5 Best Metformin Alternatives In 2021

August 6, 2021
9 min read

Many type 2 diabetics are offered metformin alternatives in accordance with the National Guidelines for the Treatment of Type 2 Diabetes. Today I will summarize metformin alternatives to the drugs prescribed to type 2 diabetics who cannot tolerate formalin. Diagnosed type 2 diabetics who are overweight and fail to implement lifestyle changes to control sugar levels in the body are prescribed metformin.

Metformin works by lowering the amount of sugar released by the liver and improving how the body reacts to insulin. It works by reducing the liver’s ability to produce glucose (blood sugar), reducing intestinal glucose absorption, and increasing insulin sensitivity. Metformin is used in more than 90% of the United States for a broad range of blood sugar-related insulin resistance disorders and off-label use in polycystic ovary syndrome (PCOS), fertility problems, longevity, and diabetes prevention.

What is Metformin?

The drug is sold under the brand name Glucophage, the preferred drug for the cure of type 2 diabetes, explicitly in overweight people. It is not linked with weight gain. It is consumed orally.

Metformin Mechanism of Action

The medication has several actions that can cause to control of glucose in the body. It primarily reduces sugar production in the liver and stops glucose from being absorbed in the intestine. It increases glucose intake in skeletal muscles. Improves sensitivity in insulin which regulates body sugar level. It does not help in insulin release, and hence there is no risk for hypoglycemia unless used in combination with other antidiabetic drugs. 

The Dangers of Discontinuing Metformin

One should have proper knowledge of the dangers they have to go through after stopping metformin.

  •  Kidney problems
  • Foot problems
  • Sexual health difficulties
  • Nerve damage
Below is the list of best Metformin Alternatives:

Prandin (Repaglinide):Include Mechanism of Action, Side Effects, and Dosages

Prandin (Repaglinide)

Mechanism of action-

This medication reduces blood glucose levels by stimulating the discharge of insulin from the pancreas. This activity is dependent upon functioning beta cells in the pancreatic islets. Insulin release is glucose-dependent and declines at low glucose concentrations.

Side effects- 

  • Common side effects are- 
  • low blood sugar
  • nausea, diarrhea
  • headache, back pain
  • joint pain
  • Freezing signs such as stuffy nose, sneezing, sore throat.

Visit your doctor one if you experience-

  • Pale or yellowed skin, deep-colored urine, fever, nervousness, or dizziness.  
  • Pancreatitis – severe pain in your upper abdomen spreading to your back, and vomiting.

Seek prompt medical help if you have allergic reactions like (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes) 

Dosages-

  • For patients who are not earlier operated with antidiabetic agents or whose glycosylated hemoglobin-
  • The initial dosage can go around 0.5 mg orally with each meal you take. 
  • For patients who are previously being treated with antidiabetic agents or whose HbA1c is 8% or higher than that-
  • The initial dosage can go around 1 or 2 mg orally with each meal. 

Canagliflozin (Invokana): Include Mechanism, Side Effects, and Dosages

Canagliflozin (Invokana)

Mechanism of action-

The drug hinders the SGLT2 cotransporter. This hindrance leads to lower reabsorption of refined glucose into the body and reduces the renal threshold for glucose, leading to enhanced glucose discharge in the urine.

Side effects- 

Common side effects:

  • genital infections
  • urinating more than usual.

Visit your physician once if you experience-

  • little or no urination
  • pain or burning when you urinate
  • new pain, sores, or infections in your legs or feet;
  • high potassium–nausea, uneven heartbeats, faintness, lack of movement
  • ketoacidosis – abdomen pain, nervousness, abnormal drowsiness, or difficulty breathing
  • dehydration symptoms–dizziness, weakness, feeling light-headed

Seek immediate medical help if you have allergic reactions like – hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Dosages-

  • The medication is usually taken once a day, before the first meal. 
  • Your doctor may change your dose occasionally. Take the prescriptions as guided by your doctor. 
  • Canagliflozin can affect the result of certain medical tests too.

