Metformin Side Effects & How To Deal With Them | Sepalika
blog detail banner

Drug Side Effects

Metformin Side Effects And How To Deal With Them

Feb 6, 2017

Metformin side effects include diabetic neuropathy, brain fog, and digestive issues. You can address them through diet, Vitamin B12, CoQ10, and exercise. Let us understand the drug Metformin in detail and study different forms of metformin, its uses and common metformin side effects along with how to deal with them.

Metformin: What Is It Used For?

Metformin is an old warhorse in the pharma battle against diabetes. It has been the mainstay in the treatment of Type 2 Diabetes for more than fifty years, often matching or outperforming newer drugs.

In fact, many new combination drugs are often created with metformin as one of the main ingredients. Thanks to its long run in the pharmaceutical world, the side effects of Metformin are also well known.

The Metformin-PCOS connection has been studied extensively since a majority of health complications associated with PCOS (polycystic ovarian syndrome) are due to hyperinsulinemia (high amounts of insulin in the blood stream). Metformin is known to reduce circulating insulin levels. The use of this drug in women with PCOS has shown highly encouraging results.

RELATED: 10 Easy Breakfast Ideas For Diabetics

Most Prescribed Names in Metformin Category Include:


It is an extended-release formulation that contains metformin hydrochloride. The tablets are designed for once-a-day administration. They deliver either 500 mg or 1000 mg of metformin. The tablet is made using a patented technology called SCOTTM that delivers the active compound slowly and at a constant rate.


Glucophage tablets contain metformin hydrochoride. They contain either 500 mg, 850 mg or 1000 mg of the active compound. Glucophage tablets do not contain any special covering and need to be taken multiple times a day until the prescribed dosage is met.

Glucophage XR:

It also contains metformin hydrochloride (in dosages of 500 mg and 750 mg of the active compound.) With this tablet, metformin is released as a constant rate, thus providing a steady dosing of metformin in the body. It has a special coating that allows this special extended release activity of Metformin. Because it has a unique coating, the tablet should never be crushed and should be swallowed whole.


It is an extended-release formulation of metformin hydrochloride. This tablet is available in 500 mg and 1000 mg dosages of the active compound. Glumetza is usually taken once a day with the evening meal. The tablet should not be split, crushed or chewed and should be swallowed whole for it to work properly.


It is a liquid formulation containing metformin hydrochloride as the active compound. It is available in two flavored formulations — cherry and strawberry — and delivers 500 mg of metformin in 5 ml of the solution. The formulation contains artificial sweeteners like saccharin, sucralose, and xylitol. To meet the daily metformin dosages, patients need to take as much as 25 ml of the syrup. Thus they should practice caution against consuming large amounts of artificial sweeteners.


It contains 500 mg of metformin hydrochloride. However, it should not be confused with another drug of the same name that is prescribed for depression and for nighttime bedwetting in children.


Formin is a formulation containing 500 mg of metformin hydrochloride in tablet form.

Daomet SR:

It is a sustained-release formulation containing 500mg or 1000 mg of metformin hydrochloride as the active compound.


It is a long-acting formulation containing metformin hydrochloride as the active ingredient. It is available in 500 mg dosage.


It is is a sustained-release formulation. It contains metformin hydrochloride as the active compound at 500 mg or 1000 mg dosage.

Metformin Side Effects

Metformin Side Effects infographics

Conventional medicine treats Type 2 Diabetes as a chronic disease that requires lifelong management with medication. Needless to say, the longer a person uses a particular medicine, the more likely it is to create side effects in them. So, most people will face metformin side effects along with its benefits.

Metformin Side Effects Are:

  • Fatigue
  • Reduced appetite
  • Stomach or abdominal discomfort
  • Macrocytic anemia (red blood cells get too large)
  • Cough or hoarseness of voice
  • Tingling or numbness in the palms and feet
  • Diarrhea
  • Pain in the lower back or in the flanks (sides)
  • Muscle pain or cramping
  • Hair loss
  • Shallow breathing
  • Painful or difficult urination
  • Blurred vision
  • Weight gain
  • Anxiety

Rare Side Effects Of Metformin

Among the rare symptoms, a more common one is lactic acidosis. It results in indications like fast or shallow breathing, a feeling of general discomfort, muscle pains, decreased appetite, loose stools and stomach discomfort.

RELATED: Getting Over The Side Effects Of Metformin

What Causes These Metformin Side effects?

Metformin gives great sugar-control benefits to diabetics. The common metformin side effects are well known and almost all doctors know how to deal with them. All this is great news. However, there is one aspect of metformin side effects that neither patients nor most doctors know.

Metformin side effects are caused because metformin interferes with the absorption, synthesis, transportation, storage, metabolism and excretion of certain nutrients. This happens due to long term use of the drug metformin.

