Metformin and Alcohol: What Are the Risks?

Key Takeaways

Regularly drinking alcohol or binge drinking while on metformin can increase your risk of developing lactic acidosis and dangerously low blood glucose levels (hypoglycemia).
There are no specific guidelines regarding how much alcohol you can drink while on metformin. Talk to your doctor about how to limit alcohol consumption while on metformin.
It is best to avoid alcohol completely when you are taking metformin due to the risk of lactic acidosis. Alcoholic drinks are also often high in calories, which can lead to weight gain.

Metformin is a prescription medication that is used to lower blood sugars and achieve metabolic control in people with Type 2 diabetes.

Taking metformin and alcohol together can increase your risk of developing lactic acidosis and other health complications. The U.S. Food and Drug Administration (FDA) has issued a black box warning about this risk.

Please continue reading to find out more about how alcohol interacts with metformin and the negative effects of consuming alcohol while taking metformin.

What happens if you drink alcohol while taking metformin?

Regularly drinking alcohol or binge drinking (too much alcohol in a short period of time) while on metformin can increase your risk of developing a serious health complication called lactic acidosis (too much lactic acid in the body). Lactic acid is a natural byproduct of cellular metabolism. However, if the body produces consistently more lactic acid, it can lead to organ failure and death. The risk of lactic acidosis is higher in people with kidney disease.

In addition, when you consume alcohol while on metformin, you are at a higher risk of low blood sugar. This is because, after you drink, your liver needs to process the alcohol.

While your liver is breaking down alcohol, it stops producing glucose. This can cause your blood sugar levels to drop quickly. Metformin reduces how quickly your liver releases glucose in response to low blood sugar levels.

Taking metformin or other diabetes medications that slow glucose production in the liver can put you at risk of dangerously low blood glucose levels (hypoglycemia). The risk is higher if you drink alcohol on an empty stomach.

The goal for people with diabetes is to lower their blood glucose levels and to maintain them at the recommended ranges. However, when blood glucose levels are overcorrected and become too low, it can lead to serious health problems, such as fainting, confusion, and loss of consciousness.

What are lactic acidosis symptoms?

Lactic acidosis is a type of metabolic acidosis that causes harmful effects in many organ systems. Symptoms can include abdominal pain, nausea, vomiting, loss of appetite, lightheadedness, dizziness, confusion, flushing, cold feeling in the hands and feet, exhaustion, weakness, body aches, muscle pain, muscle cramps, low urine output, rapid and deep breathing, shortness of breath, fast or slow pulse, and delirium.

What are low blood sugar symptoms?

Low blood sugar levels can cause symptoms such as pale skin, shakiness, dizziness, lightheadedness, sweating, nausea, irregular or fast heartbeat, low energy, and difficulty concentrating.

What happens if you drink a lot of alcohol while on metformin?

Excessive alcohol use while taking metformin can increase your risk of lactic acidosis and hypoglycemia (low blood sugar level).

Talk to your doctor if you often experience low blood sugar. Your doctor may recommend you carry glucose tablets or glucose gel to treat hypoglycemia. Side effects of metformin and alcohol together also include an increased risk of lactic acidosis. Severe lactic acidosis is a life-threatening medical emergency.

What is the best alcohol to drink on metformin?

Red wine, white wine, and light beers are probably the best alcoholic beverages to drink if you are diabetic and take metformin. They contain fewer calories. Additionally, red wine may have some heart health benefits due to its antioxidant properties.

Liquors such as whiskey, gin, rum, and vodka have a low carbohydrate content. However, they are often mixed with sugary juices or sodas. Consuming these types of mixed drinks can cause a spike in blood glucose followed by dangerously low blood glucose levels.

Dessert wines, margaritas, daiquiris, and cocktails like pina coladas have a high sugar content and can cause a spike in blood sugar. If you regularly drink alcohol, the added sugar can quickly lead to weight gain.

Keep in mind that it is best to stop drinking alcohol and avoid alcohol completely when you are taking metformin. Most alcoholic drinks contain calories. Being overweight or obese can cause other health complications, along with diabetes.

How much alcohol can you drink while on metformin?

Only your doctor can tell you whether combining alcohol and metformin is safe and how much alcohol you can drink while on metformin. In particular, if you have a history of liver disease or alcohol addiction, it is best to avoid alcoholic beverages altogether.

Generally speaking, it is best to limit alcohol intake to occasional while on metformin. Avoid regularly drinking alcohol, binge drinking, or heavy drinking. Even moderate alcohol consumption (1 drink per day for women and 2 drinks per day for men) can increase your risk of serious health complications.

What should not be taken with metformin?

Alcohol should not be taken with metformin. Mixing alcohol and metformin can increase your risk of serious side effects. In addition, taking certain other medications with metformin can increase the risk of lactic acidosis due to drug interactions. Give your healthcare provider a complete medical history and a list of all your medications before starting metformin.

Talk to your healthcare provider if you have a hard time avoiding alcohol. Your doctor can provide you with different resources and support to help you with safe alcohol consumption.

Note: Some brands of metformin extended-release tablets were voluntarily recalled in 2022 due to the presence of a probable carcinogen (cancer-causing agent). If you take extended-release metformin tablets, make sure you don’t have one of the recalled lots.

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