What Are the Risks of Mixing Metformin and Alcohol?

Is it Safe to Drink Alcohol While Taking Metformin?

If you're taking Metformin, moderate alcohol consumption may be safe. But, it's important to consult with a healthcare professional first.

However, if you struggle with any of the following, the interactions between the two can be dangerous:

• Alcohol use disorder (AUD)
• Participating in binge drinking
• Misusing Metformin

Drinking too much alcohol while taking Metformin can lead to metformin-associated lactic acidosis, which can be life-threatening. Metformin also improves the body's insulin sensitivity and reduces the amount of blood glucose produced by the liver. Meanwhile, alcohol affects the liver.

Mixing the two may cause an over-stressed liver that cannot perform as it should. This problem worsens over time and is especially dangerous for people with ongoing alcohol misuse issues.

How Many Drinks Are Safe When Taking Metformin?

If you plan to drink while taking Metformin, keep your drinks to a minimum. It’s recommended to have a maximum of one drink for women and two for men. 

Here’s a guide to help you understand what one drink equates to:

• Beer (5% alcohol content): 1 to 2 ounces
• Malt liquor (7% alcohol content): 8 ounces
• Wine (12% alcohol content): 5 ounces
• Distilled spirits or liquor (40% alcohol content): 1.5 ounces

It's important to remember that people's responses to alcohol may vary. If you want to drink alcohol while taking metformin, consult your doctor for adivce.

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What is Metformin?

Metformin is a diabetes medication that helps with blood sugar control. Combined with a healthy exercise and diet routine, Metformin can reduce blood sugar levels in people with type 2 diabetes. Depending on a person's circumstances, it can be used with or without insulin or other diabetic medications.

Side Effects of Metformin

Metformin, on its own, can have side effects. However, these side effects happen in more than 1 in 100 people.

These side effects include:

• Nausea
• Vomiting
• Diarrhea
• Stomach ache
• Loss of appetite
• A metallic taste in your mouth

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Side Effects of Mixing Metformin and Alcohol

Metformin users have an increased risk of experiencing upset stomachs and diarrhea. Drinking alcohol also triggers upset stomachs for some people. This is a serious problem when combining the two substances.

Excessive alcohol use can also affect blood glucose levels and contribute to liver damage. Alcohol interferes with your liver’s usual processes, which puts you at risk of low blood sugar. This can worsen when you drink while taking Metformin.

Symptoms of low blood sugar include:

• Dizziness
• Drowsiness
• Confusion

Severe Side Effects of Metformin and Alcohol

Alcohol also worsens Metformin’s usual side effects, especially gastrointestinal issues. The more you drink, the worse the problems. 

Side effects that are likely to be severe when Metformin is combined with alcohol include:

• Abdominal pain
• Vomiting
• Nausea
• Loss of appetite
• Excessive gas

• Indigestion
• Heartburn
• Acidic stomach
• Muscle cramping

If you choose to drink while using Metformin, consume plenty of water. It’s also a good idea to avoid alcohol consumption when new to Metformin until your body adjusts to the drug. 

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Dangers of Mixing Metformin and Alcohol

It's important for people who regularly drink alcohol to be cautious when using Metformin. Drinking excessively when using Metformin to treat diabetes can produce potentially life-threatening conditions.

Frequent drinking is also a problem and can trigger various serious complications. The most dangerous issues to arise due to mixing alcohol and Metformin include:

Hypoglycemia

Hypoglycemia is a risk for anyone mixing alcohol and Metformin because of the effect both substances have on blood sugar. Even without high alcohol intake, you can be at risk of low blood sugar levels if you:

• Take too much Metformin
• Skip meals
• Don't eat enough carbohydrates

Some of the signs of hypoglycemia mimic the usual symptoms of alcohol consumption and include:

• Weakness
• Headache
• Racing heartbeat
• Exhaustion
• Extreme hunger
• Drowsiness
• Troubling concentrating
• Cold sweats
• Blurred vision

• Pale skin
• Nightmares or otherwise restless sleep
• Anxiety
• Nausea
• Shakiness
• Dizziness
• Slurred speech

Treatment for Hypoglycemia

If you’re experiencing hypoglycemia symptoms, do the following:

• Use injectable or nasal glucagon
• Eat fast-acting carbohydrates or sugar (glucose tablets, regular soda, or fruit juice)
• Check your blood sugar after using the glucagon kit or eating

Glucagon is available for prescription. Consider training your family or friends to use the glucagon kit. If your blood sugar levels don't improve after eating or using glucagon, contact your healthcare provider or seek medical assistance.