Dapagliflozin (Farxiga): Include Mechanism, Side Effects, and Dosages

Dapagliflozin (Farxiga)

Mechanism of action-

The drug is an orally active sodium-glucose cotransporter type 2 (SGLT-2) inhibitor. Inhibiting SGLT2 activity accentuates the reabsorption of glucose in the kidney, resulting in the elimination of glucose in the urine.

Side effects- 

Common side effects: 

  • Genital yeast infection
  • Urinating more than usual.

Visit your doctor once if you experience- 

  • Little or no urination
  • Dehydration symptoms–dizziness, weakness, feeling light-headed 
  • Kidney problems
  • Abdomen discomfort, nervousness, unusual drowsiness, or difficulty in breathing
  • Signs of a bladder infection–pain or burning when you urinate, excess urination, blood in the urine, fever. 

Seek prompt medical help if you have allergic signs like- hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Dosages-

Usual dosage: 

  • The initial dose of the drug can go around 5 mg orally once a day. 
  • The dose can be increased to 10 mg orally once a day if a lower dose has been tolerated. 
  • The maximum dosage can go around 10mg per day. 

Empagliflozin (Jardiance): Include Mechanism, Side Effects, and Dosages

Dapagliflozin (Farxiga)

Mechanism of action-

The medication works by inhibiting the sodium-glucose co-transporter-2 (SGLT-2) located in the proximal tubules in the kidneys. By SGLT2 inhibition, empagliflozin lessens renal reabsorption of glucose and increases urinary excretion of glucose. 

Side effects– 

 Side effects like-

  • Urinating a lot, including at night
  • Increased thirst
  • Frequent, urgent, burning, or painful urination
  • The unusual color of urine 
  • Pelvic or back pain
  • Feeling drained, weak, along with a fever and discomfort, redness, and swelling of the genitals or the space between the genitals and the rectum. 
  • Vaginal odor, white or yellowish vaginal or vaginal itching in women
  • Redness, itching, or swelling of the penis; redness on the penis, foul-smelling release from the penis, or pain in the skin around the penis in men.

If the side effects get worse or do not go away or if you feel burden by it, pay a visit to your physician on an immediate basis. 

Stop taking this medication if you experience symptoms like-

  • Rash
  • Hives
  • Itching
  • Difficulty swallowing or breathing
  • Swelling of face, throat, tongue, lips, mouth, or eyes
  • Hoarseness

Dosages

  • Take your dose according to what your physician has prescribed to you. 
  • Never overdose.
  • If you forget to take a dose, take it immediately, but if it is the time of your next dose, then skip the missed dose. Never duplicate dose to make up for the missed one. Continue your regular dosing pattern.  

Actos (Pioglitazone): Include Mechanism, Side Effects, and Dosages

Actos (Pioglitazone)

Mechanism of action-

The drug reduces insulin resistance in the periphery and liver, resulting in enhanced insulin-dependent sugar (glucose) disposal and decreased hepatic sugar output. Not like sulfonylureas, pioglitazone is not an insulin secretagogue.

Side effects- 

Common side effects are-

  • Headache
  • Muscle pain
  • Freezing symptoms such as stuffy nose, sneezing, sore throat.

Visit a doctor if you experience side effects like-

  • Pink or red urine, unpleasant or painful urination, increased or worsening urge to urinate
  • Shortness of breath, extreme tiredness, increase in weight gain rapidly.
  • Changes in your vision.
  • Unexpected, strange pain in your hand, arm, or foot.
  • Stop using the medications if you have symptoms of- liver damage.
  • Get prompt medical assistance if you have allergic reactions like- hives, difficult breathing, swelling of your face, lips, tongue, or throat. 

Dosages-

For patients without congestive heart failure:

  • The initial dose can go around 30 mg orally once a day. 

