The whole lot You Have to Know About Metformin

Metformin is without doubt one of the hottest oral medicines used to deal with folks with kind 2 diabetes.

Taking metformin as prescribed may also help decrease each blood sugar ranges and HbA1c ranges (a measure of glucose management over the earlier 2 to three months) and battle insulin resistance (a situation wherein the physique doesn’t use insulin effectively). 

Though it isn’t accepted by the U.S. Meals and Drug Administration (FDA) as a weight-loss therapy, it could additionally assist folks drop extra pounds, in some instances.

This text will define every thing you want to find out about this well-liked diabetes drug.

Key Factors:

  • Metformin features by lowering glucose manufacturing within the liver, rising insulin sensitivity, and lowering sugar absorption from meals. 
  • It’s sometimes taken every day or two or 3 times every day with meals and is obtainable in immediate-release (IR) and extended-release varieties (XR or ER).
  • Metformin is taken into account secure, with a low threat of extreme low blood sugar. Widespread uncomfortable side effects embody gastrointestinal signs similar to stomachache and nausea.
  • Past kind 2 diabetes, metformin is being explored for treating circumstances similar to gestational diabetes and polycystic ovary syndrome (PCOS), and in most cancers, coronary heart illness, and anti-aging analysis. It’s additionally used off-label for kind 1 diabetes and weight administration.
  • Quite a lot of medicines might work together negatively with metformin, similar to sure diuretics and antibiotics. Extreme alcohol consumption can also be suggested in opposition to whereas taking metformin.
  • The drugs is very accessible and reasonably priced and coated by most medical health insurance plans, together with Medicare and Medicaid. Its cost-effectiveness and extensive availability make it a sensible alternative for many individuals managing kind 2 diabetes.
The whole lot You Have to Know About Metformin

What’s metformin?

Permitted in the USA in 1994 and studied in people because the Fifties, metformin is a prescription drug taken to assist handle diabetes. It’s the solely obtainable medication in a category of medication known as biguanides, and it is available in tablet kind and liquid kind. 

Metformin capsules can be found in each immediate-release and extended-release formulations. Relying in your administration wants and the kind of medication you take, you could be instructed to take your treatment both every day or two or 3 times every day with meals.

Metformin model names

Some model names embody:

  • Fortamet
  • Glucophage
  • Glucophage XR
  • Glumetza
  • Riomet
  • Riomet ER

Metformin can also be an ingredient in quite a lot of mixture medicines. 

Learn extra: Metformin Mixture Medicine for Type 2 Diabetes.

How does metformin work? 

Metformin lowers blood sugar ranges by three strategies:

Together with adopting a nutritious diet and interesting in common bodily exercise, this could result in decrease blood sugar ranges, lowered HbA1c ranges, and, typically, weight reduction.

Widespread uncomfortable side effects of metformin

Most individuals tolerate metformin nicely. It’s thought-about extraordinarily secure and doesn’t sometimes trigger harmful hypoglycemia (low blood sugar) except you’re taking considerably greater than prescribed or are utilizing it together with different medicines that may trigger low blood sugar, similar to insulin or a sulfonylurea.

It’s a reasonable and efficient treatment that’s extensively accessible. Nevertheless, some folks might expertise delicate to average uncomfortable side effects, together with:

  • Stomachache
  • Abdomen cramps
  • Nausea 
  • Vomiting
  • Diarrhea
  • Lack of urge for food
  • Weight reduction
  • Metallic style within the mouth
  • Weight achieve (uncommon)

Much less frequent however extra severe potential uncomfortable side effects of metformin embody:

  • Hypoglycemia (if taken together with insulin or sulfonylureas)
  • Lactic acidosis (a probably deadly situation wherein lactic acid builds up within the physique)
  • Vitamin B12 deficiency

You may be taught extra about potential uncomfortable side effects in our article: Metformin Facet Results: What You Have to Know.


Metformin hardly ever causes hypoglycemia in folks with diabetes who usually are not additionally on insulin (or one other drug that will increase insulin manufacturing) as a result of it doesn’t improve insulin manufacturing like many different diabetes medicines.

Name your physician in case you have any signs of hypoglycemia, which might embody:

  • Weak spot
  • Tiredness
  • Nausea
  • Vomiting
  • Abdomen ache
  • Dizziness
  • Lightheadedness
  • Abnormally quick or gradual heartbeat

Lactic acidosis

Metformin comes with a “black field” warning concerning the threat of lactic acidosis, probably the most extreme warning that the FDA points.

