Metformin Aftereffects: Be Aware of These Symptoms
Metformin, a low-cost, daily prescription medication, is widely used for treating Type 2 diabetes and high levels of insulin resistance. While it is generally safe and effective, it's essential to be aware of potential side effects, particularly those that may arise over the long term.
Gastrointestinal Side Effects
When you first start taking metformin, you may experience mild gastrointestinal side effects such as nausea, diarrhea, increased gas, bloating, stomach pain, weight loss, headaches, and a metallic taste in your mouth. These side effects are common early in treatment but are usually transient and decrease over time [1][3].
Vitamin B12 Deficiency
Long-term use of metformin (generally after 12+ months) can reduce vitamin B12 absorption, potentially leading to deficiency in up to 30% of patients. This deficiency may cause symptoms like anemia and peripheral neuropathy. Regular monitoring of vitamin B12 levels annually and supplementation if needed is recommended, especially for patients with symptoms like anemia or neuropathy [1][4][5].
Kidney Function
Metformin is cleared primarily by the kidneys, and while it does not damage healthy kidneys, in people with impaired kidney function, metformin can accumulate and increase the risk of lactic acidosis, a rare but serious condition. Dosage adjustments or discontinuation may be necessary based on the degree of kidney impairment. Long-term studies over decades have not shown metformin to harm kidney function in patients with normal kidneys [2][5].
Lactic Acidosis
Lactic acidosis is more likely to occur in people with reduced kidney function. Symptoms of lactic acidosis include extreme fatigue and weakness, muscle pain and body aches, trouble breathing, dizziness, fever, irregular heart rate, and confusion. Lactic acidosis is a life-threatening condition caused by a pH imbalance and too much lactic acid in the bloodstream [1].
Hypoglycemia
Hypoglycemia, or low blood sugar, can also be life-threatening and may occur when metformin is taken in combination with insulin or other diabetes medications. Early signs of hypoglycemia include shaking, weakness, sweating or chills, extreme hunger, faster heart rate, dizziness, and confusion [1].
Preventing Side Effects
To reduce the chances of these side effects, metformin should be taken with food and avoided on an empty stomach, and started out on smaller doses and increased over time as needed. If you have kidney disease or other kidney conditions, notify your healthcare provider before taking metformin [1].
Off-Label Uses
Metformin has off-label uses for treating polycystic ovary syndrome (PCOS) and for inducing weight loss for people living with prediabetes [1].
In summary, monitoring kidney function regularly and checking vitamin B12 levels annually in long-term metformin users is important to prevent and manage these side effects effectively. It's always best to discuss any concerns with your healthcare provider.
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