Metformin Side Effects (& Consequences)
Hi everyone! welcome back to another lesson. we’re talking about the side effects of metformin in this lesson – so we’re going to talk about a brief introduction as to what metformin is, and what it does, and we’re going to talk about the side effects that can happen from taking it, and why those side effects occur. let’s
First talk about what metformin actually is. it is a medication used to lower or reduce blood glucose levels. so it not only is used for diabetic patients but can also be used for other patient populations as well including patients with polycystic ovary syndrome. mechanisms. one of them is by inhibiting
Is by inhibiting glucose uptake from the one is by increasing insulin sensitivity. so by these three mechanisms it can reduce blood glucose levels. now the problem here is that severe side effects – we’re going to talk about those in this lesson and there are certain patient characteristics that increase the
Risk of actually getting side effects from taking metformin and these include the following having liver disease, having kidney disease, having heart disease, or a recent myocardial infarction, being a heavy alcohol consumer, and having a previous allergic reaction to metformin. so having these patient
Characteristics can increase the likelihood of you having certain side effects from metformin use. metformin. one of the biggest ones we’re going to see with metformin use is diarrhea. so most times the diarrhea is going to be a watery diarrhea or a softening of stool, and we can look at this by looking at the bristol
Stool chart so type 4 with metformin we can see type 5, type 6, and type 7 stool from the bristol stool chart. and diarrhea is so common that it is actually one of the most common side effects of metformin use. roughly a third of patients will have diarrhea from metformin use, and really this percentage is
Probably even higher than this. and it occurs in a dose-dependent manner – so oftentimes, metformin is started at a lower dose, patients will get diarrhea, and then the diarrhea will subside, that side effect will go away, and then the patient’s of metformin to a higher dose, and then the patient will get diarrhea
Again and then that diarrhea will subside until the therapeutic dose is reached. so again, what often happens is the side effect of diarrhea will subside and improve with continued use of metformin, and then the practitioner will increase the dose of metformin, the patient will get diarrhea again, and then that
Will subside. another common side effect of metformin is flatulence. so this is increased gas and bloating. this often occurs with the diarrhea, metformin use. alternatively, metformin can cause constipation – this is going to be less common than diarrhea but it can happen in certain patients – so constipation
In this context refers to reduced frequency of bowel movements and or can look at the bristol stool chart, type 4 is the normal stool and then with constipation we can see type 1, type 2, and type 3 stool. so that is going to be something that may occur in some patients who are on metformin. but again,
Diarrhea is going to be more common. now metformin can also cause nausea and vomiting, and nausea and vomiting is actually one of the most common side effects of metformin use occurring in upwards of two to three in 10 patients who take metformin. so again, roughly 30 percent of patients are going to experience nausea
And vomiting, so those are going to be the most common symptoms – diarrhea, nausea and vomiting. now a very significant side effect that can occur with metformin use is lactic acidosis. so lactic acidosis may occur in certain patient populations taking metformin. this is actually the black box warning with
Metformin. so this is the significant condition you want to be aware of when using metformin. that are at an increased risk for getting lactic disease, so especially those with cirrhosis, and then those that are on other medications specifically carbonic anhydrase inhibitors, so topiramate is one of them, and
Older patients, patients over the age of 65, and those who are heavy alcohol consumers. so all of those patient populations are going to be at an increased risk for getting lactic acidosis from metformin use can have symptoms of lactic acidosis including fatigue respiratory distress among other signs and
Symptoms – if you want more information on symptoms of lactic acidosis please check out my full lesson on that topic. metformin can also cause heartburn and dyspepsia. so metformin can lead to an increased acid reflux in epigastric pain and chest discomfort may also occur as well. we can also see dizziness occurring
With metformin use. this may be simply due to taking medication – so a lot of medications when you take them a common side effect of many medications, orthostatic hypotension. so metformin can lead to orthostatic hypotension so that means that when there’s a postural change if someone is going from
Sitting down to standing up very quickly they can have a drop in their blood pressure, and this can cause them to feel dizzy, so that is orthostatic hypotension. so metformin can cause this and that may be the reason why dizziness can occur in some patients who are on metformin. headaches are another possible side effect
From metformin use. so they may occur with metformin many medications like dizziness, headaches can often be side effects of many medications, but paradoxically, metformin may act to suppress migraine headaches. so in some patients, it may cause a headache, but in some other patients it may actually help reduce
Their migraine headaches. note here. now another long-term side effect of metformin use is vitamin b-12 deficiency, and as i just mentioned, deficiency of vitamin b-12 is associated with long-term use of metformin so a lot of times patients will get on metformin for their diabetes control, and they’ll be on
It for a long period of time, but the longer they will become a vitamin b12 deficient. so because of this they are susceptible to getting signs and symptoms of vitamin b12 deficiency these the red blood cells are bigger in size, fatigue and depression are some symptoms that can occur with vitamin b12 deficiency,
And then there are some neurological symptoms from vitamin b12 deficiency including peripheral neuropathy. neurological symptoms from vitamin b12 deficiency are very very important to recognize because they can become irreversible if this is not treated properly. so these neurological symptoms include
Peripheral neuropathy but some other symptoms as well including postural stability, two-point discrimination issues and some other symptoms as well. again, if you want more information on please check out my full lesson on this topic. now we can also see a possible side effect of hypoglycemia with metformin use. so
Hypoglycemia is a low glucose level, although this is very unlikely to occur as metformin is going to act to reduce gluconeogenesis and uptake of glucose it’s not going to really cause a very low level of glucose in the blood, but it could in very rare circumstances especially when metformin is used with other
Diabetes medications or after excessive alcohol consumption or exercise. so those are going to be the times when we’re going to see metformin possibly causing hypoglycemia, but most often we’re not going to see this as a potential side effect, and with hypoglycemia we’re going to see hypoglycemia symptoms and these
Include blurry vision and fatigue. some other side effects of metformin use include weakness – this is also known as asthenia. so muscle weakness and fatigue may occur with metformin use. so the muscle weakness and fatigue can be related to the metformin but could also be related to some other side effects of metformin we’ve
Mentioned before including that vitamin b12 deficiency associated anemia. so that anemia may lead to fatigue as well other side effects and with metformin use. interestingly, it can increase the risk of certain respiratory infections, particularly an increased has been noted in patients on metformin so include
Respiratory tract infections above the larynx so that means that these are going to be infections in the nose and in the throat, so we can see an increased risk of respiratory infections with metformin use, but this is an association, so this doesn’t necessarily imply causation but there is an increased association
With respiratory tract infections of the upper respiratory tract in metformin use. now some other important side effects of metformin use are taste changes – oftentimes a patient will describe a metallic taste in the mouth when they’re on metformin or they may also have sensation or taste of acid or sour taste in their
Mouth which may be related to the heartburn we mentioned earlier on in this lesson. and then some patients may describe altered or reduced taste so metformin can cause some taste changes or disturbances either it can reduce or alter the taste of certain foods and beverages or can lead to a metallic taste in the mouth
Or have an acid or sour taste in the mouth. so oftentimes this can be a side effect that a lot of patients on metformin may describe metformin can also cause myalgia – so myalgia is muscle aches and pains so this can occur with metformin touch. diaphoresis is also another side effect of metformin use. diaphoresis
Is excessive sweating. rhinitis can also occur with metformin use. so rhinitis is inflammation of the nose and this can lead to a runny nose and nasal congestion, effect of metformin use. so if you want to learn about other drugs and their side effects please check out my pharmacology playlist, subscribe for
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Metformin Side Effects (& Consequences) By JJ Medicine
