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Metformin and alcohol: What you need to know

1 min Read

Reviewed by:

Dr Odhett Cojocaru, MD

Internist

Learn how alcohol affects metformin and the potential side effects. Discover tips for safely managing your health with personalized guidance from Noom Med.

What you’ll learn:   

  • Combining metformin and alcohol can lead to low blood sugar levels and increase the risk of lactic acidosis.       
  • Drinking might interfere with how well your medication works because the liver processes both metformin and alcohol.      
  • If you drink alcohol while taking metformin, do so moderately and sporadically and monitor the effects.

Metformin is one of the most prescribed medications in the United States. Its most common use is treating type 2 diabetes, but it has also become a popular off-label solution for weight loss. If you are considering a prescription for metformin to help you lose weight, you will have to also think about your drinking habits. While metformin can help you lose a moderate amount of weight over time, it doesn’t mix well with regular or excessive drinking.

The problem? Your liver processes both metformin and alcohol, and combining the two can strain this vital organ. Alcohol can interfere with metformin’s ability to regulate blood sugar, potentially causing dangerously low levels, a condition called hypoglycemia. Also, in rare cases, this combination can lead to lactic acidosis, a serious condition associated with metformin.

How much is too much? It’s hard to say. If metformin is part of your routine—whether for weight loss or other health goals—be sure to clear any drinking with your doctor. Let’s get into everything you need to know about metformin and alcohol.

Can I drink alcohol while taking metformin?

For most people, enjoying alcohol occasionally while taking metformin is safe when done in moderation. You should only enjoy a drink occasionally and should never binge drink. It’s best to check with your doctor about specific amounts, especially if you have underlying health conditions or are taking other medications. They can provide advice tailored to your unique situation. Here’s a look at how alcohol can affect the way metformin works and why it can be dangerous in excess.

Alcohol and metformin: The science behind the interaction

Metformin is the ultimate multitasker for blood sugar—it improves insulin sensitivity, reduces glucose production in the liver, and helps cells absorb sugar more efficiently. Combining metformin and alcohol too frequently or in large amounts is asking your liver to do too much. When you drink, your liver diverts its attention to processing the alcohol, temporarily prioritizing this task over others, such as regulating blood sugar or detoxing other substances.  While an occasional drink is likely fine, in excess, this duo can cause some serious health complications. 

In the short term, excess alcohol can interfere with the liver’s ability to manage blood sugar and detoxify. Over time, excessive drinking can damage the liver, reduce insulin sensitivity, and make blood sugar management significantly harder. Here are some other ways alcohol and metformin can be a dangerous combo:

It increases the likelihood of lactic acidosis

Your liver is responsible for clearing out substances, including lactic acid—a natural byproduct produced by your body during energy metabolism. When alcohol enters your body, the liver’s efficiency drops as it prioritizes metabolizing it. Metformin can increase the risk of lactic acidosis because it suppresses the liver’s glucose production process, which usually helps prevent lactic acid buildup. When you combine these factors, you’ve got a recipe for lactic acidosis—a rare but life-threatening condition where lactic acid accumulates in the blood. This accumulation can disrupt your body’s pH balance, impair organ function, and, if left untreated, lead to severe complications. 

Symptoms to watch out for:

  • Muscle pain or cramps
  • Weakness or fatigue that just won’t quit
  • Stomach discomfort or nausea
  • Dizziness or confusion

If these symptoms appear, get medical help immediately. Although this is a rare condition, it’s not one to take lightly.

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It can cause hypoglycemia (in people with diabetes)

Alcohol can also interfere with your liver’s ability to release glucose. Pair that with metformin, which already reduces glucose production, and you could face dangerously low blood sugar, especially for people with diabetes.

Signs that your sugar might be getting too low:

  • Shaking or sweating
  • Feeling dizzy or irritable
  • A racing heartbeat
  • Sudden hunger or headaches

Here’s the fix: Grab a carb-rich snack to stabilize your blood sugar and sip on water if these symptoms creep in. If it doesn’t improve, call your doctor ASAP.

It increases the risk of vitamin B12 deficiency

Metformin is known to interfere with vitamin B12 absorption, and alcohol doesn’t help the situation because it can damage the stomach lining and impair the absorption of nutrients, including vitamin B12. Chronic alcohol consumption also affects the pancreas and liver, potentially reducing the production of a protein necessary for the body to absorb B12 effectively. Together, these factors can increase the risk of a vitamin B12 deficiency when both metformin and alcohol are involved.

Symptoms to notice:

  • Fatigue and weakness
  • Numbness or tingling in your hands and feet
  • Memory fog or confusion
  • Irritability or mood swings

This deficiency could lead to long-term nerve damage. See a doctor if something doesn’t feel right.

It may cause gastrointestinal issues

Both metformin and alcohol can irritate your digestive system. Together, they could cause uncomfortable or even dangerous reactions. Think nausea, vomiting, diarrhea, or abdominal pain.

Pro tip: Eating before drinking can help reduce some of these effects, but the safest option is to skip or limit alcohol.

It may increase the risk of liver damage 

Regularly mixing metformin and alcohol doesn’t just cause short-term issues; it can lead to bigger problems over time, like liver damage. Chronic alcohol use combined with metformin puts extra stress on your liver, increasing the risk of conditions like alcoholic hepatitis or cirrhosis.

Mixing metformin and alcohol can be dangerous. While the occasional drink might not cause an issue, it’s important to understand the risks and stay in control. Always talk to your doctor about your alcohol use and how it might interact with your medications.

Managing alcohol consumption on metformin

Mixing metformin and alcohol requires careful consideration, as the combination can lead to both short- and long-term health risks. While an occasional drink in moderation may be safe for most people, excessive or regular alcohol consumption can strain your liver, interfere with blood sugar regulation, and increase the chances of serious conditions like lactic acidosis, hypoglycemia, or vitamin B12 deficiency.

If metformin is part of your health journey—whether for diabetes management, weight loss, or another purpose—it’s essential to stay informed about how alcohol might affect your body and the medication’s effectiveness. Consulting your doctor is the best way to navigate these risks and ensure you make choices that align with your overall health goals.

If you qualify for Noom Med, our clinicians can determine whether metformin is the right treatment for you and prescribe it if necessary. If prescribed, you’ll pay $29 for the first month and $89 per month after that (billed in three-month increments). This one price covers your medication, ongoing clinical support, and full access to Noom’s behavior change program and tools. Check your eligibility here.