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Mixing Metformin and Alcohol: Side Effects, Risks, and Complications

Side effects of mixing metformin and alcohol

Metformin is one of the most used drugs for treating type 2 diabetes. More than 30 million people with diabetes use metformin in the United States. All this comes with certain conditions, and you should be careful of drug interactions when taking any medication.

The negative consequences are serious sometimes. One such example is hypoglycemia which is a low blood sugar level. Binge drinking of alcohol raises various health issues, both generally and when taking metformin. So, anyone using metformin while taking the medication should discuss drinking with their healthcare provider.

This article explains the interactions between alcohol abuse and metformin.

What’s Metformin?

Metformin is helpful in the treatment of type 2 diabetes. In the United States, Food and Drug Administration approved metformin in 1995. The trade name for metformin is Glucophage. It ranks among the top 10 most used prescription drugs in the United States.

Metformin is a pill medication for type 2 diabetes. Based on their doctor’s advice, people take it orally at least once daily. The typical metformin dosage ranges from 500 mg to 2,550 mg daily. According to doctors, dividing the dose among three meals per day is a good idea.

The disruption in Insulin sensitivity causes issues in people with type 2 diabetes. Insulin helps in the body’s regulation of blood glucose levels. However, type 2 diabetes prevents insulin from performing this function properly. Your blood sugar level increases when insulin isn’t functioning properly. This occurs when your body produces a lesser amount of insulin or when your body doesn’t react appropriately to the insulin.

Metformin helps tackle these two issues. It helps lower blood sugar levels to maintain a blood circulation balance. Metformin aids in lowering the quantity of glucose your liver excretes into the blood. Additionally, it improves how well your body utilizes insulin, allowing more blood glucose to be metabolized. Metformin is also helpful in weight loss.

How does Alcohol Interact with Metformin?

Metformin prevents your liver from producing sugar. However, when metformin obstructs sugar production, it also unintentionally increases the level of lactic acid. This is because your liver often uses lactic acid as a molecule when producing glucose.

The use of a lot of alcohol amplifies this effect. It increases the level of lactic acid in your body. However, having a lot of lactic acid in your bloodstream is not optimal. Your body might become overly acidic as a result. In addition, alcohol has side effects that demand treatment. A few of these harmful effects are similar to those of metformin.

What are the Side Effects of Mixing Metformin and Alcohol?

All diabetes treatments, including metformin, will result in low blood sugar levels (hypoglycemia). The most frequent metformin effects are digestive issues. On the other hand, alcohol consumption on an empty stomach can cause a dip in blood sugar. This might have mild to high severity levels. Metformin can be difficult on your stomach. Its most frequent side effects include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Feeling gassy
  • Heartburn

Excessive alcohol intake causes similar stomach issues. Combining the two increases the risk factor and the possible side effects. Metformin and alcohol both can potentially stop the absorption of vitamin B12, which causes health problems. It may induce or worsen health problems like anemia and nerve damage. Your healthcare provider will probably advise routine vitamin B12 tests if you’re using metformin.

The following are typical metformin side effects that alcohol drinking worsens:

  • Stomach or abdominal pain
  • Muscle pain
  • Vomiting
  • Nausea
  • Loss of appetite
  • Sour stomach
  • Indigestion or heartburn

The choice of food helps to reduce the side effects of metformin. Numerous adverse symptoms frequently disappear once the body gets used to the treatment.

The Risks of Alcohol Interaction with Metformin

The use of alcohol while taking metformin is harmful. It produces severe complications in patients with diabetes. However, individual risks vary from person to person. These risks also rely on other health variables.


Metformin helps in blood sugar regulation, but it has the potential to result in hypoglycemia or low blood sugar. This occurs if a person takes too much medication, follows a bad diet, or drinks too much alcohol. Both of the substances are known to lower blood sugar levels. So, the mixture of alcohol and metformin produces a higher risk of hypoglycemia.

According to the American Diabetes Association, blood glucose levels should be up to 70 milligrams per deciliter. The mild symptoms of hypoglycemia, such as headaches, fatigue, and hunger, are cautionary indicators.

The symptoms of low blood sugar and excessive alcohol consumption are similar. That is why people don’t notice the difference. These symptoms can be serious in certain situations. People should seek medical assistance if their symptoms are of serious concern.

Low blood sugar warning symptoms include:

  • Increased heartbeat
  • Fatigue unrelated to sleep
  • Weakness
  • Headache
  • Extreme level hunger
  • Sleepiness
  • Pale skin
  • Continuous cold sweats
  • Blurry eyesight vision
  • Nightmares
  • Severe nervousness
  • Nausea
  • Shakiness
  • Dizziness
  • Unclear speech

People with diabetes should check their blood glucose levels if low blood sugar symptoms appear. The ingesting of 15 grams of simple sugar lowers blood sugar levels. After 15 minutes, persons should take more doses until their blood sugar levels are back to normal.

The use of alcohol before bedtime causes blood sugar drops. To avoid this problem, people with diabetes should consume complex carbohydrates before or after drinking alcohol.

Treatment of Hypoglycemia

The loss of consciousness is a symptom of hypoglycemia. If you do not have a glucagon hypoglycemia rescue kit, you should dial 911. You should always have some diabetic identification on you.

Human glucagon, a syringe to inject it with, and instructions are all parts of a glucagon hypoglycemia rescue kit. You can use this kit when consuming food that is tough to treat severe hypoglycemia.

