Metformin Side Effects: What You Need to Know

What Is Metformin?

Metformin is a type of medicine that's called a biguanide. It is mainly prescribed for Type 2 Diabetes, but it may be used for other conditions, such as Polycystic Ovary Syndrome (PCOS) and insulin resistance. Metformin acts by lowering the production of sugar by the liver, inhibiting the absorption of sugar by the intestine and enhancing insulin sensitivity.

Many people start taking metformin as a first-line drug following a change in lifestyle, like diet and exercise. Although it can be very beneficial at managing blood glucose levels, there are side effects associated with it, particularly when first used or when increasing dose levels.

Common Metformin Side Effects

Metformin's most common side effects are related to the digestive system. These symptoms are typically mild and diminish as the body gets used to the drug.

Nausea

One of the most common side effects is nausea that occurs in the first few weeks of treatment. Some people get dizzy after taking their medicine, especially if they take it when they don't have any food in their stomach.

Diarrhea

Another common complaint of people taking Metformin is diarrhea. It can be anything from a little bit of discomfort to frequent bathroom trips. This symptom often can be reduced by taking metformin with meals.

Abdominal cramps and pain.

A few people may feel some stomach discomfort or bloating, or stomach cramps after beginning taking metformin. These symptoms are typically reduced as time passes, as the digestive system adjusts.

Loss of Appetite

For some, taking Metformin can lessen appetite. This can be helpful in losing weight but for some patients it may make mealtime more difficult.

Metallic taste in the mouth.

Occasionally a metallic taste in the mouth is reported. While harmless, it may be annoying and can affect food enjoyment.

Less Common Side Effects

Not as common, but some people may have other side effects, which will need to be monitored.

Headaches

Patients can get headaches if they begin taking metformin or if they change the dose. This symptom can be controlled by hydration and according to medical recommendations.

Dizziness

A few people feel dizzy or faint. This sometimes has to do with fluctuations in blood sugar levels, and not the medication.

Fatigue

Some patients may have an increase in weakness or fatigue. If it persists, fatigue should be brought to the attention of a health-care provider to exclude other causes.

Skin Reactions

In rare cases, skin irritation, itching or mild rashes may occur with the use of metformin. All severe allergic reactions are to be considered medical emergencies.

Vitamin B12 Deficiency and Metformin

Metformin has been known to cause vitamin B12 deficiency when taken for a long time. This can cause a deficiency of vitamin B12 over time, especially in the elderly or those consuming large amounts.

Vitamin B12 deficiency can cause symptoms such as:

• Fatigue and weakness
• Hands and feet feel tingly or numb
• Difficulty concentrating
• Memory problems
• Pale skin
• Shortness of breath

Periodic blood tests may be recommended to watch B12 levels while taking treatment for a long time. Sometimes, B12 supplements are needed.

Rare but Serious Side Effects

While rare, there are also some very serious side effects that can occur with the use of metformin and that you must seek treatment for right away.

Lactic Acidosis

The most severe possible side effect of taking metformin is a condition known as Lactic Acidosis. This is when the amount of lactic acid in the blood increases more rapidly than it can be eliminated.

Lactic acidosis is unusual, but can be fatal. This occurs more frequently in people with very bad kidney disease, liver disease, or people who drink too much alcohol, or people with certain heart diseases.

Symptoms may include:

• Very weak or tired.
• Muscle pain
• Difficulty breathing
• Severe dizziness
• Slow or irregular pulse.
• Abdominal pain, nausea and vomiting
• Feeling unusually cold

Emergency medical attention should be sought if someone has any of these symptoms.

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Severe Allergic Reactions

While uncommon, individuals can build up an extreme response to a drug, for example, metformin. Symptoms may include:

• The face, lips, tongue or throat becomes swollen
• Difficulty breathing
• Severe rash
• Hives

If any of the following symptoms are present, medical treatment is needed.

Who is More Likely to Experience Side Effects?

Some things can make it more likely that you will have a metformin side effect:

• Beginning with a big dose
• Rapid dosage increases
• Not eating food with the medicines
• Older age
• Existing digestive conditions
• Diseases of kidneys or liver.
• Excessive alcohol consumption

To reduce gastrointestinal side effects, doctors usually begin with a low dosage and increase it over time.

Who Is More Likely to Experience Side Effects?

Simple tips can help you manage and decrease the side effects of taking metformin.

Administered With Food.

Medicine taken with or after food helps to diminish nausea, stomach upset and diarrhea.

Stay Hydrated

Water is important to keep the digestive tract healthy, and it may help alleviate some digestive symptoms.

Follow Prescribed Dosages

Do not alter dosage without advice from a health care professional. Sometimes tolerance can be improved by making incremental increases or decreases in dose.

Consider Extended-Release Formulations

There is the possibility that there are fewer digestive side effects with extended-release metformin, compared to immediate-release varieties. If the pain persists, the patient can talk to their physician about the possibility.

Limit Alcohol Intake

It may be harmful if taken with alcohol, which may cause lactic acidosis and will increase the risk of developing some side effects. Moderation/Avoidance is generally recommended.

When to Contact a Doctor?

If the patient has any of the following symptoms, he should contact his health professional:

• Diarrhea that doesn't go away for several days
• Severe stomach pain
• Significant weight loss
• Continued vomiting, nausea
• Vitamin B12 deficiency symptoms
• Symptoms of allergic reaction
• Signs and symptoms compatible with lactic acidosis.

Early treatment can avoid complications and ensure safe treatment.

Conclusion

Metformin is one of the best and most commonly used drugs for treating Type 2 Diabetes. The side effects are mostly mild and affect the digestive system, mainly at the beginning of the treatment. Common symptoms like nausea, diarrhoea, stomach discomfort and appetite changes may get better with time. Patients should be aware of less common problems (vitamin B12 deficiency), and a rare but serious problem (lactic acidosis). With proper use, medical advice, and keeping an eye out for any strange side effects, most people can continue to use this invaluable drug without any problems and achieve effective blood sugar control.

Please book an appointment with the best Endocrinologist in Lahore, Karachi, Islamabad, and all major cities of Pakistan through InstaCare, or call our helpline at 03171777509 to find a verified doctor for your disease.