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Metformin and alcohol

Metformin hydrochloride (1,1dimethyl biguanide monohydrochloride) is an important first-line therapeutic agent in the management of type 2 diabetes mellitus when dietary and lifestyle interventions alone are insufficient to maintain glycaemic control.1 It is not associated with weight gain or hypoglycaemia in therapeutic dosage and exerts protective microvascular and macrovascular effects. In the UKPDS trial, metformin use in overweight patients with type 2 diabetes was associated with reduced incidence of complications, diabetesrelated mortality, overall mortality and myocardial infarction.2 In addition to monotherapy and combination therapy for type 2 diabetes in adult and adolescent patients aged more than 10 years, it is increasingly used for a number of other indications, including gestational diabetes, patients with pre-existing type 2 diabetes during pregnancy, and for symptomatic improvement in patients with polycystic ovarian syndrome. Specialist supervision is recommended for these latter unlicensed indications.3 However, in view of its widespread use in such varied patient populations, it is important to be familiar with the contraindications and potential risks of metformin therapy. For example, caution is advised with concomitant use of metformin with alcohol independently of the restrictions related to hepatic impairment.1 This article explores the evidence base for this recommendation and other safety considerations when initiating metformin therapy.