metformin ER side effects
November 4, 2020 4:46 AM Subscribe
I switched from regular metformin to metformin ER over a year ago but am still experiencing some persistent side effects, even though most people who take metformin ER stop having side effects. What gives?
This is largely a poop-related question, for anyone who prefers to avoid. I know YANMD.
I am on metformin because I have PCOS and it presents with slight insulin resistance and I have a family history of diabetes. I am a cisgendered woman (if that matters).
When I was on regular metformin I used to experience crippling side effects (extremely urgent need to use the restroom, massively painful stomach cramps, constant loose stool, often manifesting as actual diarrhea). Needing to run to the restroom up to ten times a day was making it difficult for me at work. I asked my endocrinologist to switch me to metformin ER.
One year later, the sudden urgency to move my bowels has dissipated, and the stomach cramps are gone, but when I do move my bowels, things are still very lose and occasionally I do end up with diarrhea. I also find that no matter what, when I go to the restroom, even if I think I'm just there to pee, the minute I sit down I end up moving my bowels - sometimes it almost feels like my body is conditioned to associate sitting on a toilet with bowel movements.
Not having to run to the bathroom for poop emergencies is a good thing, as is not having stomach cramps anymore. But I am still pooping between 5-7 times a day - usually a large one in the morning and then several small ones during the day. This seems abnormal to me.
I always take metformin ER with a meal. Everything I have read about the medication online says that digestive side effects dissipate after a few weeks. It's been over a year, and my digestive system is still weird. What gives? Do I need to accept this as my new normal, or should I speak with my endocrinologist about this at my next appointment? I don't want to go off of the metformin ER because it keeps my A1C in a safe zone. Help.
This is largely a poop-related question, for anyone who prefers to avoid. I know YANMD.
I am on metformin because I have PCOS and it presents with slight insulin resistance and I have a family history of diabetes. I am a cisgendered woman (if that matters).
When I was on regular metformin I used to experience crippling side effects (extremely urgent need to use the restroom, massively painful stomach cramps, constant loose stool, often manifesting as actual diarrhea). Needing to run to the restroom up to ten times a day was making it difficult for me at work. I asked my endocrinologist to switch me to metformin ER.
One year later, the sudden urgency to move my bowels has dissipated, and the stomach cramps are gone, but when I do move my bowels, things are still very lose and occasionally I do end up with diarrhea. I also find that no matter what, when I go to the restroom, even if I think I'm just there to pee, the minute I sit down I end up moving my bowels - sometimes it almost feels like my body is conditioned to associate sitting on a toilet with bowel movements.
Not having to run to the bathroom for poop emergencies is a good thing, as is not having stomach cramps anymore. But I am still pooping between 5-7 times a day - usually a large one in the morning and then several small ones during the day. This seems abnormal to me.
I always take metformin ER with a meal. Everything I have read about the medication online says that digestive side effects dissipate after a few weeks. It's been over a year, and my digestive system is still weird. What gives? Do I need to accept this as my new normal, or should I speak with my endocrinologist about this at my next appointment? I don't want to go off of the metformin ER because it keeps my A1C in a safe zone. Help.
I also have PCOS and desperately hoped metformin would work for me. It disrupted my life in a way that was not sustainable. I did not experience the weight loss so many people talk about and did spend an incredible amount of time in the bathroom. I started by tapering and cutting pills in half to reduce side effects but they never. went. away.
In the end I stopped taking metformin all together and my quality of life has drastically improved. I rely on Theralogix inositol and that has been a game changer. My next labs are in January so I’m very curious to see how things are going.
Feel free to MeMail me if you would like to chat about PCOS. It’s truly is the shits and most folks don’t get how disruptive it can be to one’s life.
posted by Juniper Toast at 5:46 AM on November 4, 2020 [1 favorite]
In the end I stopped taking metformin all together and my quality of life has drastically improved. I rely on Theralogix inositol and that has been a game changer. My next labs are in January so I’m very curious to see how things are going.