Signs of this situation can embody:

  • Nausea
  • Vomiting
  • Weak spot
  • Fatigue
  • Quick, deep respiration
  • Muscle cramps and physique aches

Nevertheless, based on “The Phantom of Lactic Acidosis as a result of Metformin in Sufferers With Diabetes,” revealed within the American Diabetes Affiliation’s (ADA) journal Diabetes Care, the overwhelming majority of research discovered no cases of lactic acidosis in folks taking metformin. 

Nearly all instances of lactic acidosis from metformin use are outcomes of overdoses — not regular use of the drug.

Learn extra: Can Metformin Trigger Lactic Acidosis?

Vitamin B12 deficiency

In research, researchers have discovered that long-term use of metformin could cause vitamin B12 deficiency. Left untreated, this could result in important nerve injury. 

Everybody taking metformin ought to have their B12 ranges examined yearly. In session with their healthcare supplier, anybody with insufficient ranges ought to begin taking a B12 complement instantly. (Vitamin B12 injections each few months could also be beneficial in some instances.)

As a result of vitamin B12 isn’t produced by vegetation, supplementing with the vitamin in case you are vegan or eat a largely plant-based weight loss program could also be particularly vital. 

Metformin and “false lows”

Some folks expertise “false lows” (signs of hypoglycemia even when blood sugar ranges are inside regular vary) when beginning metformin. 

This may occur in case you’re used to having near-constant excessive blood sugar ranges. As a result of your physique is used to those excessive ranges, a traditional blood sugar stage feels low. 

The false lows ought to go away as your physique adjusts to your new blood sugar stage. (At all times verify your blood sugar in case you are feeling low, because it might not be a false low.)

Easy methods to take metformin

Metformin needs to be taken entire (not crushed, damaged, or chewed) with a drink of water with a meal to assist keep away from an upset abdomen. 

Attempt to take it with a higher-protein meal or snack, and by no means take metformin on an empty abdomen. The drugs is often higher tolerated within the night, so taking it with dinner is greatest. 

If you’re experiencing extreme gastrointestinal points whereas taking metformin, converse together with your physician. They could scale back your dose or change you to an extended-release model of the drugs. 

As a result of the extended-release medication is launched over a number of hours as an alternative of instantly, you could expertise fewer digestive uncomfortable side effects with this strategy.

(Word that when utilizing the extended-release type of the pill, it’s frequent and never a trigger for concern to seek out a part of the pill in your stool. This happens after the treatment has been absorbed by your physique.)


The most typical doses for adults with diabetes are:

Quick-release tablets:

  • 500 milligrams (mg)
  • 850 mg
  • 1,000 mg

Prolonged-release tablets and liquid kind:

It’s beneficial to begin with a low dose and improve it in case you tolerate the drug nicely and want the next dose to manage your blood sugar ranges. At all times verify together with your physician first earlier than rising your dose. 

Learn extra: Metformin Dosage Information (Min and Max Doses).

What must you do in case you miss a dose?

Take your metformin as quickly as you possibly can, except it’s virtually time on your subsequent dose. Don’t take two doses at one time.

Are you able to overdose on metformin?

Sure, that is attainable, but it surely’s very uncommon. A big overdose could cause extreme and probably harmful hypoglycemia or lactic acidosis. 

Search emergency medical consideration in case you assume you’ve got overdosed.

When will I see outcomes after beginning metformin? 

The Mayo Clinic notes that “Chances are you’ll discover an enchancment in your blood glucose management in 1 to 2 weeks, however the full impact of blood glucose management might take as much as 2 to three months.” 

Be affected person. Hold recurrently checking your blood sugar ranges and taking your treatment, and you need to ultimately see important enhancements from this treatment. 

Work together with your healthcare supplier to find out how your present metformin dose is working for you, and what (if any) changes must be made to enhance outcomes or reduce any unfavourable uncomfortable side effects you could be experiencing. 

How do I do know if the treatment is working?

Metformin’s effectiveness could be gauged via a number of indicators. A discount in blood sugar ranges and HbA1c, noticeable after a number of weeks to months, usually signifies that it’s working. Some folks can also expertise modest weight reduction. 

Nevertheless, persistent excessive blood sugar ranges, no enchancment in HbA1c, or unexplained weight achieve regardless of a wholesome life-style may counsel that it isn’t working as supposed. 

For a extra detailed understanding, learn: Indicators Metformin Is Working (Or Isn’t Working).

Can I cease taking metformin?

