How Metformin works

Metformin is an anti-diabetic medication (biguanide). It works by lowering glucose production in the liver, delaying glucose absorption from intestines and increasing the body's sensitivity to insulin.

Side Effects

Nausea, Vomiting, Altered taste, Diarrhoea, Abdominal pain, Loss of appetite

Usage

Metformin is used in the treatment of type 2 diabetes
It is used in addition to diet and exercise to improve blood sugar control in adults with type 2 diabetes.

Frequently Asked Questions

Q. Is Metformin helpful in patients with polycystic ovarian syndrome (PCOS)?

Yes. Metformin is helpful in patients with PCOS. It may be used along with other medicines to induce ovulation and regularize menstrual cycles. It also delays the development of type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program.

Q. How does Metformin help in weight loss?

Metformin helps in weight loss by decreasing hunger (appetite) and hence food intake. It makes the insulin already available in your body to work more effectively. This leads to decrease glucose production, increase glucose use and decreased fat deposits which further helps to lower body weight. However, it is not yet approved for weight loss, this is an off-label use.

Q. Is Metformin useful in the treatment of infertility?

Metformin is commonly used off-label for the treatment of infertility associated with polycystic ovary syndrome (PCOS). It regulates ovulation and androgen levels in the body and improves menstrual regularity and pregnancy rates and outcomes. This beneficial effect is thought to be due to improvement in insulin resistance by Metformin.

Q. Does Metformin cause low blood sugar levels (hypoglycemia)?

Metformin can lower blood sugar level (hypoglycemia). It happens more often if you delay or miss your food, do more than your routine exercise, drink alcohol or take other antidiabetic medicine along with. So, regular monitoring of blood sugar level is important and be cautious of symptoms of hypoglycemia and always keep glucose tablets, honey or fruit juice with you.

Q. Can I take Metformin forever?

Metformin is generally a safe and well-tolerated drug even on long-term use. However, its long-term use can cause vitamin B12 deficiency leading to anemia and peripheral neuropathy (nerve damage). so, it should be taken only at prescribed doses for the duration as advised by the doctor.

Q. Is Metformin a sulfonylurea?

No, Metformin is not a sulfonylurea. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modification in diet and exercise.

Q. Is Metformin a steroid?

No, Metformin is not a steroid. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modifications in diet and exercise.

Q. Does Metformin cause bloating?

Metformin commonly causes stomach upset like bloating (heavy and uncomfortable feeling in the stomach), nausea, vomiting, and diarrhea. To avoid these side effects, it is advised to be taken after meals, preferably started at a low dose and then increased slowly over weeks, or by using slow-release tablets.

Q. Is Metformin good for fatty liver?

Metformin is seen to be beneficial in the treatment of non-alcoholic fatty liver disease (NAFLD). One of the underlying cause of NAFLD is insulin resistance. Metformin improves insulin resistance and liver enzymes in these patients. It is not seen to benefit patients of alcoholic fatty liver disease and is usually avoided in patients with liver cirrhosis as they are at an increased risk of lactic acidosis.

Q. What is the benefit of combining Metformin with coenzyme q10?

Coenzyme Q10 is an antioxidant that helps in energy production and is found in heart, liver, kidney, and pancreas (which produces insulin). It can repair the damage caused to these organs by free radicals. Low levels of CoQ10 are seen in patients with diabetes. So, some researchers suggest it be given from outside. It can be taken with Metformin as no drug-drug interactions or harmful effects have been seen between the two.

Q. Does Metformin help in improving your menstrual cycle (periods)?

Yes, Metformin does improve menstrual cycle (periods) regularity in women with polycystic ovarian syndrome (PCOS). It is associated with insulin resistance, decreased ovulation, and high androgen levels which cause menstrual irregularities like delayed periods and scanty bleeding. Metformin helps in regularizing menstrual cycles by improving insulin sensitivity, ovulation rate, and decreasing androgen levels.

Q. Can I take Metformin with atorvastatin?

Yes, Metformin can be taken with atorvastatin. There are no reported harmful effects when they are used together. Rather some studies suggest beneficial effects in diabetics as they may prevent a very high increase in blood glucose after food, decrease some inflammation markers and protect the patients from liver injury.

