Unfortunately on patients taking metformin diarrhea or at least frequent loose bowel movements is among the most common of side effects. Sometimes on metformin diarrhea can be so bothersome that patients cannot tolerate even low-dose metformin but often there are ways to use metformin that can be tolerated. Diarrhea is one of the common metformin side effects is often dose-related. Usually metformin is started at 500 mg twice daily and titrated up to a maximum dose of 2850 mg total daily dosage is needed to control blood sugars and well tolerated. By starting at a low metformin dosage often patients can avoid developing metformin diarrhea that would happen if they were started at higher dose initially. Often patients who develop metformin diarrhea will find that this side effect improves over time. Other patients simply do not tolerate metformin even at lower dosage. Metformin sustained-release has less metformin diarrhea in some patients and is often tried if patients cannot tolerate immediate release twice-daily metformin.

When metformin diarrhea is simply not tolerated often an alternative medication is needed. This can sometimes be a sulfonylurea, one of the GLP 4 inhibitors or an injectable medication like Byetta or the Victoza. Occasionally insulin is needed if oral diabetes medications are not adequate to control the diabetes. It’s estimated that metformin diarrhea occurs in up to 10% of patients who use metformin although some of these patients tolerate metformin viral well enough to continue using the medication.


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