Can You Drink Alcohol While Taking Metformin?

Metformin is one of the most popular diabetes medications used today for diabetes management.

If you’re taking metformin, you might be wondering how safe it is to drink alcohol while taking it.

There are some safety concerns from drinking a lot of alcohol, both in general and while taking metformin.

Read on to learn more about how alcohol and metformin interact and how to reduce your risk of health complications by mixing the two.

What is metformin?

Metformin is one of the most commonly prescribed medications for type 2 diabetes and was approved by the Food and Drug Administration in 1995.

Metformin is the generic name most commonly prescribed, and the brand name for metformin is Glucophage. Other brand names for metformin include Glumetza and Fortamet.

Metformin is a pill meant to be taken orally at least once daily. The common dosage for metformin ranges from 500 milligrams to a maximum of 2,550 milligrams per day. It’s usually recommended to split the dose among meals, typically three times per day.

Metformin is in a drug class called biguanides. Biguanides help reduce the amount of sugar your liver makes while improving insulin sensitivity, which helps reduce high blood sugar. There are two types of metformin – regular and extended-release (XR). Extended-release metformin can be taken just once a day.

Metformin doesn’t cause low blood sugar (hypoglycemia), which is one of its major benefits. Because it doesn’t cause low blood sugar, you can take metformin along with other medications like sulfonylureas and injectable insulin to help control your blood sugar levels.

While metformin is most commonly used for type 2 diabetes, it’s also used to help treat polycystic ovarian syndrome (PCOS). Polycystic ovary syndrome is a hormonal disorder in women often stemming from insulin resistance. 

One of the benefits of metformin is that it may support weight loss, and it doesn’t promote weight gain like some diabetes medications.

If you’re overweight, weight loss of 5-10% of your body weight can improve your blood glucose levels and insulin sensitivity, which is why it’s beneficial for both type 2 diabetes and PCOS.

Metformin and alcohol: Can I drink?

If you choose to drink alcohol while taking metformin, you should avoid drinking large amounts. It’s recommended to limit your alcohol consumption to one drink or fewer per day for women and two drinks or fewer per day for men.

Examples of what one alcoholic drink entails are as follows:

  • 12 ounces of regular beer, which is usually about 5% alcohol
  • 5 ounces of wine, which is typically about 12% alcohol
  • 1.5 ounces of distilled spirits, which is about 40% alcohol

Drinking alcohol can reduce the amount of sugar your liver releases, resulting, as a consequence, in low blood sugar. Metformin also lowers your blood sugar by reducing the amount of sugar your liver makes, so combining excessive alcohol consumption with metformin use can cause hypoglycemia (low blood sugar).

Lactic acidosis and metformin

Drinking a lot of alcohol while taking metformin can also increase your risk of developing lactic acidosis. Excessive alcohol intake can make it harder for your body to clear lactic acid from your body.

Lactic acidosis is a form of metabolic acidosis. When your body overproduces or underutilizes lactic acid and your body can’t keep up, lactic acidosis occurs. When this happens, your body cannot metabolize the lactic acid quickly enough.

Lactic acidosis can have a quick onset that appears within minutes. It might happen gradually, over a few days.

If you are experiencing lactic acidosis, it may be a problem in your liver. Or it’s possible that (in the case of chronic kidney disease) your kidneys are having a hard time removing excess acid from the body due to renal impairment or renal dysfunction/renal insufficiency.

According to a study, the leading cause of lactic acidosis in patients with type 2 diabetes is alcohol abuse. If you also have impaired kidney function, your risk of lactic acidosis is even higher since your kidneys don’t clear medications like metformin from your body as quickly as healthy kidneys.

Metformin overdose is the main risk factor for developing lactic acidosis, which is very rare. Suppose you have severe renal impairment or kidney disease. In that case, you might also be at greater risk of developing lactic acidosis because your kidneys can’t clear the lactic acid from your system. 

