Overview
Metformin is a first-choice medication to control your blood sugar and lower your risk of death from diabetes, although some people cannot tolerate the stomach side effects.
What is Metformin used for?
- Type 2 diabetes
How Metformin works
Metformin is a medication used to manage diabetes. It lowers the amount of sugar your body makes or absorbs, and allows you to use your body's natural insulin better.
When does Metformin start working?
Time passed since treatment started:
Pharmacist tips for Metformin
- Stomach side effects, especially diarrhea, are common with metformin. For most people, this will go away after a few weeks of taking it. If it doesn't stop or is excessive, ask your provider about the long-acting version of metformin, which is less likely to have these side effects.
- Take your metformin with food to help lessen stomach upset.
- Limit or avoid alcohol when taking this medication. Too much alcohol or chronic alcohol use can put you at risk for a life-threatening side effect called lactic acidosis.
- Make sure to have any blood tests done and go to your regular check ups. This will tell your provider how well metformin is working for you.
- Check your blood sugar regularly. Keeping a log of your sugar levels is helpful for your provider.
What are the risks and warnings for Metformin?
Metformin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
LACTIC ACIDOSIS
- Risk factors: Kidney problems | Liver problems | Heart problems | Age 65 or greater | Alcohol use | Using contrast dye
Metformin can, on rare occasions, cause a condition called lactic acidosis (too much lactic acid in your blood). This condition can lead to other health problems that can be deadly. Call your provider immediately if you experience fast breathing, fast or slow heartbeat, heartbeat that does not feel normal, very upset stomach or throwing up, feeling very sleepy, shortness of breath, feeling very tired or weak, dizziness, feeling cold, or muscle pain. These can be signs of too much lactic acid in your blood. Tell your provider about any existing health problems and other medications before taking metformin.
LOW VITAMIN B12 LEVELS
- Risk factors: Long-term use of metformin | Lower than average calcium absorption | Lower than average vitamin B12 absorption
This risk is more relevant to people receiving long-term treatment with metformin. Metformin can cause low levels of vitamin B12, which can lead to anemia. Let your provider know about any persistent low energy, muscle weakness, low appetite, or tingling or numbness on hands or feet. A blood test can help determine if you have anemia and if metformin is the reason. Your provider should monitor your vitamin B12 levels at 2-3 year intervals.
LOW BLOOD SUGAR (HYPOGLYCEMIA)
- Risk factors: Changes in diet and exercise | Drinking alcohol | Taking other medications for diabetes | Over age 65 | Liver or kidney problems
Metformin alone or together with other diabetic medications can cause low blood sugar. Very low blood sugar may be life-threatening. Symptoms of low blood sugar include feeling shaky, being nervous or anxious, fast heartbeat, sweating or body chills, confusion, feeling sleepy, weakness or low energy, and excessive hunger. Talk to your provider or pharmacist if you are concerned about this.
Strengths
Ml of oral solution
- 500mg/5ml
Tablet
- 500mg
- 850mg
- 1000mg
Dosages
Metformin is usually started as 500 mg by mouth twice daily or 850 mg by mouth once daily. Depending on how well it works, the dose can be raised to a total of 2,550 mg by mouth per day split into a few doses throughout the day.
