Metformin and Alcohol Interactions

Is it Safe to Drink Alcohol While Taking Metformin?

Moderate alcohol consumption is safe for most people taking Metformin. 

However, if someone is struggling with alcohol use disorder, participates in binge drinking, or misuses Metformin, the interactions between the two can be dangerous. 

Metformin users risk the potentially fatal condition called lactic acidosis when they drink too much alcohol. 

Metformin improves the body’s insulin sensitivity and reduces the amount of blood glucose produced by the liver.  

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’re planning 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

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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 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.

In general, people with type 2 diabetes should avoid alcohol use, especially excessive alcohol use. Drinking alcohol affects your blood sugar and irritates  the liver. 

Alcohol interferes with your liver’s usual processes, which puts you at risk of low blood sugar. Symptoms of low blood sugar include:

• Dizziness
• Drowsiness
• Confusion

These symptoms are similar to what you experience when consuming alcohol. Some people mistake a dip in blood sugar for an alcohol “buzz.”

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. 

Discuss with your healthcare provider whether or not it is safe for you to consume a mild amount of alcohol. 

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Dangers of Mixing Metformin and Alcohol

In some cases, the side effects of mixing Metformin and alcohol is more than unpleasant—it’s dangerous. 

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 Metformin and alcohol because of the effect both substances have on blood sugar. Even without high alcohol intake, Metformin users who take too large a dose or eat poorly are at risk. Alcohol increases the risk because it causes a dip in blood sugar.

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. This is available for prescription. It’s best to train your family or friends to use the glucagon kit.
• Eat fast-acting carbohydrates or sugar. This can be glucose tablets, regular soda, or fruit juice.
• Check your blood sugar after using the glucagon kit or eating.

Lactic Acidosis

Lactic acidosis is one of the most severe risks of mixing Metformin and alcohol. It occurs when a person's blood supply cannot 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. 

The risk of lactic acidosis was so great that the FDA ordered the placement of a “black box warning” on the drug’s packaging. Consuming alcohol increases this risk even more.

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, so the two combined 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, and other 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 Alcohol and Metformin?

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

• People with liver problems: Alcohol puts more stress on the liver, making liver problems worse.
  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 are more sensitive to alcohol’s effects. They experience the effects 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.

Summary

Mixing Metformin and alcohol can cause serious problems. Limiting your drinking or avoiding alcohol altogether when you have diabetes is best. 

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.