Metformin is safe to use when your estimated glomerular filtration rate (GFR) is greater than or equal to 45 milliliters per minute. The GFR is an indicator of how efficiently your kidneys filter blood. A GFR greater than 60 mL/minute is considered normal, and kidney failure occurs when the GFR falls below 15. 

Your healthcare provider likely won’t prescribe metformin or other medications that are cleared by your kidneys if your GFR is very low.

How much alcohol can you drink while taking metformin?

There isn’t a set amount of alcohol recommended while taking metformin. In general, you should avoid drinking more than one drink a day if you’re a woman and no more than two drinks a day if you’re a man.

According to the American Diabetes Association, drinking alcohol in moderation may have some health benefits, including improved blood sugar control and reductions in A1c. However, drinking several (more than three) drinks per day raises blood sugar levels and worsens glycemic control.

How long after taking metformin could you drink alcohol?

Metformin stays in your system for hours after you take it. It takes between four and nearly nine hours for half of the amount of metformin to be cleared from your system. This means that there will always be a little metformin in your system at all times if you’re taking it as prescribed.

If you choose to drink alcohol while taking metformin, it would be ideal to space your last dose and your drink as far apart as possible. If you’re not able to do that, just be careful not to drink excessive amounts of alcohol while taking metformin and maybe have a drinking limit goal.

What are the side effects of mixing metformin and alcohol?

If you develop hypoglycemia (low blood sugar) from mixing metformin and alcohol use, you may experience some symptoms such as:

  • Feeling shaky and/or dizzy
  • Sweating
  • Hunger
  • Feeling irritable or moody
  • Feeling anxious or nervous
  • Headache

If you develop lactic acidosis from drinking too much alcohol while on metformin, the warning signs to watch out for include:

  • Abdominal or stomach discomfort
  • Decreased appetite
  • Diarrhea
  • Fast, shallow breathing
  • A general feeling of discomfort
  • Muscle pain or cramping
  • Unusual sleepiness, tiredness, or weakness

If you experience low blood sugar while mixing metformin and alcohol, you can take steps to correct it. A blood sugar reading of less than 70 mg/dL is considered low. If you experience low blood sugar, it should be treated by eating or drinking something containing 15 grams of carbohydrate.

Fruit juice and candies are preferred to treat low blood sugar since they are rapidly absorbed into your bloodstream. It doesn’t take much juice to treat low blood sugar – about one-half cup of juice contains around 15 grams of carbohydrates.

If your blood sugar is very low (below 55 mg/dL) and/or isn’t responding to treatment, you should seek urgent medical attention.

What happens if I drink a lot while I am taking metformin?

If you drink a lot of alcohol while taking metformin, you may develop other health issues besides the potential scenarios listed above.

Drinking too much alcohol over time can have health risks, including:

  • Impact your brain and your ability to think, as well as your mood
  • Increase your risk of heart problems, high blood pressure, and stroke
  • Damage your liver health/ liver complications
  • Cause pancreatitis, a painful inflammation of your pancreas
  • Increase your risk of certain cancers
  • Interfere with your immune system, which may make you more susceptible to illness and infections

Alcohol and diabetes

As mentioned earlier, drinking alcohol in moderation may provide health benefits, including reduced blood sugar levels. However, drinking too much alcohol may cause low or high blood sugar.

Drinking alcoholic drinks with added sugar can raise your blood sugar. If you choose to drink alcohol and have diabetes, try to select those without sugary mixers and added carbohydrates.

Here are some examples of popular alcoholic drinks and their carbohydrate content:

  • Whiskey (1 oz): 0 grams
  • Tequila (1 oz): 0 grams
  • Brandy (1 oz): 0 grams
  • Dry Martini (7.5 oz): 0 grams
  • Bloody Mary (7.5 oz): 7 grams
  • Gin and Tonic (7.5 oz): 15 grams 
  • Cosmopolitan (8 oz): 16 grams
  • Rum and Coke (7.5 oz): 18 grams
  • White Russian (7.5 oz): 27 grams
  • Margarita (7.5 oz): 38 grams

The carbohydrate content of wine and beer can vary significantly between types. Dry wines tend to be lower in sugar and carbohydrates, and light beer is lower in carbs than IPAs and stouts.

