Metformin Side Effects: Common, Severe and Long Term

Medically Reviewed By: Dr. Surajeet Kumar Patra, MBBS, MD, FDIAB, MBA & APMP January 11, 2022

Metformin is a very popular and commonly used oral medication for treating and managing type-2 diabetes. The objective of the treatment of type-2 diabetes is to mainly manage blood glucose levels. The blood glucose levels of the body fluctuate due to the body’s resistance to insulin and the reduction in insulin production. Metformin thus aims to control these fluctuating blood glucose levels. Read this article to know about the side effects of metformin medicine.

Metformin Need- Type 2 Diabetes and Liver role

The liver and pancreas help in maintaining blood glucose levels. Insulin is secreted by the pancreas when the glucose from the digestion of the food enters the bloodstream. It is with the help of insulin the body cells can absorb the glucose for energy and metabolism. But the excessive body glucose is stored in the liver as hepatic glycogen [5].

During emergency needs, the hepatic glycogen from the liver is broken down to release glucose. Due to diabetes, the body becomes resistant to insulin. Thus, the body cell absorption of glucose decreases [5]. Cells need energy and thus liver starts converting the stored hepatic glycogen into glucose. This in turn increases the glucose level in the bloodstream.

Thus, in type-2 diabetes, the hepatic glucose production is high resulting in high blood glucose levels. Thus, there is a need to control hepatic glucose production. Metformin is an oral medicine that reduces hepatic glucose production by the liver [5].

Summary

Metformin is an oral medicine that reduces the hepatic glucose production of the liver. In this way, it controls blood glucose levels for type-2 diabetes management.

Metformin Uses

What is metformin used for?

  • Manages Type-2 diabetes by controlling liver glucose production: Metformin acts as an inhibitor to the respiratory chain of the liver. This inhibition results in a decrease in hepatic glucose production. Thus, Metformin manages glucose production in the liver [5].
  • Insulin sensitivity: It also helps in increasing the insulin sensitivity of the cells. This helps in controlling the glucose levels of the body.
  • Increased glucose utilization: Metformin helps in increasing the body glucose utilization in the intestine. This in turn regulates the blood glucose levels.
  • Weight management: Metformin alters the body’s stored fat usages. It also reduces your appetite and thus is used in weight management.
  • Polycystic ovary syndrome: Metformin stimulate ovulation and thus helps in treating polycystic ovary syndrome.

Summary

Metformin usages are controlling blood glucose levels, weight management, and polycystic ovary syndrome management.

Metformin Drug information & Dosages

It comes under different brand names namely: Glucophage, Glucophage XR, Fortamet, Glumetza, and Riomet [5].

Oral tablets of Metformin are also available in different doses. Immediate release Metformin tables are available as Metformin 500 mg, Metformin 850 mg, and Metformin 1000mg. Extended-release tablets are available as Metformin 500 mg, Metformin 750 mg, and Metformin 1000mg [5].

metformin side effects

The Metformin dose varies from person to person. The doctor shall prescribe these dosages as per your condition. The maximum dose of the medicine is 2000mg per day [5].

Also Read: Foods to Avoid While Taking Metformin

Metformin Side Effects

Metformin Common side effects

Some people may experience Metformin side effects. Some of the metformin’s most common side effects are as follows:

  • Continuous feeling to vomit i.e. nausea
  • Complaint of diarrhoea. Metformin can cause indigestion problems and can thus cause metformin diarrhoea.
  • Bloating, gastritis, and heartburn issues.
  • Having stomach ache
  • Fever or chills
  • Sleepiness
  • Having unusual muscular pain
  • Decrease in the desire to eat
  • Having an unusual taste in the mouth [7].

Generally, these metformin common side effects last for a few days. If they continue or they reappear again then seek the doctor’s help immediately.

Metformin Side Effects

Metformin Serious side effects

Certain effects can cause health issues. One should not delay in seeking a health expert’s advice immediately. These metformin serious side effects include:

Lactic acidosis

  •  A serious side effect of metformin is metformin lactic acidosis. In this condition lactic acid levels increases.
  • It is more common in patients with type-2 diabetes and with kidney problems [1].
  • Metformin increases anaerobic respiration by inhibiting cellular respiration. This causes lactate levels to increase [1].
  • Patients with renal issues are unable to clear accumulated lactic acid. This thus leads to lactic acid accumulation. This is metformin induced lactic acidosis.
  • This causes muscular pain, stomach problems, diarrhoea, trouble while breathing, and a decrease in appetite. You feel tired and have sleeping issues [1].
  • Leaving lactic acidosis untreated can be problematic. Various health issues like heart problems, sepsis, liver damage, kidney damage, and even death can occur due to lactic acidosis [1].
  • Seek immediate help in case you find any of these symptoms.

