What is the downside of taking metformin?

Long-term side effects Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.

nhs.uk - Side effects of metformin - NHS

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Common side effects

These common side effects of metformin happen in more than 1 in 100 people. There are things you can do to help cope with them: Feeling sick (nausea) Take metformin with food to reduce the chances of feeling sick. It may also help to slowly increase your dose over several weeks. Ask a pharmacist or your doctor for advice. Being sick (vomiting) Take small, frequent sips of water or squash to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor. If you take contraceptive pills and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet to find out what to do. Diarrhoea Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If you take contraceptive pills and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice. Stomach ache Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you're in a lot of pain, speak to your pharmacist or doctor. Loss of appetite Eat when you'd usually expect to be hungry. If it helps, eat smaller meals more often than usual.

A metallic taste in the mouth Try chewing sugar-free gum.

If this advice does not help and any of these side effects continue to bother you, tell your doctor or pharmacist.

Vitamin B12 deficiency

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Taking metformin can cause vitamin B12 deficiency. Call your doctor or contact 111 if you:

feel very tired

have muscle weakness

have a sore, red tongue

have mouth ulcers

have problems with your vision

have pale or yellow skin (this may be less obvious on brown or black skin Your doctor can check your vitamin B12 serum levels. If they are too low, they may prescribe B12 vitamin supplements.

Low blood sugar

Metformin does not usually cause low blood sugar (known as hypoglycaemia, or "hypos") when taken on its own. But hypos can happen when you take metformin with other diabetes medicines, such as insulin or gliclazide.

Early warning signs of low blood sugar include:

feeling hungry

trembling or shaking

sweating

confusion

difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar may happen if you:

take too much of some types of diabetes medicines

do not eat meals at regular times or skip meals

are fasting

do not eat a healthy diet and are not getting enough nutrients

change what you eat

exercise too much without eating enough carbohydrates

drink alcohol, especially after skipping a meal

take some other medicines or herbal remedies at the same time

have a hormone disorder, such as an underactive thyroid (hypothyroidism)

have kidney or liver problems

To prevent hypoglycaemia, it's important to have regular meals, including breakfast. Try not to miss or delay a meal. If you're planning to exercise more than usual, make sure you eat carbohydrates like bread, pasta or cereals before, during or after exercise. Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help. You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer. Call your doctor or call 111 if taking in sugar does not help, or the hypo symptoms come back

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Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious side effects

Serious side effects are rare and happen in less than 1 in 10,000 people.

Call your doctor or contact 111 straight away if:

you get a general feeling of being unwell with severe tiredness, fast or shallow breathing, being cold and a slow heartbeat the whites of your eyes turn yellow, or your skin turns yellow, although this may be less obvious on brown or black skin – this can be a sign of liver problems

Go to 111.nhs.uk or call 111.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to metformin. Immediate action required: Call 999 or go to A&E now if: you get a skin rash that may include itchy, red, swollen, blistered or peeling skin

you're wheezing

you get tightness in the chest or throat

you have trouble breathing or talking

your mouth, face, lips, tongue or throat start swelling You could be having a serious allergic reaction and may need immediate treatment in hospital.

Long-term side effects

Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.

Other side effects

These are not all the side effects of metformin. For a full list, see the leaflet inside your medicine packet.

nhs.uk - Side effects of metformin - NHS

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