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Interactions
Metformin may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Metformin. Please note that only the generic name of each medication is listed below.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Acetrizoic Acid
- Diatrizoate
- Ethiodized Oil
- Iobenzamic Acid
- Iobitridol
- Iocarmic Acid
- Iocetamic Acid
- Iodamide
- Iodipamide
- Iodixanol
- Iodohippuric Acid
- Iodopyracet
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iohexol
- Iomeprol
- Iopamidol
- Iopanoic Acid
- Iopentol
- Iophendylate
- Iopromide
- Iopronic Acid
- Ioseric Acid
- Iosimide
- Iotasul
- Iothalamate
- Iotrolan
- Iotroxic Acid
- Ioxaglate
- Ioxitalamic Acid
- Ipodate
- Metrizamide
- Metrizoic Acid
- Tyropanoate Sodium
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aspirin
- Balofloxacin
- Besifloxacin
- Bupropion
- Capmatinib
- Chloroquine
- Ciprofloxacin
- Dasabuvir
- Dofetilide
- Dolutegravir
- Enoxacin
- Fleroxacin
- Flumequine
- Gatifloxacin
- Gemifloxacin
- Hydroxychloroquine
- Ioversol
- Lanreotide
- Levofloxacin
- Lomefloxacin
- Moxifloxacin
- Nadifloxacin
- Norfloxacin
- Octreotide
- Ofloxacin
- Ombitasvir
- Paritaprevir
- Pasireotide
- Pazufloxacin
- Pefloxacin
- Pioglitazone
- Prulifloxacin
- Ritonavir
- Rufloxacin
- Sitagliptin
- Sparfloxacin
- Tafenoquine
- Thioctic Acid
- Tosufloxacin
- Vandetanib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Atenolol
- Betaxolol
- Bisoprolol
- Bitter Melon
- Carteolol
- Carvedilol
- Celiprolol
- Colesevelam
- Esmolol
- Fenugreek
- Furazolidone
- Glucomannan
- Guar Gum
- Iproniazid
- Isocarboxazid
- Labetalol
- Levobunolol
- Linezolid
- Methylene Blue
- Metipranolol
- Metoprolol
- Moclobemide
- Nadolol
- Nebivolol
- Nialamide
- Oxprenolol
- Patiromer
- Penbutolol
- Phenelzine
- Pindolol
- Practolol
- Procarbazine
- Propranolol
- Psyllium
- Ranolazine
- Rasagiline
- Rifampin
- Safinamide
- Selegiline
- Sotalol
- Timolol
- Tranylcypromine
- Verapamil
Side-effects
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Diarrhea (53%)
- Nausea or vomiting (26%)
- Gas (12%)
- Indigestion (7%)
- Stomach pain (6%)
- Headache (6%)
Other Side Effects
- Weakness
- Headache
- Low vitamin B12 levels
- Change in taste
Serious Side Effects
Contact your healthcare provider immediately if you experience any of the following.
- Lactic acidosis (too much lactic acid in the blood that can lead to death)
When do Metformin possible side effects begin and end?
Time passed since treatment started:
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
- Abdominal or stomach discomfort
- Cough or hoarseness
- Decreased appetite
- Diarrhea
- Fast or shallow breathing
- Fever or chills
- General feeling of discomfort
- Lower back or side pain
- Muscle pain or cramping
- Painful or difficult urination
- Sleepiness
Less common
- Anxiety
- Blurred vision
- Chest discomfort
- Cold sweats
- Coma
- Confusion
- Cool, pale skin
- Depression
- Difficult or labored breathing
- Dizziness
- Fast, irregular, pounding, or racing heartbeat or pulse
- Feeling of warmth
- Headache
- Increased hunger
- Increased sweating
- Nausea
- Nervousness
- Nightmares
- Redness of the face, neck, arms, and occasionally, upper chest
- Seizures
- Shakiness
- Slurred speech
- Tightness in the chest
- Unusual tiredness or weakness
Rare
- Behavior change similar to being drunk
- Difficulty with concentrating
- Drowsiness
- Lack or loss of strength
- Restless sleep
- Unusual sleepiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Acid or sour stomach
- Belching
- Bloated
- Excess air or gas in the stomach or intestines
- Full feeling
- Heartburn
- Indigestion
- Loss of appetite
- Metallic taste in the mouth
- Passing of gas
- Stomachache
- Stomach upset or pain
- Vomiting
- Weight loss
Less common
- Abnormal stools
- Bad, unusual, or unpleasant (after) taste
- Change in taste
- Difficulty with moving
- Discoloration of the fingernails or toenails
- Flu-like symptoms
- Joint pain
- Rash
- Sneezing
- Stuffy or runny nose
- Swollen joints
Common Concerns
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