Metformin and Diarrhea: Is It Common?

The Unexpected Side Effect: Metformin and Digestive Distress

Metformin has been known to cause diarrhea in patients. In fact, Diarrhea is a well-known adverse and somewhat common side effect when metformin is initiated for type 2 diabetes. However, it usually resolves itself with continued use (or as your body adapts to your new medication). Only a few cases of chronic diarrhea have been reported after months or years of taking metformin.

Key Takeaways

Around 75% of patients taking metformin have experienced gastrointestinal side effects, including diarrhea. The exact percentage of people who experience diarrhea depends on the type of metformin tablet taken.
Immediate-release (IR): In one clinical study, 53% of people taking IR metformin experienced diarrhea. Extended-release (ER): In another clinical study, 10% of people taking ER metformin experienced diarrhea.

Why Metformin Causes Diarrhea

The exact reason for the side effect is fairly unclear. However, since metformin works through your body's microbiome, it’s an assumption that your body is having an adverse reaction to the medication, causing loose stool. Metformin works by helping to restore the body's response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb. If your intestines are having a temporary negative reaction to the medication, it may start to have some inflammation which can cause diarrhea.

Number of Patients Who Experience Diarrhea

Around 75% of patients who have taken metformin have experienced gastrointestinal side effects. With 53% of those patients being those who took immediate-release tablets (IR) and 10% of those taking extended-release (ER) tablets.

Making diarrhea a fairly common adverse side effect of Metformin.

How to Control the Diarrhea Side Effect With Metformin

Here are some tips to help control this side effect:

1. Ask your doctor about the extended-release (ER) tablets

Patients who took the extended release (ER) tablets experienced far less symptoms of diarrhea. In fact, patients who took this type of tablet only experienced diarrhea 10% of the time vs. those who took immediate-release (IR) tablets, having experienced it 53% of the time.

If you’re experiencing these issues, speak with your primary care provider about switching the type of tablet that you consume.

2. Watch your meals

You may want to limit the types of foods that you eat while your body adjusts to your new medication. Instead of just focusing on fibrous meals, try to stick to some of the basics. Aim for whole foods, with low acidity. These foods will be easier to digest and will put less stress on your intestine.

Stick to foods like:

Chicken
Root vegetables (potatoe, beets, asparagus)
White or brown rice
Low-fat milks and yogurts

3. Take the tablet with meals

If you don’t have the extended release (ER) tablets and are taking immediate-release (IR) tablets, then taking your medication with meals and a full glass of water can certainly help with the gastrointestinal issues as your body digests.

If you stick to low-acidic foods while taking your medication, your body will have the ability to counteract any of the medications discomfort with the food that it’s digesting.

4. Start with smaller dosages

The typical metformin dose looks like the following: 500 mg orally twice a day or 850 mg orally once a day. If you can, speak with your doctor about starting on a schedule that ramps up your milligram dosage over time.

They can create a plan for you that not only mitigates the potential of diarrhea as a side effect (especially if you know you have common issues with this). But it can also mitigate other common side effects.

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Sources

Subramaniam, K., Joseph, M. P., & Babu, L. A. (2021). A common drug causing a common side effect at an uncommon time: Metformin-induced chronic diarrhea and weight loss after years of treatment. Cureus, 13(4), e14518. https://doi.org/10.7759/cureus.14518
Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of Research in Medical Sciences, 19(7), 658–664. PMCID: PMC4214027, PMID: 25364368.