Stopping metformin needs to be a rigorously thought-about choice, prompted by lack of effectiveness, extreme uncomfortable side effects, or modifications in your healthcare wants and life-style. 

It’s essential to not cease the drugs abruptly, since this could result in unfavourable well being results similar to excessive blood sugar and potential diabetes issues. At all times converse together with your physician for steerage on methods to wean off the drug. This will likely contain adjusting the dosage over time and exploring different medicines or life-style modifications. 

For additional insights, learn: Stopping Metformin: When and How You Can Cease Taking Metformin.

Are there different medicines?

Whereas metformin is a extensively used and efficient therapy for kind 2 diabetes, it might not go well with everybody as a result of uncomfortable side effects or lack of efficacy. Luckily, quite a lot of different treatment choices exist, every with their very own advantages and potential uncomfortable side effects. 

Way of life modifications like weight loss program and train will also be efficient, both to be used alongside a special medication or as standalone remedies, in some instances. 

It’s vital to talk together with your healthcare supplier to seek out probably the most appropriate different based mostly in your particular person wants and circumstances. 

For an in-depth have a look at these choices, see: The Finest Options to Metformin for Type 2 Diabetes Administration.

Who mustn’t take metformin?

Individuals with sure circumstances could also be suggested in opposition to taking metformin. Communicate together with your physician previous to taking this medication in case you:

What medicine to keep away from whereas taking metformin

The Mayo Clinic lists the medicine that will work together negatively with metformin. 

Utilizing metformin with the next medicines is just not beneficial. If you’re on any of those medicines, work together with your physician to find out the most effective strategy: 

  • 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
  • Iopronic Acid
  • Ioseric Acid
  • Iosimide
  • Iotasul
  • Iothalamate
  • Iotrolan
  • Iotroxic Acid
  • Ioxaglate
  • Ioxitalamic Acid
  • Ipodate
  • Metrizamide
  • Metrizoic Acid
  • Tyropanoate Sodium

Utilizing metformin with any of the next medicines is usually not beneficial however could also be required. On this case, your physician might alter the dose or how usually one or each of the medicines is used. Communicate together with your physician to determine what’s going to work greatest for you: 

  • Abiraterone Acetate
  • Acetazolamide
  • Alogliptin
  • Aspirin
  • Bexagliflozin
  • Bictegravir
  • Brinzolamide
  • Bupropion
  • Capmatinib
  • Chloroquine
  • Chlorpropamide
  • Cimetidine
  • Ciprofloxacin
  • Dasabuvir
  • Delafloxacin
  • Dichlorphenamide
  • Dofetilide
  • Dolutegravir
  • Dorzolamide
  • Enoxacin
  • Fedratinib
  • Fexinidazole
  • Gatifloxacin
  • Gemifloxacin
  • Glimepiride
  • Glipizide
  • Glyburide
  • Grepafloxacin
  • Hydroxychloroquine
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Bovine
  • Insulin Degludec
  • Insulin Detemir
  • Insulin Glargine, Recombinant
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Iopromide
  • Ioversol
  • Isavuconazole
  • Lanreotide
  • Levofloxacin
  • Levoketoconazole
  • Liraglutide
  • Lomefloxacin
  • Methazolamide
  • Moxifloxacin
  • Nateglinide
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Ombitasvir
  • Paritaprevir
  • Pasireotide
  • Pioglitazone
  • Pramlintide
  • Ranolazine
  • Repaglinide
  • Semaglutide
  • Sitagliptin
  • Somatrogon-ghla
  • Sotagliflozin
  • Sparfloxacin
  • Tafenoquine
  • Thioctic Acid
  • Tolazamide
  • Tolbutamide
  • Topiramate
  • Trovafloxacin
  • Vandetanib
  • Zonisamide

Keep away from extreme alcohol use when taking metformin. Communicate together with your physician about how a lot, if any, alcohol use is secure for you.

Study extra about this mixture in: Metformin & Alcohol: Can You Drink Whereas Taking Metformin?

Widespread questions on metformin

How ought to the capsules be saved?

It’s beneficial to retailer the capsules at room temperature, between 68 to 77 levels Fahrenheit (20 to 25 levels Celsius) however they are often stored safely at 59 to 86 levels Fahrenheit (15 to 30 levels Celsius) for some time in case you are touring.

The capsules ought to all the time be saved in a light-resistant container (just like the container they initially got here in) away from warmth and extra moisture.

Can metformin trigger hair loss?

No, metformin is just not a identified explanation for hair loss. 