Drinking alcohol can provide additional empty calories to your diet. Empty calories are those that don’t offer any nutritional value.

If you eat more calories than you burn, you gain weight. Unwanted weight gain can worsen your blood sugar control by worsening insulin resistance.

Alcohol consumption can worsen high blood pressure, especially if you drink excessively. You’re already at greater risk of developing high blood pressure and heart disease if you have diabetes, so it’s another reason to drink alcohol in moderation.

Alcohol consumption and diabetes

It might seem like drinking any alcohol is detrimental to your health. However, light to moderate alcohol consumption may offer some benefits, according to scientific studies.

If you enjoy alcohol in moderation, you may be at lower risk of heart attack, heart failure, ischemic stroke, dementia, and osteoporosis. 

Light alcohol consumption may even help lower your risk for type 2 diabetes, whereas binge drinking can increase your risk of getting type 2 diabetes.

Moderate alcohol consumption may help promote higher HDL cholesterol levels, which is considered good cholesterol. Having high HDL cholesterol levels can help protect you against the inflammatory effects of LDL (“bad” cholesterol), which may help lower your risk of developing heart disease.

If you drink and have diabetes, you should also take the following precautions:

  • Never consume alcohol on an empty stomach.
  • When your blood sugar is low, avoid drinking alcohol.
  • Eat something before or after you consume alcohol.
  • Drink plenty of water when consuming alcohol to stay hydrated.
  • Check your blood sugar levels before drinking, while drinking, before going to bed, and for 24 hours after drinking alcohol.

Conclusion

Drinking too much alcohol while taking metformin can result in low blood sugar and, more rarely, lactic acidosis. If you choose to drink alcohol while taking metformin, try to do so in moderation, which means not having more than one drink per day for women and not more than two drinks per day for men.

Drinking alcohol may offer some health benefits, but only when consumed in light to moderate amounts. Excessive alcohol consumption can worsen your blood sugar control and increase your risk of serious health problems.

If you don’t already drink alcohol, you shouldn’t start for the potential health benefits. If you enjoy drinking alcohol and take metformin, you can do it more safely by not drinking excessive amounts.

Explore More

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Sources

  1. Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975915/
  2. Krzymień J, Karnafel W. Lactic acidosis in patients with diabetes. Pol Arch Med Wewn. 2013. https://pubmed.ncbi.nlm.nih.gov/23299861/
  3. Hur, K. Y., Kim, M. K., Ko, S. H., Han, M., Lee, D. W., Kwon, H. S., Committee of Clinical Practice Guidelines, Korean Diabetes Association, & Committee of the Cooperative Studies, Korean Society of Nephrology (2020). Metformin Treatment for Patients with Diabetes and Chronic Kidney Disease: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement. Diabetes & metabolism journal, 44(1), 3–10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043977/
  4. Standridge JB, Zylstra RG, Adams SM. Alcohol consumption: an overview of benefits and risks. South Med J. 2004. https://pubmed.ncbi.nlm.nih.gov/15301124/
  5. Pietraszek A, Gregersen S, Hermansen K. Alcohol and type 2 diabetes. A review. Nutr Metab Cardiovasc Dis. 2010. https://pubmed.ncbi.nlm.nih.gov/20556883/
  6. De Oliveira E Silva ER, Foster D, McGee Harper M, Seidman CE, Smith JD, Breslow JL, Brinton EA. Alcohol consumption raises HDL cholesterol levels by increasing the transport rate of apolipoproteins A-I and A-II. Circulation. 2000. https://pubmed.ncbi.nlm.nih.gov/11067787/

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