Q. Can I take Metformin with phentermine?

Metformin can be taken with phentermine. These are sometimes given together in obese patients who are also diabetic and are taking Metformin along with exercise and diet modification. Phentermine decreases food intake by its action in the brain. However, phentermine can decrease the effect of Metformin leading to very high blood glucose levels. So, a dose adjustment of Metformin may be needed.

Q. Can I take Metformin with levothyroxine?

Metformin can be taken with levothyroxine but the dose of Metformin may need to be adjusted. Levothyroxine can decrease the effect of Metformin leading to very high blood glucose levels. These are used together in patients with coexisting thyroid disease and diabetes mellitus or polycystic ovarian syndrome (PCOS).

Q. Can I take Metformin with prednisolone?

Metformin can be taken with prednisolone but the dose of Metformin may need to be adjusted. Prednisolone can decrease the effect of Metformin leading to very high blood glucose levels. Continuous use of steroids like prednisolone can also cause diabetes known as glucocorticoid-induced diabetes and use of Metformin is recommended in these patients.

Q. Can I take Metformin with metoprolol?

Metformin can be taken with metoprolol. There are no reported drug interactions or harmful effects in humans when they are used together. However, some animal studies suggest that metoprolol can decrease the blood levels of Metformin and on long-term use can increase lactic acid and uric acid levels.

Q. Does Metformin clear acne?

Metformin is not indicated for clearing acne due to just any condition. It only helps in clearing acne in women with polycystic ovarian syndrome (PCOS) along with other problems like facial hair, abdominal obesity, and irregular menstruation.

Q. Does Metformin cause hair loss?

No, hair loss has not been reported with Metformin. It only helps in clearing facial hair (hirsutism) in women with polycystic ovarian syndrome (PCOS) along with other problems like acne, abdominal obesity, and irregular menstruation.

Q. Does Metformin cause weight gain?

No, weight gain has not been reported with Metformin. Rather it helps in decreasing weight especially abdominal fat patients of type 2 diabetes mellitus and in women with polycystic ovarian syndrome (PCOS) along with other problems like facial hair, acne, and irregular menstruation.

Q. Does Metformin cause constipation?

Metformin is not known to cause constipation. Some common side effects associated with the use of Metformin includes nausea, vomiting, abdominal pain, altered taste, diarrhea, and loss of appetite.

Q. Is Metformin safe?

Metformin is a safe and well-tolerated drug even on long-term use when taken strictly as advised by the doctor. However, there are some very common side effects like nausea, vomiting, abdominal pain, altered taste, diarrhea, and loss of appetite you may experience even at therapeutic doses.

Q. Does Metformin increase blood pressure?

Metformin is not known to increase blood pressure. Some common side effects associated with the use of Metformin includes nausea, vomiting, abdominal pain, altered taste, diarrhea, and loss of appetite.

Q. Is Metformin an insulin?

No, Metformin is not an insulin. Metformin is an oral drug used in type 2 diabetes mellitus and lowers blood glucose levels by decreasing its production and increasing absorption and making the already available insulin in your body to work better. Insulin is a normally produced hormone in the body, used in the injectable form in the treatment of both type 1 and 2 diabetes mellitus and it works by absorbing and storing glucose from the blood.

Q. Is Metformin a banned drug?

No, Metformin is not a banned drug. It is a prescription medicine and is available when prescribed by registered medical practitioner.

Q. Is Metformin a birth control pill?

No, Metformin is not a birth control pill. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modification in diet and exercise.

Q. Is Metformin a statin?

No, Metformin is not a statin. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modification in diet and exercise.

Q. Can I take Metformin with saxagliptin?

Both Metformin and saxagliptin are anti diabetic drugs and can be used together. Their fixed dose combinations are also available and commonly advised once Metformin is unable to control blood sugar levels even after giving the maximum tolerated dose. As they work by different mechanisms, they help in better control of blood sugar levels compared to either drug taken alone.

Q. Does Metformin cause blurry vision?

Metformin is not known to cause blurred vision. Change in vision in a patient with diabetes could be due to multiple reasons. It could be a temporary problem either due to high blood sugar levels which cause your lens inside your eye to swell and change your vision. If the blurred vision continues for a long time, consult a doctor.