Nevertheless, long-term use of metformin could cause vitamin B12 deficiency. This may in flip stop hair follicles from receiving oxygenated blood, resulting in hair loss. Ask your physician for a vitamin B take a look at in case you discover hair loss or thinning hair.

Do I would like to vary my weight loss program?

Adjusting your weight loss program whereas taking metformin is vital for maximizing the drugs’s effectiveness and minimizing frequent uncomfortable side effects. Though no particular meals are strictly prohibited, it’s advisable to restrict alcohol, saturated and trans fat, refined carbohydrates, and high-sodium gadgets. Specializing in a balanced weight loss program wealthy in entire fruits, greens, lean proteins, and lower-fat dairy may also help improve metformin’s advantages in managing blood sugar ranges.

Extreme consumption of sure gadgets can decrease the drug’s effectiveness and worsen uncomfortable side effects. 

For detailed steerage on optimizing your weight loss program whereas on metformin, learn: Meals to Keep away from Whereas Taking Metformin.

Can I exploit metformin if I’m pregnant (or making an attempt to grow to be pregnant)?

Sure. Research haven’t proven any threat for mom and child when taking metformin. Nevertheless, all the time discuss to your physician concerning the medicines you’re taking while you’re pregnant or making an attempt to grow to be pregnant. 

Are you able to grow to be hooked on metformin?

No, there isn’t any proof that metformin is addictive.

Does metformin trigger most cancers?

In 2019, the FDA investigated whether or not some types of metformin contained excessive ranges of a chemical known as N-nitrosodimethylamine (NDMA), which is probably carcinogenic (cancer-causing).

In 2020 and 2021, a number of firms voluntarily recalled sure plenty of extended-release metformin based mostly on the FDA’s suggestions. You may verify to see in case your metformin was included in these remembers right here. 

Even in case you take a metformin product that has been recalled, it’s vital that you simply proceed to take your treatment till you discuss to your healthcare skilled. 

There isn’t a short-term well being threat — no human most cancers instances have been immediately linked to NDMA right now — and the unfavourable results of abruptly stopping metformin therapy far outweigh the advantages.

Testing by the FDA didn’t present NDMA in immediate-release metformin merchandise.

Are there different advantages of metformin? 

Metformin is at present getting used to deal with gestational diabetes (a kind of diabetes that happens throughout being pregnant) and polycystic ovary syndrome (PCOS, a situation wherein a girl’s hormones are out of stability, ensuing within the improvement of small, cyst-like sacs on the ovaries). 

The American Diabetes Affiliation has stated that extra medical doctors needs to be prescribing metformin to their sufferers to deal with prediabetes (a situation wherein blood glucose ranges are excessive, however not within the vary for a diabetes analysis) as nicely, particularly for folks underneath the age of 60. 

Researchers are additionally learning if metformin may also help within the battle in opposition to circumstances together with most cancers, coronary heart illness, weight problems, neurodegenerative circumstances (like Huntington’s illness and Parkinson’s illness), age-related macular degeneration (AMD), and even function an anti-aging complement. 

Metformin and kind 1 diabetes

Metformin is just not at present accepted in the USA or Europe for the therapy of kind 1 diabetes.

Nevertheless, many individuals with kind 1 diabetes take metformin “off-label” (in a approach not accepted by the FDA) to assist handle blood sugar ranges, reduce insulin resistance, and even drop extra pounds. 

A 3-year examine revealed within the journal The Lancet discovered that individuals with kind 1 diabetes taking metformin misplaced weight in comparison with placebo (inactive therapy).

Analysis has proven that metformin might assist scale back blood glucose ranges in folks with kind 1 diabetes. Metformin has been proven to cut back required insulin doses in addition to HbA1c ranges in folks with kind 1 diabetes.

Remember that taking metformin whereas on insulin for kind 1 diabetes could cause decrease blood sugars and the necessity for much less insulin. Subsequently, it is very important be conscious of potential hypoglycemia, particularly in a single day.

Closing ideas

If you’re an individual with kind 2 diabetes, taking metformin is a straightforward, cheap, and efficient option to decrease your blood sugar ranges, scale back your HbA1c stage, enhance your insulin sensitivity, and perhaps even lose slightly weight. 

The uncomfortable side effects are often delicate and the drug is taken into account very secure. And since there are such a lot of generic varieties, metformin is extraordinarily reasonably priced (and it’s coated by almost all medical health insurance plans, together with Medicare and Medicaid). 

In case your blood sugar ranges usually are not at goal together with your present therapy, converse together with your physician about the potential of including this treatment to your diabetes administration.

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