Also Read: Glucophage 500 MG Tablets to Control Your Blood Sugar Level

Allergic reaction

Metformin allergic reactions are not so common. Seek immediate health expert advice in case you notice any of the symptoms like:

  • Rashes on skin or hives
  • Fast and irregular heartbeats
  • Swelling of throat or tongue
  • The severe form of dizziness. Headache. Some may complain of headaches after consumption of metformin [4].
  • Shakiness and seizures [4]
  • Trouble while breathing and chest discomfort. Feeling tightness in the chest [4].

Hypoglycemia

  • Metformin hypoglycemia is seen in people who are also on insulin along with metformin.
  • Metformin lowers blood sugar levels. Sometimes overdose of metformin or metformin with insulin or its substitutes can decrease these blood sugar levels resulting in hypoglycemia [4].
  • The symptoms of hypoglycemia are feeling of trembling and shaky hands, sweating, feeling hungry, confusion, decreased focus, sleepy, difficult concentrating [4].
  • Sometimes improper diet along with metformin can cause hypoglycemia.
  • Measure your blood glucose levels before taking medicine. Measure the levels regularly after taking metformin. Don’t skip meals.
  • Take fast-acting carbohydrates to overcome hypoglycemia.
  • If your hypoglycaemic episodes continue seek doctor advice immediately.

Anaemia like serious symptoms

Metformin reduces vitamin B12 absorption [4]. This results in vitamin B12 and iron deficiency. Left untreated can cause anaemia symptoms that can cause serious health issues. Some metformin less common symptoms similar to anaemia and vitamin B12 deficiency that require immediate health attention are

  • changes in the skin colour, yellowness
  • feeling sleepy and dizzy
  • difficult in concentration and decrease in reflexes
  • depression and irritation
  • Dementia or memory loss [4].

Summary

Allergic reactions, lactic acidosis, hypoglycemia, anaemia are some serious side effects of Metformin that require health experts’ attention.

Metformin Long Term Side Effects

Most of the long-term side effects known to be caused by Metformin are in fact due to poor management of diabetes. Metformin long term side effect thus includes:

Anaemia and Vitamin B12 Deficiency: 

  • People on metformin can feel symptoms of fatigue, dizziness, difficulty in walking, changes in skin colour, etc.
  • This is because of vitamin B12 deficiency and iron deficiency. Metformin decreases vitamin B12 absorption and this leads to anaemia [4].
  • Get regular blood check-ups. In this way, the monitoring of proper levels of vitamin B12 can be done.
  • If the levels of vitamin b12 are low the health expert may suggest you take supplements or stop metformin [4].

Symptoms of Anaemia and vitamin B12 deficiency are:

  • Paleness of skin.
  • Having sore tongue and swelling of the tongue
  • decreased reflexes due to confusion
  • irritability and depression
  • decreased sense of smell
  • nerve damage and muscular pain [4].
  • difficulty while walking
  • memory or dementia-like symptoms

You should ask your doctor about Vitamin B12 and Iron supplements while taking metformin.

Also Read: Metformin 500 Mg Tablet Uses

Metformin Warnings

While taking Metformin it is necessary to know about metformin and other drug reactions, as well as health complications. Following are key warning points:

  • You should avoid taking Metformin with drugs like steroids, diuretics, Estrogen pills, oral contraceptive medicines. These medicines reduce the metformin effect and thus make its usage ineffective.
  • Avoid using alcohol while taking metformin. Metformin along with alcohol may lead to lactic acidosis and serious health issues.
  • Avoid metformin during lactation. Metformin is capable of passing through breast milk and thus can reach the newborn. Thus avoid metformin while breastfeeding [7].
  • Limit or avoid metformin in people with kidney and liver diseases. A kidney and liver test is necessary before taking the right amounts of Metformin [7].
  • People with breathing problems and circulatory problems should avoid Metformin usage.
  • People undergoing surgery or MRI scan or CT scan should inform the doctor on metformin usage. Anaesthesia before surgery can cause hypoglycemia. While iodinated contrast agents that are given before MRI and CT scans can cause risks of lactic acidosis [7].

Therefore, before using metformin discuss with your health expert about various health issues. Follow proper guidelines of usage and in case of any issues consult a health expert immediately.

Summary

Avoid metformin with kidney and liver disease, with alcohol, with steroids and diuretics, before surgery, MRI, and CT scan.

Metformin General Issues and Pieces of Advice

Metformin and Sleep Issues

Does metformin make you sleepy?

A common side effect of Metformin is that it can make you sleepy or feeling of dizziness. Seek health expert help if you have other problems like blurred vision, difficulty in concentration along with dizziness. It can be due to hypoglycemia or lowering of your blood glucose levels [5].

