Key takeaways

Mixing metformin and excessive alcohol use is advised against due to the risk of hypoglycemia and the potential masking of its symptoms by alcohol.
Metformin carries a black box warning from the FDA for the risk of lactic acidosis, especially when combined with excessive alcohol intake.
People with diabetes can consume alcohol in moderation, adhering to specific guidelines to manage blood sugar levels and prevent hypoglycemia.
The choice of alcohol for those with diabetes should be mindful, choosing light beers, red or white wine, or spirits mixed with low-calorie options, and avoiding high-alcohol or sugary drinks.

If you are among the 34.2 million people with diabetes in the United States, you may take a popularly prescribed drug called metformin. Metformin (brand name Glucophage) is an FDA-approved diabetes medication that is used, along with diet and exercise, to improve blood sugar control in adults and children with Type 2 diabetes.

As life is slowly returning to normal in the wake of the COVID-19 pandemic, and social events that involve drinking alcohol are somewhat back in swing, you may be wondering: Do metformin and alcohol mix? Is it safe to take metformin with alcohol? Read on to find out.

Can you drink alcohol with metformin?

Whether you enjoy an occasional drink with friends or have a daily nightcap, you may be wondering if you can mix metformin and alcohol. Is there a metformin and alcohol interaction?

The manufacturer information for metformin (this includes both immediate-release and extended-release metformin) states that you should avoid the combination of metformin with excessive alcohol use.

Certain patients are more susceptible to the hypoglycemic (low blood sugar) side effects of metformin. Hypoglycemia can occur if your blood sugar levels fall below 70 mg/dL. Hypoglycemia can come on quickly and include various symptoms, such as shakiness, irritability, confusion, weakness, dizziness, hunger, blurred vision, headaches, or even seizures.

If you drink too much alcohol in a short time, you are more likely to experience low blood sugar (hypoglycemia). Also, alcohol can mask the symptoms of low blood sugar, so if you are drinking, you may not even realize your blood sugar is low. Older, debilitated, or malnourished people and people with adrenal or pituitary problems are also more likely to become hypoglycemic. If you have one of these risk factors AND you drink excess alcohol, you have an even higher risk of hypoglycemia.

Too much alcohol in combination with metformin can also affect lactate metabolism (more on this below).

What are the signs of lactic acidosis with metformin?

Metformin comes with a black box warning, the most severe warning required by the FDA, due to the risk of lactic acidosis.

Excessive alcohol intake is one risk factor for metformin-associated lactic acidosis.

Metformin has been reported to cause lactic acidosis. Lactic acidosis is a buildup of lactic acid in the blood, which is a life-threatening medical emergency that requires treatment in the hospital.

Symptoms of lactic acidosis are often nonspecific and can include tiredness, muscle pain, difficulty breathing, and abdominal pain.

Metformin-associated lactic acidosis can cause hypothermia, low blood pressure, heart rate changes, and even death.

Can I drink alcohol if I have diabetes?

Most people with diabetes can drink some alcohol: 1 drink per day for women, or 2 drinks per day for men. But, be mindful of serving size. One drink equals one of the following:

1 and ½ ounces of liquor
12 ounces of beer
5 ounces of wine

Alcohol can lower your blood sugar for up to 24 hours. Some tips to stay safe:

Drink plenty of water to stay hydrated, and remember to eat (don’t drink on an empty stomach).
Wear a medical ID that says you have diabetes, especially because hypoglycemia can be confused with alcohol intoxication (with either one you may feel sleepy, confused, and dizzy).
Educate your friends and family about the symptoms of low blood sugar, so they can keep an eye on you.
Again, be mindful of serving sizes—most glasses hold much more than recommended serving sizes.
Test your blood glucose levels more often on the day you drink and the next day, to see the effect of alcohol. Also, test before bedtime, and if your sugar is low, have a snack.

Not everyone with diabetes can safely drink alcohol. You should avoid alcohol if you have diabetes and:

Have substance use problems
Are pregnant
Are under 21 years old
Were told by a doctor to avoid alcohol
Have diabetes that is not well controlled
Have complications like nerve damage
Have high blood pressure or high cholesterol
Take medications that are not compatible with alcohol (ask your pharmacist if you are unsure)

As always, consult your healthcare provider for medical advice regarding alcohol consumption and your medical conditions.

What’s the best alcohol to drink for a person with diabetes?

The Glucophage (metformin) manufacturer’s information recommends: “Do not drink a lot of alcoholic drinks while taking Glucophage or Glucophage XR. This means you should not binge drink for short periods, and you should not drink a lot of alcohol on a regular basis.”

Consult your healthcare provider or diabetes educator for advice about alcohol consumption if you have diabetes.

Some better choices:

Light or low carb beers
Red or white wine
Liquor mixed with diet soda, light cranberry juice, water, or seltzer
Cocktails with natural sweeteners and fresh fruit

Avoid:

Craft beers (they contain more alcohol and calories than regular beer)
Flavored wines, dessert wines, or wine coolers
Sangria
Liquor mixed with regular soda or juice
Bloody Mary
Sweet cocktails like piña coladas and margaritas