A pharmacist has issued a warning to millions of people taking Metformin about a potentially dangerous combination of medications that could "catch you out." Raj Patel, known as TikTok's Straight-Talking Pharmacist, highlighted the risks of taking the diabetes drug alongside common painkillers such as Ibuprofen and Diclofenac.
Metformin is taken by more than 150 million people worldwide for type-2 diabetes, with more than 3 million people in the UK using it. The medication works by reducing the amount of sugar produced by the liver, decreasing sugar absorption in the intestines, and increasing the body's sensitivity to insulin. It is generally considered safe and effective for long-term use.
Kidney strain from painkillers
Mr Patel said the main concern involves kidney function, as the kidneys remove Metformin from the body. He stated: "If you take Metformin, the interaction that could catch you out the most is a painkiller you buy for yourself. The main issue is your kidney function. It's because your kidneys remove Metformin from your body."
He explained that anti-inflammatory painkillers like Ibuprofen or Diclofenac can put extra strain on the kidneys, especially if the person is dehydrated. Some water tablets and blood pressure medicines can also affect kidney function. While these are often prescribed safely with Metformin, monitoring may be needed.
Mr Patel also warned that too much alcohol can increase the risk of a rare, serious condition called lactic acidosis, particularly if a person is fasting, dehydrated, or has liver problems. He advised anyone starting a new medicine, vitamin, or supplement to ask their pharmacist whether it is suitable with Metformin, adding: "Whatever you do, do not stop prescribed medicines by yourself. One quick check can prevent a much bigger problem."
Vitamin B12 deficiency risk
Mr Patel is not the only pharmacist to warn about Metformin. The drug is also used to manage insulin resistance and regulate menstrual cycles in people with Polycystic Ovary Syndrome, to delay or prevent type 2 diabetes in high-risk people with prediabetes, and to control blood sugar during gestational diabetes. There is no time limit for taking it, and it is generally safe to take long-term.
Pharmacist Anil Sharma, a committee member and regional representative for the East of England at Community Pharmacy England, explained that monitoring Vitamin B12 levels is vital. Developing a vitamin B12 deficiency is a common side effect affecting up to one in 10 people. Mr Sharma said: "This is a problem since it can cause nerve damage (numbness, burning, or tingling in your hands and feet), anaemia (tired, weak, and dizzy), memory loss, confusion and depression."
According to the NHS, vitamin B12 or folate deficiency anaemia can cause a wide range of symptoms that usually develop gradually but can worsen if untreated. Symptoms include rapid breathing or shortness of breath, headaches, indigestion, loss of appetite, palpitations, problems with vision, feeling weak or tired, diarrhoea, a sore or red tongue sometimes with mouth ulcers, and problems with memory, understanding and judgment.
When to see a GP
According to Gov.uk: "The risk of low vitamin B12 levels increases with higher metformin dose, longer treatment duration, and in patients with risk factors for vitamin B12 deficiency." The NHS advises seeing a GP if experiencing symptoms of vitamin B12 or folate deficiency anaemia, which can often be diagnosed based on symptoms and a blood test.
The NHS adds: "It's important for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible. Although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible if left untreated. The longer the condition goes untreated, the higher the chance of permanent damage."