Feel free to MeMail me if you would like to chat about PCOS. It’s truly is the shits and most folks don’t get how disruptive it can be to one’s life.
posted by Juniper Toast at 5:46 AM on November 4, 2020 [1 favorite]
I also experienced those effects with Metformin. For me, it was worse with the extended release. When I told my doctor, she sent me for a specialty consult with a pharmacist, who has more training with multiple drug interactions, and is allowed to prescribe medications in the region where I live (Washington state, USA).
He began by changing me from 2000 mg/day Metformin ER to just 1000 mg/day regular tabs. Now I take one 500 mg pill in the morning and one in the evening.
Next the pharmacist made up for the reduction in Metformin by prescribing Glipizide 5mg twice a day, and Pioglitazone HCL 45 mg once a day. This made up the shortfall and managed my diabetes while also reducing the Metformin side effects. He started with Glyburide, but switched it to Glipizide fairly soon because there was a new study suggesting Glipizide has bad side effects for cardiac health. These are the kind of things a clinical pharmacist does every day and my doctor might not have instantly known.
Then, the real game changer for my A1C was adding in Empaglifozin 12.5 mg once a day. This medication, trade name Jiardiance, has its own side effects-- if you eat too much sugar, your body urinates it out fairly quickly. This can be its own type of unpleasant, but it very quickly trains you to reduce the amount of sugar you eat. It is the most effective thing I have had in years for managing my diabetes. I went from a very worrying 11 AIC down to 7.9 in just a few months.
(If you bring these numbers to a physician, it may help to know a baseline that I am a 52-year-old Caucasian male, 355 lbs, with a stubborn history of type 2 diabetes and increasing A1C over eight years that no other medication was reducing.)
So, there are options out there. What worked for me may not work for you, but you definitely don't have to endure such frequent bowel movements. (Gross story, Metformin also altered the color of my poop to bright orange.) Talk to your doctor, and don't take "no" for an answer. If possible, ask for a pharmacist to be brought into the discussion about your medications. For me, that was the single most important thing to positively improve my health in several years. Good luck!
posted by seasparrow at 6:52 AM on November 4, 2020 [1 favorite]
He began by changing me from 2000 mg/day Metformin ER to just 1000 mg/day regular tabs. Now I take one 500 mg pill in the morning and one in the evening.
Next the pharmacist made up for the reduction in Metformin by prescribing Glipizide 5mg twice a day, and Pioglitazone HCL 45 mg once a day. This made up the shortfall and managed my diabetes while also reducing the Metformin side effects. He started with Glyburide, but switched it to Glipizide fairly soon because there was a new study suggesting Glipizide has bad side effects for cardiac health. These are the kind of things a clinical pharmacist does every day and my doctor might not have instantly known.
Then, the real game changer for my A1C was adding in Empaglifozin 12.5 mg once a day. This medication, trade name Jiardiance, has its own side effects-- if you eat too much sugar, your body urinates it out fairly quickly. This can be its own type of unpleasant, but it very quickly trains you to reduce the amount of sugar you eat. It is the most effective thing I have had in years for managing my diabetes. I went from a very worrying 11 AIC down to 7.9 in just a few months.
(If you bring these numbers to a physician, it may help to know a baseline that I am a 52-year-old Caucasian male, 355 lbs, with a stubborn history of type 2 diabetes and increasing A1C over eight years that no other medication was reducing.)
So, there are options out there. What worked for me may not work for you, but you definitely don't have to endure such frequent bowel movements. (Gross story, Metformin also altered the color of my poop to bright orange.) Talk to your doctor, and don't take "no" for an answer. If possible, ask for a pharmacist to be brought into the discussion about your medications. For me, that was the single most important thing to positively improve my health in several years. Good luck!
posted by seasparrow at 6:52 AM on November 4, 2020 [1 favorite]
Yes, you should tell the endo on your next appointment. It seems like you can handle this new pattern since it doesn't disrupt your schedule like the old one did, though. If you can handle it and are just concerned that it is abnormal, your doctor will be able to explain if it is something to worry about or not.
posted by soelo at 7:37 AM on November 4, 2020
posted by soelo at 7:37 AM on November 4, 2020
Yay! A thread about PCOS and Metformin!
