Metformin Alternatives: What Are Your Options?

Metformin is a common medication used by healthcare providers for type 2 diabetes, insulin resistance, PCOS, and prediabetes. 

Some people can’t take metformin, and others may prefer a different medication to avoid certain side effects.

There are many metformin alternatives. Some of them are canagliflozin (Invokana), empagliflozin (Jordiance), and others. 

In this article, we’ll explore alternative options, possible drug interactions, risks of stopping metformin, and when to see a medical provider.

Metformin Alternatives

Metformin is a biguanide medication, the only one of its kind that is still sold in the United States. 

While there are no other drugs in the same class, there are many other drugs that have similar effects as metformin.

Metformin helps to normalize glucose levels by preventing the liver from making more glucose (a process called glycogenolysis). It also increases the sensitivity of the body’s cells to insulin to help reduce insulin resistance.

Metformin is approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes. 

There are other drugs approved for the same reason, and may work as metformin alternatives. They include:

• Canagliflozin: Sold under the brand name Invokana, this medication is used for the treatment of type 2 diabetes alongside diet and lifestyle changes. Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. It lowers blood glucose levels by making the kidneys eliminate more glucose in the urine. The typical dosage is between 100-300 mg per day for glucose control. Common side effects include frequent urination (including throughout the night), increased thirst, dry mouth, and constipation.

• Dapagliflozin: Available as the brand name Farxiga, dapagliflozin is used to treat type 2 diabetes in combination with diet and exercise. It is used to help lower blood sugar levels. It is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that works by eliminating extra glucose through the kidneys, bladder, and urine. The typical dosage is 5-10 mg per day. Common side effects are frequent urination and increased thirst.

• Empagliflozin: Sold as the brand name Jardiance, empagliflozin works alongside diet and lifestyle changes to control blood sugar levels in people who have type 2 diabetes. It is in the class of drugs known as sodium-glucose co-transporter 2 (SGLT2) and works by prompting the kidneys to eliminate extra glucose via the bladder and urine. The most frequently noted side effects are increased thirst and excess urination, even through the night. Typical dosage is 10-25 mg per day.

• Repaglinide: Available as the brand name Prandin, repaglinide is used to treat type 2 diabetes. It lowers blood sugar levels by stimulating more insulin release from the pancreas. It is in the drug class known as meglitinide analogs. Repaglinide is taken 15-30 minutes before a meal. Typical dosage is 0.5-4 mg per meal, with a maximum of 16 mg per day. Common side effects are typically related to causing low blood sugar, which is known as hypoglycemia. They include shaky feelings, dizziness, lightheadedness, sweating, irritability, headache, weakness, pale skin, hunger, clumsy movements, and tiredness.

• Pioglitazone: Sold as the brand name Actos, pioglitazone belongs to a drug class known as thiazolidinediones. It works by binding to receptors in fat cells and helping to remove them from circulation. This increases insulin sensitivity. Side effects can include weight gain, headache, muscle pain, sore throat, and gas. Typical dosage is 15-45 mg per day.

Metformin Drug Interactions

Metformin has the potential to cause many drug interactions. 

If you take metformin, or any other prescriptions, be sure that your healthcare provider and pharmacist know everything that you take, including other prescription medications, OTC medicines, and dietary supplements and herbs.

Metformin interactions include:

• Beta blockers
• Procainamide
• Triamterene
• Ranitidine
• Dofetilide
• Morphine
• Garlic
• Diuretics
• Estrogens
• Quinidine
• Vancomycin
• Phenytoin
• Chromium
• Sympathomimetics
• Cimetidine
• Digoxin
• Calcium channel blockers
• Coenzyme Q10
• Oral contraceptives
• Corticosteroids
• Green tea
• Phenothiazines

Risks of Stopping Metformin

There are many reasons why someone may want to stop taking metformin.

It is important to understand the risks before discontinuing it or other diabetes medications.

If you stop treatment that is helping to control blood sugar or insulin, those could become unstable, which could worsen the overall effect of diabetes on the rest of your health.

Even without medication, lifestyle and dietary changes, including regular exercise, are essential for managing type 2 diabetes.

When glucose levels get too high, it can lead to potentially serious complications that include:

• Nerve damage (diabetic neuropathy)
• Vision problems (diabetic retinopathy)
• Kidney problems (diabetic nephropathy)
• Heart problems and increased risk of cardiovascular disease, heart failure, and heart attack
• Sexual health issues
• Foot problems

Medicines for Lowering A1C

There are many treatment options for type 2 diabetes that can help to lower hemoglobin A1C. A healthcare provider will recommend the option that is best for your medical history and health needs.

Alternatives to metformin also work to lower glucose levels or to improve insulin sensitivity. But they work in different ways, and some types of medications are more effective than others.

For people who have heart failure, kidney disease, or liver disorders, there are fewer options that may be safely used to treat diabetes and lower hemoglobin A1C.

Since hemoglobin A1C is a measure of the average glucose levels over the course of 3 months, any medication that helps to increase insulin sensitivity and decrease circulating glucose levels will help to decrease A1C.

When to See a Medical Provider

If you take metformin and want to consider an alternative, your healthcare provider can discuss options with you. 

Sometimes diet and lifestyle alone can control type 2 diabetes, but it’s important not to stop taking your medication unless a healthcare provider has reviewed options with you.