For patients with congestive heart failure:

  • The initial dose is 15 mg orally once a day. 

The maintenance dose can go around 15 mg to 45 mg orally once a day. 

The maximum dose can be 45 mg orally once a day. 

Natural Metformin Alternatives

Natural Metformin Alternatives

Inositol

This is a member of B-vitamins. Myo and d-chiro inositol are the types of INOSITOL from the other 9. When the prescriptions are used in a 40:1 ratio of myo to d-chiro, they are more productive in decreasing insulin resistance, enhancing egg quality, and reviving ovulation.

Inositol operates by helping with insulin signaling in the body. Inositol supports the cells take in glucose from the blood. You don’t want excess glucose to be hanging nearby in the blood. This leads to insulin resistance and eventually diabetes if not properly directed. 

Berberine:

Previous reviews of several studies have shown that Berberine is more effective than oral diabetes drugs, including metformin. In 2014, a review of studies evaluated Berberine as one of the “metformin alternatives” with anti-inflammatory effects in metabolic disorders such as diabetes, considered an inflammation disorder. For this reason, the researchers examined 14 significant studies, and it was as effective as an oral diabetes drug, such as methadone. 

This is a chemical derived from plants like goldenseal, golden thread, and Oregon grape. The chemical protects against atherosclerosis and has potent anti-inflammatory properties. The properties in it can reduce heart failure pathology, insulin resistance, and also has been observed in the reduction of fat mass in people with diabetics while improving cholesterol levels. This is a chemical derived from plant-like goldenseal, golden thread, and Oregon grape. The chemical protects against atherosclerosis and has potent anti-inflammatory properties. The properties in it can reduce heart failure pathology, insulin resistance, and also has been observed in the reduction of fat mass in people with diabetics while improving cholesterol levels.        

N-Acetyl Cysteine (NAC)

This is an amino acid. It increases the level of glutathione which is the major antioxidant in our body. The antioxidant helps repair and protect our cells from damage. N-Acetyl Cysteine has been shown to improve insulin sensitivity. NAC can slow down blood clotting and hence highly recommended for the patients who are taking blood-thinning medications or have bleeding disorders.

Conclusion

Studies have shown that patients with severe insulin resistance lose more weight on metformin than insulin-sensitive patients. Women with polycystic ovary syndrome (PCOS), a condition in which insulin resistance is a major cause of the disorder, and NAC have also shown that superior metformin can improve cholesterol levels, rapid blood sugar levels, and rapid insulin levels. Berberine’s negative side effects are that you may take other substances that can reduce blood sugar levels, and formalin in combination with another medication can cause your blood sugar levels to be too low.

References

Ahrén B, Schweizer A, Dejager S, Villhauer EB, Dunning BE, Foley JE (2011). Mechanisms of action of the dipeptidyl peptidase-4 inhibitor vildagliptin in humans. Diabetes Obes Metab. 2011 Sep;13(9):775-83. doi: 10.1111/j.1463-1326.2011.01414.x. PMID: 21507182. Available at: https://doi.org/10.1111/j.1463-1326.2011.01414.x Accessed on 01/08/2021

Jabbour S, Ziring B (2011). Advantages of extended-release metformin in patients with type 2 diabetes mellitus. Postgrad Med. 2011 Jan;123(1):15-23. doi: 10.3810/pgm.2011.01.2241. PMID: 21293080. Available at: https://doi.org/10.3810/pgm.2011.01.2241 Accessed on 01/08/202

Taylor, R (2020), Newcastle University, Newcastle, UK. Type 2 diabetes and remission: practical management guided by pathophysiology (Review). J Intern Med 2020. Available at: https://doi.org/10.1111/joim.13214 Accessed on 01/08/2021

eMC (2020). SmPC: Pioglitazone 15mg tablets. Available at: https://www.medicines.org.uk/emc/product/7407/smpc Accessed on 01/08/2021

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