Metformin Insomnia

Numerous studies have found that people with diabetes have problems with sleep patterns. This is because of variations in blood glucose levels. But when a diabetic patient suffers from depression it leads to insomnia problems [2]. In such cases, metformin can induce insomnia further. Metformin insomnia is the therefore an unwanted side effect of metformin. This side effect is noticeable within a few days of taking the medicine [2].

Metformin and Tooth Decay

Diabetes is linked with tooth decay. During diabetes, the bone resorption rate increases and it causes bones to weaken [3]. This can cause Periodontitis issues and tooth decay. Henceforth, dental care is highly essential for diabetes.

On the other hand, Metformin has proven to reduce the bone resorption rate. This helps in reducing bone decay [3]. It thus helps in improving the results of surgical and non-surgical periodontal or dental therapy. Thus, Metformin does not cause tooth decay, rather diabetes cases tooth decay [3].

Also Read: Glycomet GP 1 Tablets Uses, Side Effects and Safety Advice For Diabetics

Metformin and Depression

Can metformin cause depression?

Insulin resistance that causes diabetes is linked to anxiety and depression. In diabetes, fluctuating blood sugar levels result in sleeping disorders. These sleeping disorders along with stress induce depression. Thus, diabetes along with stress causes depression.

On the other hand, Metformin helps in reducing the effects of depression. It is clinically proven that Metformin treatment has antidepressant effects on diabetic patients. It also improves their cognitive function. Thus, metformin does not cause depression rather it helps in treating depression in diabetic patients.

Also Read: fruits to avoid in diabetes

Bottom line:

Doctors use metformin as a drug to treat fluctuating blood glucose levels during diabetes. In women it is used for treating polycystic ovary syndrome. Before taking Metformin treatment you must provide all the health details to the doctor. You should take the right amounts of dosage and avoid taking overdoses. In case you notice any side effects of the medicine, seek health expert advice immediately.

Also Read: Glycomet GP2 Tablet Uses, Side Effects, and Safety Advice 

FAQs:

Can take metformin cause diabetes?

Research regarding the effect of metformin in non-diabetic patients is still going on. But early research and other clinical findings suggest that some drugs like corticosteroids, beta-blockers can cause diabetes. But in some cases such drug-induced diabetes is reversible. While in some cases it is permanent. Research suggests that metformin is useful in treating other health conditions apart from diabetes. For example depression, weight management, polycystic ovary syndrome, etc. [6]. But till date there is no evidence that metformin causes diabetes.

Can Metformin cause kidney problems?

A widely believed notion is that metformin can cause kidney problems. But metformin does not cause kidney damage. It is rather due to poor diabetes management that causes kidney problems. Metformin usage while already having kidney disease can cause further worsening of the disease. Thus, doctors ask for blood test and urine test before giving metformin to such patients’. Otherwise, limit or avoid using metformin.

How long do metformin side effects last?

The drug metformin’s common side effects are generally short-term. These last for 2 weeks. Long-term effects can last for months and sometimes years. But if common side effects reappear frequently consult a doctor immediately.

References:

  1. Blough, B., Moreland, A., & Mora, A., Jr (2015). Metformin-induced lactic acidosis with emphasis on the anion gap. Proceedings (Baylor University. Medical Center), 28(1), 31–33. https://doi.org/10.1080/08998280.2015.11929178.
  2. Wiwanitkit, S., & Wiwanitkit, V. (2012). Metformin and sleep disorders. Indian journal of endocrinology and metabolism, 16 Suppl 1(Suppl1), S63–S64. https://doi.org/10.4103/2230-8210.94262
  3. Najeeb, S., Zafar, M. S., Khurshid, Z., Zohaib, S., Madathil, S. A., Mali, M., & Almas, K. (2018). Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis. Saudi pharmaceutical journal: SPJ: the official publication of the Saudi Pharmaceutical Society, 26(5), 634–642. https://doi.org/10.1016/j.jsps.2018.02.029
  4. Aungst, T.,(2019 ), Long-Term Side Effects of Metformin: What Are the Risks? Retrieved from: https://www.goodrx.com/blog/long-term-side-effects-of-metformin-what-are-the-risks/
  5. Metformin. Retrieved from: https://www.nhs.uk/medicines/metformin/
  6. Abdelgadir, E., Ali, R., Rashid, F., & Bashier, A. (2017). Effect of Metformin on Different Non-Diabetes Related Conditions, a Special Focus on Malignant Conditions: Review of Literature. Journal of clinical medicine research, 9(5), 388–395. https://doi.org/10.14740/jocmr2922e
  7. Carter, A (2020). Can people with type 2 diabetes stop taking metformin? Retrieved from: https://www.medicalnewstoday.com/articles/323128

Last Updated on by Dr. Damanjit Duggal 

Disclaimer

The information included at this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.

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