Taking Metformin and Alcohol: Lactic Acidosis Risk

You should avoid drinking alcohol while taking metformin, or only drink in very limited amounts under medical advice.

Mixing metformin and alcohol can increase the risk of serious side effects, including lactic acidosis, low blood sugar, and worsening diabetes control. If you’re unsure whether it’s safe for you, it’s important to understand the risks before drinking.

In this article, we hope to enlighten you about what metformin is, how alcohol and other drugs interact with metformin, and understand the potential risks associated with mixing other substances and drugs with metformin. We will also discuss what lactic acidosis is and its relation to alcohol, other drugs, and metformin.

What is Metformin?

Metformin, also known as dimethyl biguanide hydrochloride, is a medicine primarily used by doctors to treat type 2 diabetes. People who are diabetics take the drug because their bodies aren’t making enough insulin.

It is available in several forms: standard metformin tablets, extended-release metformin tablets, sachets, and even liquid form for children and people who find it difficult to swallow tablets. To know what kind of tablet to take, consult your healthcare provider.

Is it Safe to Drink Alcohol While Taking Metformin?

No, mixing alcohol and metformin can cause hypoglycemia and lactic acidosis. On the other hand, if taking alcohol can’t be avoided, control or moderate your alcohol consumption. While small amounts may be tolerated in some people, combining the two increases the risk of:

• Lactic acidosis (rare but serious)
• Low blood sugar (hypoglycemia)
• Liver strain

The risks are higher if you drink heavily, drink on an empty stomach, or have existing health conditions. If you take metformin to treat your type 2 diabetes, you may wonder if this drug is safe to mix with alcohol, so keep in mind that regularly drinking alcohol can affect your diabetes directly, but you may face additional risks if you consume too much alcohol with metformin. 

Should You Skip Metformin When Drinking Alcohol?

You should not stop taking metformin without medical advice. Skipping doses can disrupt blood sugar control and may lead to complications.

Instead of skipping medication, the safer approach is to limit or avoid alcohol altogether, especially if you have diabetes or other health conditions.

If you regularly drink or are unsure how alcohol affects your medication, speak to a healthcare professional.

Lactic Acidosis and Hypoglycemia: The Complications of Taking Metformin and Alcohol

Lactic Acidosis

Alcohol use while taking metformin will tax your liver and may cause you to have this complication. It comes about because metformin slows down glucose production in your liver, but this results in the body producing more lactic acid.

Additionally, consuming alcohol may increase the production of lactic acid to process the alcohol in your body. These conditions create a severe buildup of lactic acid, therefore developing a severe case of lactic acidosis.

Consequently, due to this interaction, the US Food and Drug Administration (FDA) issued a black box warning for Metformin to alert patients and doctors about the drug’s serious side effects, i.e., lactic acidosis.

What is a black box warning? A black box warning is the highest safety-related warning that the FDA can assign to medications and is intended to bring a consumer’s attention to the major risk of a certain drug. 

As of April 8, 2016, the FDA revised the warning and labelled metformin as a major concern to kidney-impaired patients. Still, the black box warning is apt, considering that taking metformin can also cause severe hypoglycemia.

Hypoglycemia: Low Blood Sugar

As discussed earlier, metformin helps control your blood sugar, but taking this medication, when used in conjunction with other anti-diabetes medications, can result in a grave drop in blood sugar.

The side effects of drinking alcohol for people with diabetes are also pretty much tied together because alcohol interferes with the body’s ability to produce glucose, which causes blood sugar to drop. This, therefore, is another case of alcohol compounding a drug’s side effects and creating a bigger problem.

Significant Drug or Substance Interactions with Metformin

Metformin can interact quite significantly with other drugs and alcohol. The two significant harmful effects, as mentioned earlier, are severe hypoglycemia and lactic acidosis. 

Some other drugs that may increase the risk of lactic acidosis are:

• Bupropion: an antidepressant medication used to treat depression and seasonal affective disorder, also helps people to stop smoking and have better weight control.
• Cephalexin: used to treat infections caused by bacteria, including upper respiratory infections, ear infections, skin infections, urinary tract infections, and bone infections.
• Cimetidine: a stomach acid reducer used to treat and prevent certain types of stomach ulcers.