Dr. Ross Pelton, RPh, CCN has made this amazing connection in his research. If diabetics simply put these vital nutrients back into their body, they can actually prevent (or at least reduce) the side effects of metformin. The additional good news is that just a couple of dietary supplements could cover several side effects. These nutrients often cost a fraction of what drugs cost. Within the recommended doses, they have a few or no side effects.

RELATED: Reduce Metformin Dosage With Simple Lifestyle Changes

Symptoms Due To Nutrient Loss Caused By Metformin


Metformin causes depletion of Vitamin B12, Folic Acid and CoQ10, leading to feelings of tiredness, weakness and in some cases, even anemia. If you have been feeling tired all the time and are lacking the energy to do anything, you may be missing Vitamin B12, or Folic Acid (Vitamin B9), or Coenzyme Q10 (CoQ10). These nutrients are needed to ensure that red blood cells of the right size are created in the body and cells are able to produce energy.

Tingling or Numb Hands and Feet (Diabetic Neuropathy)

Arms and feet could tingle or feel numb due to depletion of Vitamin B12, which is critical for nerve insulation. Our nerves are like electric wires and we need Vitamin B12 to keep the protective sheath of the nerves healthy. Metformin interferes with B12 absorption in the body. This leads to nerves becoming extra sensitive, almost like having a short circuit. If nerves get deadened instead, one could feel numbness or that ‘pillow walking’ feeling diabetics often complain about.

Memory and Cognition Issues (Brain Fog)

Vitamin B12 depletion could lead to memory and cognition issues, especially in elderly diabetics. Diabetics who have vitamin B12 depletion could suffer from confusion, memory loss, moodiness, abnormal gait, agitation, dizziness, delusions, dementia and even hallucinations. The risk of symptoms relating to a B12 deficiency increases in elderly diabetics. With age, we produce lesser stomach acid and intrinsic factor, both of which are important for digestion and absorption of Vitamin B12 from regular food sources.

[mc4wp_form id=”12950″]

Skin And Hair Issues

Vitamin B9 depletion could cause hair loss while Vitamin B12 loss could cause your skin to bruise easily. If you find that your skin bruises a lot easier than it used to/that you have dermatitis/that your skin is a lot more sensitive, you could be missing vitamin B12. Folic Acid (Vitamin B9) depletion could also lead to hair loss.

Digestive Issues

CoQ10 depletion could cause gum problems, while depletion of Vitamins B9 and B12 could cause diarrhea, nausea and loss of appetite. A loss of appetite, nausea and diarrhea could be caused by, both, B12 and Folic Acid (B9) depletion. Since the digestive tract begins with the mouth, we must mention gingivitis or gum problems here. These can happen when CoQ10, another vital nutrient, is depleted from the body by Metformin (Biguanides).

Muscle Pains, Cramps, Swollen Feet and Cardiac/Heart Issues

Diabetics often complain of unexplained pain in the legs, especially calf muscles. The heart is the most important muscle in the human body and loss of CoQ10 causes a feeling of ‘heaviness’ in the heart.  Metformin causes depletion of CoQ10, which is critical for muscle energy. One of the key vitamin-like compounds that is depleted by Metformin (Biguanides) is called Coenzyme Q10 or CoQ10. It is also called ubiquinone, from the word ubiquitous, meaning everywhere. It is needed for energy production in, literally, every muscle of the human body. Depletion of this vital compound leads to lack of energy and muscle pains. Another impact of the loss of CoQ10 on cardiac health shows itself in stubborn swelling in the legs and feet.

The heart is the most energy-demanding muscle in the human body. So, lack of CoQ10 can lead to –

  • High blood pressure
  • Angina (discomfort in the chest)
  • Cardiac arrhythmia (irregular heartbeat)
  • Cardiomyopathy (labored breathing, swelling of feet, bloated belly)
  • Serious conditions like congestive heart failure, mitral valve prolapse and stroke.
RELATED: Diet & Nutrition And Reversal Of Chronic Diseases: A Case Study

How Do I Get Relief From Metformin Side Effects such as Nausea, Stomach Pain, Diarrhea?

These are the most common side effects of metformin. Doctors handle the nausea, stomach pain, diarrhea etc. caused by Metformin by:

  • Adjusting the dose of metformin – Usually they will start you off with a lower dose than the one prescribed previously and then slowly ramp it up.
  • Asking you to take the medicine with meals, instead of taking it on an empty stomach – This way the medicine works at a time when blood sugar is higher, reducing side effects.
  • Prescribing a slow-release version of metformin – This ensures that your body does not feel the impact of the whole dose in one go.

Nevertheless, you need to get back to your doctor regarding these side effects so that he/she can help you cope on a personal level.