I can only speak from personal experience (I take 500 mg of normal Metformin three times a day): It made a remarkable difference when I took the Metformin (immediately) AFTER meals rather than during. I seem to need a full stomach to avoid/lessen stomach cramping. I notice that my stomach is more likely to cramp when I drink alcohol (especially some types of beer). And perhaps it is just coincidence, but I have sometimes felt that a meal that was heavy in sugars or carbs also contributed to more cramping/exuberant poops.
I have adjusted by taking my Metformin after meals, I drink less alcohol (I often stick to a single glass of white wine or cider, once or twice a week), and increasing fiber, fat, and protein in my meals. I imagine that the extended release might cause issues by releasing the drug when I didn't have food in my stomach. Would grazing on fiber/protein/fat rich foods (and maybe avoiding alcohol, if you are currently consuming it) compensate for the extended release?
Good luck, and thanks for asking this question. I will follow the other answers with interest. I do think you should mention it to your endocrinologist, but understand your reluctance*. It seems difficult for others to understand how disruptive the symptoms of PCOS actually are to one's daily, lived experience, and how amazing it feels to have those symptoms alleviated.
*Side rant: I recently had a very frustrating interaction with a (male) doctor who seemed to think 1) my PCOS diagnosis was incorrect due to my lack of external, aesthetic symptoms (this was during a phone appointment, and he has never seen me!), 2) dismissed the symptoms I did present as insignificant because they weren't symptoms he could see (over the phone?), and 3) doubted that Metformin would be an effective treatment for PCOS anyways. So he was pretty sure I didn't need Metformin :-(
posted by Sauter Vaguely at 8:07 AM on November 4, 2020 [1 favorite]
I can only speak from personal experience (I take 500 mg of normal Metformin three times a day): It made a remarkable difference when I took the Metformin (immediately) AFTER meals rather than during. I seem to need a full stomach to avoid/lessen stomach cramping. I notice that my stomach is more likely to cramp when I drink alcohol (especially some types of beer). And perhaps it is just coincidence, but I have sometimes felt that a meal that was heavy in sugars or carbs also contributed to more cramping/exuberant poops.
I have adjusted by taking my Metformin after meals, I drink less alcohol (I often stick to a single glass of white wine or cider, once or twice a week), and increasing fiber, fat, and protein in my meals. I imagine that the extended release might cause issues by releasing the drug when I didn't have food in my stomach. Would grazing on fiber/protein/fat rich foods (and maybe avoiding alcohol, if you are currently consuming it) compensate for the extended release?
Good luck, and thanks for asking this question. I will follow the other answers with interest. I do think you should mention it to your endocrinologist, but understand your reluctance*. It seems difficult for others to understand how disruptive the symptoms of PCOS actually are to one's daily, lived experience, and how amazing it feels to have those symptoms alleviated.
*Side rant: I recently had a very frustrating interaction with a (male) doctor who seemed to think 1) my PCOS diagnosis was incorrect due to my lack of external, aesthetic symptoms (this was during a phone appointment, and he has never seen me!), 2) dismissed the symptoms I did present as insignificant because they weren't symptoms he could see (over the phone?), and 3) doubted that Metformin would be an effective treatment for PCOS anyways. So he was pretty sure I didn't need Metformin :-(
posted by Sauter Vaguely at 8:07 AM on November 4, 2020 [1 favorite]
This thread is closed to new comments.
Mind you, my side effects were much worse when I wasn't spacing the metformin out - I'm now at 750 mg every 12 hours. Perhaps you could try that?
posted by I claim sanctuary at 5:00 AM on November 4, 2020 [2 favorites]