Q. What is lactic acidosis and how is it related to Metformin use?

Lactic acidosis is a rare, but serious complication associated with the use of Metformin. Patient has high blood lactic acid levels and may present with tiredness, weakness, stomach pain, loose stools, severe muscle pain, muscle cramps and difficulty in breathing. It is especially seen in old age patients, those with kidney, liver or heart disease, or who take large amounts of alcohol. If you have these symptoms, stop taking Metformin and consult your doctor.

Q. Is Metformin use associated with liver pain?

Metformin is not known to cause any liver pain or damage. Rather, it is seen to be useful in patients with non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C. However, it is usually avoided in patients with liver cirrhosis as they are at an increased risk of lactic acidosis which is a serious complication associated with the use of Metformin.

Q. Does Metformin make you feel high?

No, Metformin does not elevate the mood or make you feel high. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modification in diet and exercise. Rare side effects of Metformin include anxiety and depression.

Q. Can Metformin cause back pain?

Usually, Metformin is not associated with back pain. However, it can be a presentation of stomach upset, a common side effect caused by Metformin which includes bloating (heavy and uncomfortable feeling in the stomach), nausea, vomiting, and diarrhea, or it could be a symptom of lactic acidosis, a rare and a serious complication of Metformin.

Q. Can long-term use of Metformin cause vitamin b12 deficiency?

Yes, Metformin causes vitamin B12 deficiency on long-term use as it interferes with absorption of vitamin B12 in the stomach. If untreated, it may cause anemia and nerve problems and the patient can have tingling sensation and numbness in hands and feet, weakness, urinary problems, change in mental status and difficulty in making balance (ataxia). To avoid these problems, some researchers suggest an intake of vitamin B12 from outside at least once every year.

Q. Is Metformin useful in the management of metabolic syndrome?

Yes, Metformin is seen to be useful in the management of metabolic syndrome, a collection of risk factors that include high blood pressure, high blood sugar levels, abnormal blood cholesterol levels and excess fat around the waist. Metformin is an insulin sensitizer and it improves the action of insulin and normalises blood sugar levels and reduces body weight.

Q. How beneficial is it to take Metformin with glimepiride?

Both Metformin and glimepiride are anti diabetic drugs and can be used together. They work by different mechanisms and can control the blood sugar levels in a much better way when used together as compared to either drug taken alone. However, glimepiride can cause very low blood glucose levels, so a regular monitoring of blood glucose is very important.

Q. Is it safe to take Metformin with cetirizine?

Yes, Metformin can be taken with cetirizine. There are no reported drug interactions or harmful effects when they are used together.

Q. Can I take Metformin and ranitidine together?

Metformin can be taken with ranitidine. However, if you are taking them together, you need to monitor blood glucose levels regularly as ranitidine can decrease the removal of Metformin from the body and increase its blood levels. This can cause very low blood sugar levels and other side effects as well and the dose of Metformin may need adjustment.

Q. How beneficial is it to take Metformin with linagliptin?

Both Metformin and linagliptin are anti-diabetic drugs and can be used together. Their fixed dose combinations are also available and commonly advised once Metformin is unable to control blood sugar levels even after giving the maximum tolerated dose. As they work by different mechanisms, they help in better control of blood sugar levels compared to either drug taken alone.

Q. Does Metformin inhibit hepatitis B virus protein?

Yes, some research studies have shown that Metformin can decrease the multiplication and growth of hepatitis B virus when given along with other antiviral drugs. However, this is indication is still under research and not yet approved.

Q. Can I take Metformin before or after a chest x-ray? Does its use lead to chest x-ray abnormality?

Metformin should be temporarily discontinued before chest or any X-ray that requires injection of a contrast medium or dye. These dyes can decrease kidney function and Metformin along with these dyes can cause a serious side effect like lactic acidosis. So you may need to stop taking Metformin. However, do not stop taking any medicine without talking to your doctor.

Q. Does Metformin make you sleepy?

Metformin can cause sleepiness which could be an early symptom of lactic acidosis along with tiredness, weakness, stomach pain, loose stools, severe muscle pain, muscle cramps and difficulty in breathing. It is a serious condition caused by Metformin seen in old age patients, those with kidney, liver or heart disease, or those who take large amounts of alcohol. If you have these symptoms, stop taking Metformin and consult your doctor.