Lactic Acidosis

Lactic acidosis is one of the most severe risks when you mix Metformin and alcohol. It occurs when your blood supply can't bring enough oxygen to the muscles and organs and when there is a buildup of lactic acid.

All Metformin users are at risk of this condition. Because of this, the FDA placed a "black box warning" on the drug's packaging.

Although the risk of developing lactic acidosis while taking Metformin is rare, excessive alcohol consumption can increase the risk. If you experience any symptoms of lactic acidosis, seek emergency medical attention immediately.

Symptoms include:

• Cramping, especially in the abdomen
• Diarrhea
• Fluttering heartbeat
• Fast or shallow breathing
• Muscle seizures
• Intense weakness

• Fatigue or tiredness
• Decreased appetite
• Low blood pressure
• Fast pulse rate
• Nausea
• Vomiting
• General discomfort

Treatment for Lactic Acidosis

The treatment for lactic acidosis varies depending on your situation. You’ll need to treat the underlying cause. Some ways to manage the symptoms include:

• Intravenous administration of sodium bicarbonate
• Increasing oxygen to the tissues
• Vitamin therapy

Vitamin B-12 Deficiency

Metformin reduces vitamin B-12 absorption for some users. Alcohol consumption also interferes with absorption by causing inflammation in the stomach. With that in mind, combining these two can create a dangerous scenario related to B-12 deficiency.

Warning signs of a B-12 deficiency include:

• Headache
• Inability to concentrate
• Confusion
• Numbness or tingling, especially in the hands and feet

• Neuropathy
• Anemia
• Impaired memory
• Dementia
• Delirium

Treatment for Vitamin B-12 Deficiency

You can overcome vitamin B-12 deficiency through a proper diet. Good sources of vitamin B-12 include:

• Meat
• Fish
• Eggs
• Milk
• Dairy products

Tablets and injections are also available to overcome vitamin B-12 deficiency. You can take vitamin tablets or B-12 injections.

Who is at Risk When Combining Metformin with Alcohol?

People more sensitive to alcohol’s effects are more at risk for negative effects from combining Metformin with alcohol. These include the following:

• People with liver problems: Alcohol puts more stress on the liver, making liver problems worse
• People with reduced kidney function: Having kidney problems can affect how long alcohol and Metformin stay in your system
• Women: Women have less water in their bodies; as a result, alcohol is more concentrated in a woman’s body than a man’s
• Adults over 65: Older people experience the effects of alcohol more quickly than younger people

How to Manage Diabetes If You Drink Alcohol 

If you have diabetes but still want to drink alcohol, you can follow these tips:

• Never drink alcohol on an empty stomach.
• Avoid calorie and carbohydrate-rich mixers. Have diet-free or sugar-free mixers instead.
• Limit your alcohol intake. Have a maximum of one drink per day for women and two per day for men. 

Treatment for Metformin and Alcohol Abuse

Combining alcohol and Metformin is most dangerous when you consume alcohol excessively or use the drug without a doctor’s orders. If your healthcare provider has recommended Metformin and you are concerned that abstaining from alcohol could be a problem, it’s best to seek AUD treatment. 

Medical treatment is also necessary if you or a loved one abuses Metformin for weight loss. Available treatment options include:

• Inpatient treatment: Involves checking yourself into a rehab facility for 24-hour medical supervision
• Outpatient treatment: A treatment program where you are freely allowed to leave the rehab facility
• Dual diagnosis treatment: A treatment program that addresses co-occurring mental health conditions alongside addiction
• Cognitive behavioral therapy: A short-term therapy technique explores the link between thought patterns and addiction
• Support groups and aftercare programs: Provide a much-needed community to help maintain sobriety after treatment

Summary

Combining alcohol and Metformin can cause serious problems. It's best to limit your drinking or avoid alcohol together when you have diabetes. 

Remember to consult with a healthcare professional before drinking while taking medication. They can help you understand the possible risks of drinking alcohol while taking Metformin.

Drinking too much alcohol while on Metformin can lead to unpleasant and even life-threatening side effects. Talk to your doctor so you can maintain optimal blood glucose control and avoid potential risks.