Drugs & Supplements

Metformin and Alcohol

Metformin and Alcohol: Is drinking safe for people with diabetes?

Metformin is a drug approved by the U.S. Food and Drug administration that helps people to manage type 2 diabetes Mellitus and occasionally prediabetes. Drinking alcohol can affect your diabetes directly, but you may face additional risk if you drink alcohol with metformin.

Typically, doctors advise that drinking alcohol while consuming metformin does not support diabetes management and is not safe. Metformin and alcohol both put accentuation on the liver, intensifying the harmful effects of both and increasing the risk of liver complications.

This article gives you the possible interaction between metformin and alcohol, a possible complication from it, how drinking alcohol can affect your diabetes as well as the whole detail about metformin.

Alcohol and Metformin

It is important for the diabetic patient or for anyone taking metformin to talk with their doctor about using alcohol while talking about the medications.

Metformin is approved, competent, and economical management medication that doctors prescribe for the treatment of type-2 diabetes mellitus. Doctors are prescribing metformin more and more frequently to people with prediabetes. The use of the drug in people in type 1 Diabetes Mellitus and who are also overweight may reduce insulin need and increase metabolic control.

Metformin work by bettering insulin sensitivity, advertising the uptake of glucose into tissues and reducing sugar level in the bloodstream. Metformin and alcohol can interact with harmful effects, though it happens rarely. You are at high risk if you drink alcohol regularly.

This harmful effect can be life-threatening. One developing an extremely low blood sugar level, called hypoglycaemia., and another condition called lactic acidosis.

Lactic acidosis

Metformin and alcohol can cause lactic acidosis. There is a possible interaction between metformin and alcohol. This interaction can lead to a condition called lactic acidosis. Lactic acidosis occurs when the blood turns acidic and there is a build-up of a chemical called lactate in your body. Metformin alone can lead to lactate build-up in the body, and alcohol has been shown to have this effect as well as.

Therefore a combination of metformin and alcohol together maybe even more dangerous than either one alone. The food and drug administration (FDA) issued black Box Warning on metformin to look out of symptoms and risk factors for lactic acidosis, an nd excessive alcohol use in the risk factor.
If lactic acidosis is not treated right away, the organ may shut down, which can lead to death. symptoms of lactic acidosis include:

  • Weakness
  • Tiredness
  • Lightheadacheness
  • Unusual muscle pain, such as sudden and severe pain in the muscle that does not usually cramp
  • Difficulty breathing
  • Stomach discomforts, such as nausea and vomiting
  • Feeling cold
  • Tachycardia

Lactic acidosis is the medical emergency that must be treated in hospital. If you taking metformin and drinking alcohol and if you notice these symptoms, call your doctor right away, or go to a nearby hospital as soon as possible.


Metformin helps to regulate blood sugar, so it can cause hypoglycaemia or low blood sugar. This can happen when someone takes too large a dose, maintain a poor diet, or consume too much alcohol.

Some symptoms of low blood sugar levels can be similar symptoms having had too much to drink. These includes:

  • Drowsiness
  • Dizziness
  • Confusion
  • Blurry vision
  • Headache
  • Weakness
  • Restless sleep
  • Extreme hunger
  • Cold sweats
  • Slurred speech

In severe cases, these symptoms are more acute and can become life-threatening. If symptoms are intense or alarming, people should seek medical attention immediately.

What is Metformin

Metformin It differs markedly from SUs: causes little or no hypoglycaemia in nondiabetic subjects, and even in diabetics, episodes of hypoglycaemia are rare. It does not stimulate pancreatic cells. Metformin is reported to improve lipid profile as well in type 2 diabetics.

Mechanism of action

Biguanides do not cause insulin release, but the presence of insulin is essential for their action. Metformin is not effective in pancreatectomized animals and in type 1 diabetics. Though the details are not clear, recent studies have recognized the activation of AMP-dependent protein kinase (AMPK) to play a crucial role in mediating the actions of metformin, the key features of which are:

  1. Suppresses hepatic gluconeogenesis and glucose output from the liver. This is the chief activity responsible for lowering of blood glucose in diabetics.
  2. Enhances insulin-mediated glucose uptake and disposal in skeletal muscle and fat. Insulin resistance exhibited by type-2 diabetics is thus overcome. This translates into—
  • glycogen storage in skeletal muscle
  • Abbreviated lipogenesis in adipose tissue and enhanced fatty acid oxidation.
  1. Interferes with mitochondrial respiratory chain and promotes peripheral glucose utilization through anaerobic glycolysis.

AMPK activation by metformin appears to be an indirect consequence of interference with cellular respiration and lowering of intracellular ATP and other energy sources.

Metformin also retards intestinal absorption of glucose, other hexoses, amino acids and Vit B12.

Adverse effects of Metformin

Side effects with metformin are frequent, but generally not serious. Abdominal pain, anorexia, bloating, nausea, metallic taste, mild diarrhoea and tiredness are the usual complaints, which tend to subside with time. Metformin does not cause hypoglycaemia except in overdose.

Lactic acidosis Small increase in blood lactate occurs with metformin, but lactic acidosis is rare (<1 per 10,000 patient-years) because it is poorly concentrated in hepatic cells. Alcohol ingestion can precipitate lactic acidosis.

Vit B12 deficiency due to interference with its absorption can occur with a high dose of metformin.

In addition to general restrictions for use of oral hypoglycaemics, metformin is contraindicated in hypotensive states, heart failure, severe respiratory, hepatic and renal disease, as well as in alcoholics because of increased risk of lactic acidosis.

Drugs like cimetidine, furosemide may compete with metformin excretion and enhance its toxicity.

Metformin Uses

Metformin is now established as a first-choice drug for all type 2 DM patients, except when not tolerated or contraindicated.

Advantages of metformin are:

  • Nonhypoglycaemic
  • weight loss promoting
  • has the potential to prevent macrovascular as well as microvascular complications of diabetes
  • no acceleration of  cell exhaustion/ failure

in type 2 DM.

  • antihyperglycaemic efficacy (HbA1c reduction by 0.8–1.2%) equivalent to other oral drugs.
  • can be combined with any other oral or injectable antidiabetic, if one drug is not adequate.

The limiting feature is g.i. intolerance, especially at higher doses, but lack of serious toxicity is well established by decades of use.

Infertility: Metformin has been found to improve ovulation and fertility in some infertile women with polycystic ovary. This benefit is observed irrespective of the glycaemic status of the woman. It may be due to the mitigation of insulin resistance and lowering of circulating insulin levels.


  • It is occasionally safe to drink a moderate amount of alcohol with metformin (while on the course of metformin).
  • However, regular drinking excessive amounts can reduce the effectiveness of the medication and increases the risk of a serious complication.




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