On the other hand, drugs that can enhance the hypoglycemic effect of metformin include:

• Alpha-Lipoic Acid:  used as an antioxidant for treating type 2 diabetes and HIV. It has also been used for cancer, liver ailments, and various other conditions.
• Pegvisomant: a man-made protein that is similar to human growth hormone. Pegvisomant binds to the same receptor in the body as growth hormone and blocks the effects of growth hormone.
• Androgens:  stimulate the development of male sexual characteristics (such as deepening of voice and growth of beard) and the development of male sex organs.

With that being said, alcohol remains one of the most common substances that can easily debilitate people who are on a plethora of medications. 

How Does Metformin Work in the Body?

Metformin helps your body by affecting your liver, muscles, and intestines. Metformin reduces the amount of sugar your liver releases into your blood, as the liver is responsible for glucose production, and also helps your muscles absorb more glucose to function well.

The medicine interacts with your liver by inhibiting gluconeogenesis (the liver’s creation of new glucose) and reducing glycogenolysis (the breakdown of stored glycogen for glucose). Metformin helps increase insulin sensitivity in muscles, allowing your muscles to utilize glucose better. It slows the absorption of sugar in your intestines when your blood sugar level rises.

Metformin can increase the production of a hormone in your intestines called GLP-1 (which increases insulin production) and decrease glucagon (which stops blood sugar from dropping too low). Additionally, when blood sugar level falls, it decreases GLP-1 production but leaves glucagon alone, so you don’t increase the risk of hypoglycemia or low blood sugar.

Although if taken with other substances, it could increase your risk of experiencing side effects, which will be discussed later on.

What are the Side Effects of Metformin?

Treating diabetes isn’t its only benefit, despite diabetes being a gateway to many other diseases developing. A good side effect of using metformin is safe weight management, reducing appetite and improving insulin sensitivity.

People on metformin alone can increase life expectancy by controlling blood sugar levels, which prevents the onset of diabetes, and numerous cancers, such as blood cancer and bone cancer. Other effects of taking metformin include improving cardiovascular health, preventing liver disease and kidney disease, and improving aging, all stemming from sugar control. 

Lactic Acidosis and Other Adverse Reactions with Metformin

Due to metformin being prescribed by doctors to treat type 2 diabetes, metformin use may eventually cause some side effects, which are especially related to drug or substance interactions, but mostly due to the length of use.

For example, among youth who have type 2 diabetes and are treated with metformin, about 30% begin to develop gastrointestinal (GI) symptoms, therefore needing additional treatments to improve quality of life and medication adherence.

Metformin can increase your risk of developing these common GI symptoms:

• Diarrhea
• Nausea and Vomiting
• Stomach Pain
• Bloating and Gas

One of the unexpected and more severe reactions to taking metformin is an increased risk of developing lactic acidosis and hypoglycemia (a state of low blood sugar) in your body. Lactic acidosis occurs when there is a buildup of lactic acid in the body, primarily in your blood, because your body produces more lactate when your tissues are deprived of oxygen.

Early symptoms of lactic acidosis include the common GI symptoms, which are one of the reasons why it’s dangerous. It can be misdiagnosed due to common underlying symptoms, leading to delays in treatment, and if left untreated, severe lactic acidosis occurs, increasing mortality.

However, when combined with excessive alcohol intake and other drugs, severe hypoglycemia and lactic acidosis can pose a higher risk of being even more fatal. 

Alcohol and Metformin

In conclusion, it is best to stop drinking alcohol while on metformin. Say no to heavy drinking and alcohol abuse because when alcohol interacts with metformin, or any other medication you may also be taking, things tend to take a turn for the worse.

But if using alcohol cannot be avoided, such as drinking to celebrate with friends and family, try to limit yourself to one drink per day, due to the risk of a rare, potential side effect developing. The amount of alcohol you consume does matter in the long run, and binge drinking isn’t worth the risk, which is why getting help is the first step towards having a better quality of life.

When to Seek Medical Help

You should seek medical attention immediately if you experience:

• Unusual muscle pain or weakness
• Trouble breathing
• Severe fatigue
• Dizziness or confusion
• Nausea or stomach pain that doesn’t improve

These can be signs of lactic acidosis, a rare but serious condition linked to metformin and alcohol use.

If alcohol use is becoming difficult to control, professional support can help you stay safe and protect your health.

Getting Help for Alcohol Abuse

Here at our luxury rehab in Los Angeles, we recognize the importance of providing various treatment options that cater to every client. Our experienced and competent clinical team is equipped to deal with specific concerns you may have regarding some of the complications that occur from alcohol abuse while dealing with other health concerns.

If you’re struggling to manage your health and would like to address an ongoing addiction, we are ready to help.