Key takeaways:
Metformin is a prescription medication that treats Type 2 diabetes. If you take metformin, it’s generally OK to drink alcohol every once in a while if your diabetes is well managed.
Combining alcohol and metformin has its risks. Drinking alcohol can make it more likely to develop lactic acidosis, a health complication that needs medical attention. It can also have a sizable impact on your blood sugar (blood glucose) levels.
It’s recommended to talk to a healthcare professional before drinking alcohol while taking metformin. This can help prevent potentially serious side effects from happening.
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Metformin is a common medication that’s taken by millions of people in the U.S. every day. In fact, it’s one of the most popular prescription medications in the country. It’s a first-choice medication for treating Type 2 diabetes.
If you take metformin, you’ve probably been told about the importance of exercising and consuming a nutritious diet to keep your blood sugar (blood glucose) levels well managed. One part of a diabetes-friendly diet is avoiding excessive alcohol intake, especially since it’s linked to certain diabetes-related health complications.
Understably, avoiding or limiting alcoholic drinks can be tough. Alcohol is an established part of society, and it's accessible in many daily situations. So if you take metformin, what’s the move? Are a few drinks every now and then OK?
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Here, we’ll talk about whether it’s safe to drink alcohol while taking metformin.
Can you take metformin with alcohol?
Ideally, you should avoid the combination when possible. This is because alcohol can worsen your diabetes management and the odds of experiencing medication side effects.
However, the biggest risks are mostly linked to heavy or frequent alcohol intake. Metformin’s labeling recommends avoiding excessive alcohol use. So if you do decide to drink, try to avoid binge drinking or drinking alcohol consistently (chronically) over time. Both of these behaviors elevate your risks for metformin-related side effects.
Drinking in moderation — or less — is key. This means no more than 2 drinks per day for men and 1 drink per day for women.
Is having 1 or 2 drinks OK?
If your diabetes is well managed, having a few drinks every now and then is usually fine while taking metformin. But it’s important to keep in mind what 1 drink looks like:
Beer or hard seltzer: 12 oz, or 355 mL (5% ABV)
Malt liquor (beer with high alcohol content): 8 oz, or 237 mL (7% ABV)
Wine: 5 oz, or 148 mL (12% ABV)
Spirits or liquor: 1.5 oz, or 44 mL (40% ABV)
But this doesn’t mean you have an automatic green light to have a drink. Before raising your glass, it’s best to talk to a healthcare professional first. They can give you personalized guidance about your risks of drinking alcohol while living with diabetes.
Are certain people more at risk when combining alcohol and metformin?
Some people are more sensitive to the effects of alcohol than others. This can potentially put them at higher risk when combining metformin and alcohol.
People with liver problems: In some cases, metformin and alcohol can each cause liver damage. The likelihood is worse when you combine the two.
People with kidney problems: Metformin by itself should be used with caution by people with kidney problems, and alcohol can hurt your kidneys.
Women: In general, women are more susceptible to alcohol’s effects than men. Women have less body water than men, and this allows alcohol to concentrate more easily.
Older adults: Adults ages 65 and older are generally more sensitive to alcohol than younger adults. This can raise the risk of accidental injuries and unintended side effects.
A metformin diet: Learn about which foods to steer clear of in the grocery store while taking metformin.
Metformin side effects: Some side effects are common when taking metformin. Learn more about what you can expect while taking this medication.
Your metformin questions, answered: Hear the facts on how long it takes metformin to start working, in addition to other essential metformin FAQs.
How does alcohol interact with metformin?
One of metformin’s jobs is to stop your liver from making sugar. But when metformin interferes in this sugar-making process, it also indirectly raises the amount of lactic acid that’s in your bloodstream. This is because lactic acid is a chemical that your liver normally takes advantage of when it's making glucose.
Alcohol plays a role by making this effect even stronger. It further boosts the amount of lactic acid that’s in your bloodstream. But it’s not ideal to have lots of lactic acid in your bloodstream. It can cause your body to be too acidic.
Separately, alcohol also has its own side effects that mirror some of metformin’s side effects. This can make some of them worse than they would have been otherwise.
What are the side effects of mixing metformin and alcohol?
All diabetes medications, including metformin, have a risk of causing low blood sugar levels (hypoglycemia). Drinking alcohol, especially on an empty stomach, can also drop your blood sugar. The severity of this can range from mild to severe.
Metformin is also known to be pretty tough on your stomach. Some of the more common metformin side effects are:
Diarrhea
Nausea
Vomiting
Feeling gassy
Heartburn
Alcohol can cause similar stomach problems. Using the two together can make these feelings even worse.
Are there any serious side effects or risks?
As mentioned, metformin can raise the amount of lactic acid in your body. In rare cases, this can lead to lactic acidosis.
Lactic acidosis
This is a health condition that’s caused by dangerously high lactic acid levels in your bloodstream. Because of this, metformin has a boxed warning for lactic acidosis. This is the most serious warning that the FDA can give to a medication.
If you think you or a loved one are experiencing lactic acidosis, you should seek medical attention right away. Possible signs and symptoms include:
Severe drowsiness
Muscle pain
Stomach pain
Trouble breathing
Low blood pressure
Slow heart rate
Low body temperature
Separately, alcohol and metformin can both interfere with vitamin B12 absorption. Not having enough vitamin B12 can be problematic. It can potentially cause or worsen health conditions such as anemia and nerve damage. If you’re taking metformin, your prescriber will likely recommend routine vitamin B12 testing over time.
When should you get medical attention?
If you believe you’re experiencing lactic acidosis, seek medical help right away. Lactic acidosis should generally be treated in the hospital.
You and your loved ones should also know how to recognize and treat signs and symptoms of low blood sugar. If you have an episode of extremely low blood sugar, you may need an emergency glucagon injection and additional assistance from emergency personnel.
If you’re experiencing diarrhea, nausea, or other side effects that are bothersome or uncontrollable, you should also see a healthcare professional.
Are there any diabetes medications that aren’t affected by alcohol?
Not really. Diabetes medications aim to lower your blood sugar in some way, and alcoholic drinks can also cause this effect. Plus, some medications — like Invokana (canagliflozin) — are also linked to acid-related problems that may be worsened by alcohol.
However, specific alcohol-related risks vary for each diabetes medication. If you’re taking — or looking to take — any diabetes medications and are curious how alcohol may affect them, it’s recommended to talk to a pharmacist or other healthcare professional.
The bottom line
If you take metformin, it’s generally fine to drink alcohol every once in a while. But you should try to avoid binge drinking and consistent drinking. These behaviors can worsen your diabetes management and increase the odds of developing metformin-related complications. The main risks of combining metformin and alcohol are lactic acidosis and out-of-range blood sugar levels.
Before you decide to crack one open, be sure to talk to a healthcare professional. They can help you decide if occasional alcohol intake is OK for you or if you should avoid it entirely.
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References
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