Q. Does the use of Metformin cause joint pain?

Use of Metformin is not associated with joint pain. However, diabetes itself decreases blood circulation to the joints and even damages them leading to joint pain. Use of anti-diabetic drugs like sitagliptin or saxagliptin is also associated with joint pain. Early symptoms of lactic acidosis like muscle pain and cramps with weakness and tiredness can be mistaken for joint pain.

Q. Can Metformin help in reducing weight gain caused by antipsychotics?

Metformin may be of help in the treatment and prevention of weight gain caused by antipsychotics along with lifestyle modifications like a change in diet and regular exercise. Weight gain is an important reason for discontinuation of these medicines. Metformin improves insulin sensitivity and prevents weight gain, both of these factors are affected by the use of antipsychotics.

Q. Is Metformin useful in the treatment of fragile X syndrome?

Metformin has shown promising results in some animal research studies in the treatment of fragile X syndrome. It may help in improving mental and behavioral disorders (autism) and control obesity and risk of developing diabetes in these patients. But these results are very preliminary and it is still not approved for the treatment of fragile X syndrome.

Q. What is the difference between liraglutide and Metformin?

Metformin and liraglutide are antidiabetic drugs and both control blood sugar levels effectively. Metformin is taken by oral route and it decreases glucose production from liver and glucose absorption from the gut and increases insulin sensitivity. While liraglutide is an injectable and it increases insulin release from the pancreas. Both cause stomach upset, like nausea, vomiting, diarrhea and bloating while liraglutide also increases the risk of pancreatitis.

Q. Does Metformin use make you feel high?

No, Metformin does not elevate the mood or make you feel high. It is an antidiabetic drug used to control high blood sugar levels in newly-diagnosed type 2 diabetes patients, along with modification in diet and exercise. Rare side effects of Metformin include anxiety and depression.

Q. Does Metformin make you sweat?

Yes, sweating is one of the known side effects of Metformin. The exact cause of this is not known. Some researchers suggest it to be due to low blood sugar levels especially at night which can cause night sweats as well. Monitor your blood sugar levels regularly and talk to your doctor as your dose of Metformin may need to be adjusted.

Q. Can I take Metformin with clomiphene citrate?

Metformin can be taken with clomiphene citrate. They are advised together in patients with infertility along with polycystic ovarian syndrome (PCOS). Clinical studies have shown an improvement in ovulation and pregnancy rates in these patients as compared to use of clomiphene citrate alone or if the patients are resistant to the effects of clomiphene citrate. However, this is still under research.

Q. Is Metformin useful in treating or preventing breast cancer?

Metformin is seen to be useful in the treatment and prevention of cancers especially breast cancer in research studies. As high insulin levels are known to increase the risk of cancer, Metformin decreases cancer cell growth by decreasing insulin and blood glucose levels. However, its use in treating breast cancer is not yet approved.

Q. Does Metformin use increase your chance to get Helicobacter pylori infection?

No, Metformin is not associated with an increased risk of Helicobacter pylori infection. Diabetes itself increases the risk of H.pylori infection which increases the chances of stomach upset like nausea, vomiting, diarrhea, and bloating by Metformin.

Q. Does Metformin use leads to anemia?

Metformin may decrease the levels of vitamin B12 on long term use which may rarely cause a type of anemia in which blood cells are larger than normal (megaloblastic anemia). You may need to take foods rich in vitamin B12 like eggs, dairy products, and meat or a supplement from outside.

Q. Is Metformin useful in the treatment of prediabetes?

Metformin is seen to be useful in the management of prediabetes, a condition with blood glucose levels higher than normal but not high enough to label you as diabetic. Metformin makes the insulin already available in your body to work more effectively, decreases glucose production by liver and increases use of glucose by the muscles and lowers body weight. However, lifestyle modifications like a change in diet and exercise should be tried first as they are seen to be more effective than Metformin.

Q. Can I take Metformin with teneligliptin?

Yes, Metformin can be taken with teneligliptin. It is a good add-on treatment if the blood sugars are very high even after taking Metformin. The risk of low blood sugar levels (hypoglycemia) is also very low with both the medicines. However, consult your doctor before taking them together as a dose adjustment may be needed.