Common Metformin (500 mg) Dosage & Mechanism of Action

There is no fixed dosage regimen of any anti-diabetic drug for the management of hyperglycemia. Dosages should be individualized based on effectiveness, tolerance and the patient’s own efforts in controlling blood sugar levels.

Initial dosages should be Metformin 500 mg orally twice a day, or 850 mg once a day. The dosage can be increased in 500 mg weekly increments or 850 mg every two weeks as tolerated. Maintenance dose is usually 2000 mg daily in divided doses and the maximum dose should never exceed 2550 mg per day.

On average, diabetics are found to produce two to three times more glucose in their liver than non-diabetics. Metformin effectively suppresses glucose production in the liver. Metformin also makes cells more sensitive to insulin. Experts agree that diabetes starts with insulin resistance. Insulin is the courier that carries glucose from your food into cells. When cells resist, insulin is not able to deliver sugar into muscle and fat cells. Sugar then backs up in the bloodstream instead.

Precautions to Follow While Taking Metformin

Pregnant and breastfeeding women should not take metformin as it can negatively affect the development of the fetus and child.

While metformin is safe, it does interact with certain medications and should not be taken along with them. These include medications like gatifloxacin, herbs that lower blood sugar (like Gymnema), certain acid-blocking drugs like cimetidine, diuretics (“water pills”) like furosemide, oral contraceptives, etc.

If you are on medications to treat your heart conditions or have impaired liver or kidney function, you should inform your healthcare practitioner and be extremely careful while taking metformin.

Metformin also reacts adversely and severely with certain drugs that are given prior to imaging/CT scan procedures. If you need to get a scan done, you should stop taking metformin for a few days before and after the scan.

Best Dietary Supplements For Relief From Metformin Side Effects

Best Dietary Supplements For Relief From Metformin Side Effects - Vitamin B, CoQ10 and Folic Acid

Best Dietary Supplements For Relief From Metformin Side Effects – Vitamin B, CoQ10 and Folic AcidBest Dietary Supplements For Relief From Metformin Side Effects – Vitamin B, CoQ10 and Folic Acid

  • Vitamin B12: 200-1000 mcg, preferably sublingual administration (taken orally under the tongue)
  • Folic Acid or Vitamin B9: 400-800 mcg
  • CoQ10: 30-200 mcg (Upper limit is often cited at 400 mcg)

Vitamin B12

Vitamin B12 is available in several forms. There’s much controversy surrounding which forms of Vitamin B12 are best absorbed by human beings. Manufacturers of each form claim support in the scientific literature for their form. But, something else seems to matter more.  If you have a clear deficiency (identified with an inexpensive blood test), you need upwards of 1000mcg to quickly shore up your Vitamin B12 levels.

Folic Acid or Vitamin B9

Folic Acid or Vitamin B9 may be had separately or may be combined with Vitamin B12 and other Vitamins in the B family in a single Vitamin B-complex capsule. This is because the remaining members of the Vitamin B family (Vitamins B1 through B7), each, has some benefit to offer diabetics. Here, the majority opinion is in favour of the form of B9 (called folate). It is closer to nature than folic acid, which is chemically synthesized.


Finally, the opinion on form of CoQ10 is divided. Some functional medicine practitioners prefer the Ubiquinol form, while others prefer the Ubiquinone form. Whichever one you pick, the closer your supplements are to natural sources (extracted from them), the better absorption and results you’ll have.

Doses are per day, unless stated otherwise, and are based on studies. Please consult your medical doctor for what supplement and dosage would suit you best.

Reducing Metformin Doses With Diet, Exercise and Stress Management

Controlling blood sugar levels must be given top priority and that is why drugs like metformin are suggested for regular use by doctors. However, research also shows that dietary supplements can help you reduce the burden of prescription drugs and their side effects by supporting better blood sugar control.

Intermittent fasting is also recommended by several M.D.s, like Dr.Jason Fung, who believe that Type 2 diabetes can be reversed. Considering diabetes as a dietary disorder, adopting Low Carbohydrate High Fat or LCHF diet as your core diabetic diet principle is also gaining favor among the same functional doctors.

Stress management, including meditation and performing specific yoga poses, have been shown to improve diabetes control.

So, go ahead and take the next step. Share this information with your medical practitioner and get rid of metformin’s side effects.

Nachiket Rajadhyaksha
Nachiket holds a first class degree in Pharmacy and is passionate about writing. He believes that subject experts must simplify medical concepts to make them interesting and accessible to everyone.



  1. Drug-Induced Nutrient Depletion Handbook: Ross Pelton, James B. LaValle, Ernest B. Hawkins, Daniel L.Krinsky , 2nd Edition. Supplement Your Prescription: Hyla Cass, M.D.