Ask your doctor if you want to get this kit. They may suggest a rescue kit using metformin with other diabetes drugs. If you’ve already experienced severe hypoglycemia, you might also require one.

Lactic Acidosis

Lactic acidosis is a rare side effect of metformin. According to the National Library of Medicine, it affects 1 in 30,000 patients. The fact that the muscles primarily generate their energy through oxygen-dependent activities leads to this disease.

The body requires more oxygen than is readily available during long-form exercise. In long-form exercise, cells may convert to anaerobic or oxygen-lacking. Anaerobic metabolism of glucose creates lactic acid and further decomposes into lactate. After that, lactate is converted to glucose in the liver.

Lactate levels may increase during prolonged exercise or demanding tasks because the body needs oxygen to eliminate it. Lactate can accumulate and make blood and muscles more acidic if it remains in the bloodstream.

Development of Lactic Acidosis

Lactic acidosis develops when lactate concentrations are too high. Both metformin and alcohol slow the liver’s ability to absorb lactate. While taking metformin alone, there is little chance of developing lactic acidosis. However, the use of metformin and alcohol raises the dangers considerably.

On the packaging of metformin, the U.S. Food and Drug Administration (FDA) places a black box warning about lactic acidosis. FDA identifies excessive alcohol use disorder as a risk factor for experiencing the related side effect of using metformin.

Symptoms of Lactic Acidosis

At first, lactic acidosis symptoms are vague and subtle, such as stomach ache and fatigue. However, the symptoms of severe lactic acidosis are strong and can rise suddenly. Lactic acidosis can be fatal. People should seek medical assistance right away if symptoms appear.

Lactic acidosis warning indicators include:

  • Pain or cramping around the gut
  • Diarrhea
  • Breathing issues
  • Increasing heartbeat
  • Discomfort
  • Muscles` seizing
  • Continuous weakness
  • Lower appetite
  • Low blood pressure
  • High pulse rate
  • Nausea
  • Vomiting

Treatment of Lactic acidosis

The treatment of lactic acidosis is available in a hospital. If you are on metformin, have consumed alcohol, and experience any of these symptoms, contact your doctor immediately or head to the medical emergency room of the closest hospital.

Vitamin B12 Deficiency

Vitamin B-12 is a necessary nutrient for red blood cell function, cardiovascular health, and neurological health. Metformin decreases the absorption of vitamin B-12. Alcohol delays the absorption of vitamin B-12 by inflaming the stomach.

Metformin use can occasionally cause vitamin B-12 deficiency as a side effect. However, the risk is higher. Ten to 30 percent of people taking metformin for type 2 diabetes have reported decreased circulating vitamin B-12.

Significant vitamin B-12 deficiency results in considerable health risks even when the symptoms are mild. People should seek medical guidance if they believe they are vitamin B-12 deficient.

Vitamin B-12 deficiency consequences and warning signals include:

  • Confusion
  • Numbness in the hands and feet
  • Memory loss
  • Dementia
  • Delirium
  • Headache
  • Difficulty in concentration

The change in diet plans helps to reverse the B-12 deficits. Foods such as cattle, eggs, and dairy products are high in vitamin B-12. Metformin-using diabetics should talk to their doctor about B-12 testing alternatives.

Frequently Asked Questions (FAQs)

Metformin and alcohol interactions are harmful. Alcohol consumption isn’t always prohibited, though. People react to alcohol differently, and only your healthcare provider has enough information about your medical history to advise you about drinking while taking metformin.

How long should I wait after taking the diabetes tablet to drink Alcohol?

In an ideal situation, you should avoid the combination of alcohol and metformin. This is because drinking alcohol increases your risk of suffering medication side effects and worsens your diabetes management.

However, heavy or frequent alcohol consumption is mainly connected to the risks and dangers. The labeling for metformin advises against drinking excessively. So, if you want to consume alcohol, try to refrain from heavy drinking or drinking continuously.

The idea is to drink moderately or less. For men, this means a daily limit of two drinks and a daily limit of one drink for women. The occasional drink is usually okay while taking metformin if your diabetes is under control.

Can diabetic patients drink alcohol? If so, what are the limits?

The effects of alcohol can affect some persons more than others. When taking metformin and alcohol together may increase their danger. Alcohol and metformin both have the potential to harm individuals who already have liver issues.

Diabetic patients can drink alcohol in some situations if they don’t have other problems. People with kidney issues should use metformin cautiously because Alcohol can harm your kidneys.In general, women are more sensitive to the adverse effects of alcohol than men. Women have less body water than males, making it simpler for alcohol to concentrate.

Older people: People over the age of 65 are more at risk for alcohol side effects than adults in their younger years. This may increase the chance of unintentional harm.

Can you test positive for alcohol if you have diabetes?

Alcohol consumption can cause your blood sugar to spike or fall if you have diabetes. Although the number of calories in alcohol is high, a change in the state of the test result is not essential.

 If you drink, do it in moderation and only when your blood sugar and diabetes are under control. Consult your healthcare provider to determine whether alcohol use is safe for you.

When authorities conduct a blood test to assess a person’s alcohol concentration, diabetes will not impact the accuracy of the results. This is so because ethyl alcohol, the component in all alcoholic drinks that causes impairment, is specifically tested for in blood testing.

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