: 400;\">Thiazide diuretics<\/span><\/a><span style=\"font-weight: 400;\"> such as hydrochlorothiazide and chlorthalidone<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/calcium-channel-blockers\"><span style=\"font-weight: 400;\">calcium <\/span><\/a><span style=\"font-weight: 400;\">channel-blocking blood pressure medications, such as verapamil and nifedipine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/corticosteroids\"><span style=\"font-weight: 400;\">Steroids<\/span><\/a><span style=\"font-weight: 400;\"> such as prednisone<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Medications that may increase the risk of serious side effects through liver or kidney damage:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">IV contrast medication given before some MRIs, X-rays, or CT scans\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Excessive alcohol<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High doses or long-term use of non-steroidal anti-inflammatory drugs (<\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/nsaids\"><span style=\"font-weight: 400;\">NSAIDs<\/span><\/a><span style=\"font-weight: 400;\">) like ibuprofen or naproxen<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Interactions that may <\/span><a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a696005.html\"><span style=\"font-weight: 400;\">increase the risk<\/span><\/a><span style=\"font-weight: 400;\"> of lactic acidosis:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Glaucoma drugs <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/carbonic-anhydrase-inhibitors\"><span style=\"font-weight: 400;\">acetazolamide, dichlorphenamide, and methazolamide<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/topiramate\/what-is\"><span style=\"font-weight: 400;\">Topiramate<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/zonisamide\/what-is\"><span style=\"font-weight: 400;\">Zonisamide<\/span><\/a><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">People taking thyroid medication may also need to monitor thyroid levels more closely.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metformin may be prescribed on its own as a generic medication. Or it may be prescribed as part of a brand-name combination pill such as<\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/janumet\/what-is\"><span style=\"font-weight: 400;\"> Janumet<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/invokamet\/what-is\"><span style=\"font-weight: 400;\">Invokamet<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/actoplus-met\/what-is\"><span style=\"font-weight: 400;\">Actoplus Met<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/synjardy\/what-is\"><span style=\"font-weight: 400;\">Synjardy<\/span><\/a><span style=\"font-weight: 400;\">. Ask your healthcare provider or pharmacist whether your combination pills contain metformin.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To avoid drug interactions with metformin, talk with your healthcare provider about all prescription and over-the-counter (OTC) medications you take. Include vitamins and supplements.<\/span><\/p>\n<h2 id=\"managing-metformin-side-effects\"><span style=\"font-weight: 400;\">Managing metformin side effects<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Take metformin only as the dosage and schedule recommended by your healthcare provider.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some of the more common side effects may be managed by:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Starting at a low dose and increasing slowly<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Taking it <\/span><a href=\"https:\/\/www.accessdata.fda.gov\/spl\/data\/8b4401f6-af1d-47ce-b577-c431c3313afe\/8b4401f6-af1d-47ce-b577-c431c3313afe.xml\"><span style=\"font-weight: 400;\">with meals<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Switching to an extended-release version of metformin<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To prevent the more serious side effects of metformin, keep regular appointments for follow-up visits and lab tests. This will help ensure that no changes occur that may increase the risk of side effects.<\/span><\/p>\n<h2 id=\"metformin-vs-metformin-er\"><span style=\"font-weight: 400;\">Metformin vs. metformin ER<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Metformin and metformin extended-release (ER) are essentially the same medication, but the body absorbs the ER version more slowly. It\u2019s usually taken only once a day instead of twice.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Just like regular metformin, metformin ER should only be taken as directed by your healthcare provider. The potential medication interactions and side effects are similar, but the risk of GI side effects is lower with metformin ER.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Metformin is an oral medication commonly prescribed to treat Type 2 diabetes and prediabetes. It helps to control blood glucose levels and restore the body&#8217;s response to insulin. When someone is first diagnosed with Type 2 diabetes, metformin is one medication that is often recommended along with diet and exercise. However, it can cause side [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":8245,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[10298,12752],"coauthors":[8861],"class_list":["post-8750","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-diabetes","tag-medication-side-effects","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 side effects and interactions, and how to avoid them<\/title>\n<meta name=\"description\" content=\"Upset stomach and weight loss are some metformin side effects. 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