Side effects of stopping metformin or missing a dose

Key takeaways

• Metformin is a commonly prescribed medication for managing type 2 diabetes. When used as directed, it helps control blood sugar levels effectively.
• Abruptly stopping metformin may trigger withdrawal symptoms, including nausea, vomiting, and stomach discomfort. However, occasionally missing a dose will most likely not cause significant adverse effects.
• Elevated blood sugar levels resulting from missed doses or cessation of metformin can increase the risk of diabetes-related complications.
• Consistency in taking metformin is crucial for maintaining stable blood sugar levels and reducing the risk of complications associated with diabetes.
• If you encounter difficulties taking metformin or experience side effects, promptly communicating with your healthcare professional is important. 

Metformin, also marketed under the brand name Glucophage, is a medication primarily utilized for managing type 2 diabetes. It falls under the category of biguanide drugs, which function by reducing liver glucose production and enhancing the body's sensitivity to insulin, a hormone pivotal in regulating blood sugar levels.

Typically prescribed in conjunction with lifestyle modifications like dietary adjustments and physical activity, metformin helps regulate blood sugar levels effectively.

Additionally, doctors sometimes prescribe it for treating other hormone-related conditions like polycystic ovary syndrome (PCOS), a disease associated with excessive production of male hormones in females.

While this medication is effective in regulating blood sugar, individuals sometimes stop using it for various reasons, but such abrupt discontinuation of this medication is not advisable.

Why do individuals stop taking metformin?

There are different treatment options for diabetes, and metformin is one of the most widely prescribed for type 2 diabetes. 

However, it's not uncommon for individuals to contemplate discontinuing metformin independently, perhaps because they want to explore alternative remedies or simply seek a change in their treatment regimen.

Also, sometimes, individuals experience intolerable side effects, have reduced kidney function, or no longer require metformin. In such cases, people stop taking metformin.

However, it's important to understand that stopping metformin suddenly can have serious consequences. This is known as withdrawal symptoms.

Side effects of stopping metformin abruptly

Abruptly stopping metformin can lead to various side effects, especially if you've been taking it regularly for some time. These side effects may include:

1. Weight gain

Stopping metformin suddenly might result in weight gain due to the reversal of its positive impact on insulin sensitivity and glucose metabolism. While metformin is typically linked with slight weight loss in those with type 2 diabetes, stopping it can upset this balance, potentially fostering weight gain. 

Factors like changes in insulin sensitivity, altered glucose metabolism, and shifts in lifestyle patterns may all play a role in the weight gain observed after discontinuing metformin. 

2. Menstrual issues

Stopping metformin suddenly can cause menstrual irregularities, particularly in individuals with conditions like polycystic ovary syndrome (PCOS) or insulin resistance. 

Metformin is often prescribed to regulate menstrual cycles and improve fertility by lowering insulin and androgen levels. When discontinued, this hormonal balance may be disrupted, leading to irregular periods or ovulatory dysfunction. 

Consulting a healthcare professional before stopping metformin is important to address concerns about menstrual health and explore alternative treatment options.

3. Occurrence of dementia

One research suggests that stopping metformin treatment may raise the risk of dementia, which could have significant implications for managing diabetes in adults. Furthermore, it reinforces previous evidence indicating that metformin might actually lower the risk of developing dementia, highlighting its potential benefits beyond managing blood sugar levels.

4. Increased daily dose of insulin DDI

When metformin is combined with insulin therapy in type 2 diabetes patients, it enhances blood sugar control and reduces the amount of insulin needed daily. However, if cardiac, liver, or kidney issues arise, metformin should be stopped. 

In patients on insulin and metformin, discontinuing metformin can still maintain blood sugar control, but it requires significantly increasing the daily insulin dose by 20 to 36% through an intensified treatment approach.

5. Gastrointestinal Distress

Some individuals experience gastrointestinal side effects like nausea, diarrhea, or stomach discomfort when starting metformin, and these symptoms may return or worsen if the medication is stopped suddenly.

Does missing 1 or 2 doses of metformin cause any effect on the body?

Missing 1 or 2 doses of metformin is unlikely to cause significant effects on the body for most individuals, provided the blood sugar levels have been stable. However, it's essential to stay consistent with this medication to manage blood sugar levels effectively. 

While missing occasional doses may cause temporary fluctuations in blood sugar, it's unlikely to result in significant complications. 

However, if you have concerns about missing doses or if it becomes a frequent occurrence, it's best to consult with your healthcare provider for personalized advice. They can provide guidance on managing your medication regimen effectively.

What to do if you miss a dose of metformin?

If you miss a dose of metformin, skip the missed dose and resume your regular dosing schedule. You will also need to check your blood sugar level to ascertain the effect of the missed dose on your blood sugar levels.  

Avoid taking two doses to compensate for the missed one. Establishing reminders, such as alarms, having a fixed time of the day for taking your medication, and keeping the tablet always in your bag can be helpful if you frequently forget doses. 

When is it okay to stop taking metformin?

Whether to stay on metformin for life depends on individual health circumstances and the advice of a healthcare professional. In many cases, metformin is a long-term treatment for managing type 2 diabetes. However, there are situations where stopping metformin may be appropriate. For example:

• If lifestyle modifications such as dietary adjustments, increased physical activity, and weight reduction result in substantial improvements in blood sugar regulation, a healthcare provider may carefully consider gradually reducing or discontinuing metformin under close monitoring.
• If an individual encounters unbearable side effects from metformin or encounters health complications like kidney issues that make its use unsuitable, a healthcare professional may advise discontinuing metformin.
• There are instances where different medications or treatment strategies might be more appropriate for controlling diabetes, rendering metformin unnecessary.

It's important to discuss any plans to stop metformin with your healthcare provider. They can assess individual health needs, monitor progress, and provide guidance on the safest and most effective course of action.

The right way to stop metformin to prevent side effects

To prevent side effects when stopping metformin, it's vital to taper off gradually under medical supervision. This typically involves reducing the dose gradually over a period of time rather than stopping abruptly. 

A gradual decrease in metformin dosage rather than stopping the medication abruptly allows the body to adjust, lowering the risk of withdrawal symptoms or sudden blood sugar spikes. 

Close monitoring of blood sugar levels during this process is crucial to ensuring a smooth transition and prompt detection of any complications. 

When to seek medical advice

Seeking medical advice is essential before making any changes to medication regimens, including starting or stopping metformin. 

Healthcare providers can offer personalized guidance based on individual health needs and circumstances. They can assess potential risks and benefits, provide information about proper dosing and administration, and monitor for any adverse effects or complications. 

Consulting with a healthcare provider also ensures that medication decisions are made safely and effectively, optimizing overall health outcomes.

Final words

Stopping metformin suddenly or missing doses can lead to various side effects. These may include a sudden rise in blood sugar levels, which can result in symptoms like increased thirst, frequent urination, fatigue, and blurred vision. 

Additionally, abruptly stopping metformin can sometimes cause withdrawal symptoms such as nausea, vomiting, and stomach discomfort.

In conclusion, it's important to take metformin as prescribed and not to discontinue it or miss doses without consulting a healthcare provider.