In working with patients, the metformin side effect of diarrhea can be a real challenge.  As a healthcare professional, I understand how beneficial it can be for some patients to be on metformin.  It has a lot of great attributes for a diabetes medication.  It can help with weight loss as well as not cause hypoglycemia like some other agents.  It also comes at a low cost compared to some of the newer agents for diabetes. When you get done reading this, be sure to check out the podcast on metformin!

The major downside with metformin is that it can have a substantial incidence of diarrhea and/or other GI side effects.  Managing these appropriately can help keep your patients on metformin and avoid the use of agents that cause weight gain, hypoglycemia, or cost a lot of money.  Here’s a few thoughts on how to manage the metformin side effect of diarrhea.

1. Take with food. If patients aren’t doing this and are having GI side effects, I encourage patients to give this a shot prior to calling it quits with metformin.
2. Try the extended release product.  The extended release product has a much lower incidence of GI side effects.
3. Reduce the dose. Reducing the total daily dose is a potential option here.  We may have to add an additional medication in this situation, but remaining on some metformin can help reduce the need for other medications.
4. Change the timing.  If patients are having trouble at a specific time of day, make sure the metformin dose and timing is reviewed.  Maybe shifting 500-750 mg to a different time of day could help reduce adverse effects.
5. Change medication.  For those patients who continue to have diarrhea despite some of the above changes, sometimes the only thing we can do is change to another medication altogether.

Do you have any tips or strategies for helping your patients remain on metformin?

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