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VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

Metformin is one of the most common drugs used on a permanent basis in the treatment of type II diabetes. It's worth taking a look at its effects, as well as the most common side effects it causes. How often does metformin contribute to hair loss?

Metforminis the first line treatment for type II diabetes. In 2022, 2.9 million adult Poles had diabetes (i.e. every eleventh adult patient). This shows that this drug can be found in many first-aid kits of Poles. What side effects may appear from the use of metformin?

Metformin - what is this drug?

It is a substance that is a derivative of biguanide and thus a first-line drug used in the treatment of type II diabetes, the most common type of diabetes, which results from impaired insulin secretion by the pancreas and increasing tissue resistance to this hormone. Obesity and low physical activity of patients play an important role in the development of type II diabetes.

Metformin is the most commonly used drug in the treatment of diabetes, therefore many patients under the care of a family doctor use it chronically. This substance is taken orally, in the dose prescribed by a doctor.

Metformin - glucose lowering action and mechanism

Metformin lowers blood glucose through several mechanisms. First, it reduces the production of glucose in the liver by inhibiting certain metabolic pathways.

Second, metformin increases the sensitivity of the body's tissues to insulin, allowing more glucose to enter and be used by the cells. What's more, it reduces the absorption of glucose and stimulates such biochemical reactions that result in the formation of glycogen - a chemical compound made of glucose molecules.

Importantly, metformin does not lead to an excessive drop in blood glucose, i.e. hypoglycemia. It is a safe and effective drug, and interestingly - it also has a positive effect on the concentration of lipids in the blood.

It reduces the concentration of triglycerides and cholesterol. It also has a positive effect on weight loss in overweight and obese patients. It's good to know that metformin is thereused not only in the treatment of type II diabetes, but also in the treatment of pre-diabetes and polycystic ovary syndrome (PCOS).

Metformin - side effects of the drug

As with any drug, the use of metformin also carries the possibility of certain side effects. The most common side effects of metformin are:

  • nausea, vomiting,
  • stomach pains,
  • diarrhea,
  • taste disturbance,
  • decreased appetite.

These symptoms usually disappear some time after you start taking metformin. Therefore, this drug is introduced gradually - starting with lower doses, and from time to time the doctor decides to increase the dose of the drug.

Administering metformin in divided doses (that is, for example, in the morning and at noon) is also intended to minimize the side effects described above.

Metformin - rarer side effects of the drug

Less common side effects of metformin include:

  • skin reactions - such as hives, erythema or itchy skin,
  • lactic acidosis - results from the accumulation of lactic acid in the body - this product is produced by anaerobic glucose conversion reactions. Lactic acidosis may manifest itself in breathing problems (a characteristic feature of this condition is frequent and deep breathing - the so-called Kussmaul breath, also known as the chased dog's breath), as well as nausea, vomiting, abdominal pain, or disturbed consciousness,
  • reduction of vitamin B12 absorption and lowering its level in serum - vitamin B12 deficiency may contribute to the appearance of anemia, in this case called megaloblastic anemia,
  • hepatitis, manifested by e.g. increase in the value of liver enzymes (ALT, AST).

Metformin and hair loss - case report

There is not much information in the medical literature about hair loss caused by metformin use. An interesting case report, however, was presented in the Gynaecology case reports.

A patient taking metformin due to polycystic ovary syndrome noticed massive hair loss. This happened one month after starting 1 gram metformin twice a day.

The patient discontinued the drug, and within six months, the condition of her hair returned to the starting point, which confirms that the cause of the hair loss in this case was the use of metformin.

These symptoms were explained by the fact that metformin can lower vitamin B12 levels, and hersdeficiency causes hair loss. This patient appears to have had low vitamin B12 levels at baseline, as hair loss is not a common side effect of metformin.

Metformin and eyelash and eyebrow loss

Another interesting case report shows a 69-year-old patient with type 2 diabetes taking a combination of anti-diabetic drugs - 50 mg sitagliptin and 850 mg metformin.

We use drug combinations in the treatment of diabetes in those patients who cannot achieve normal blood glucose levels by using metformin alone.

This patient experienced a sudden loss of eyebrows and eyelashes 4 months after starting the combination of metformin and sitagliptin. Other causes of this event were excluded, including dermatological and rheumatological diseases. which may cause loss of eyelashes and eyebrows.

In this situation, the authors linked the loss of eyebrows and eyelashes to the use of the drug combination described above. However, it is not known which drug was responsible for these symptoms, and perhaps the loss of eyebrows and eyelashes was due to an interaction between the two substances. It should be emphasized that in the literature it is difficult to find other scientific reports confirming that this combination of drugs leads to the loss of eyelashes or eyebrows.

What medications can cause hair loss?

There are drugs that cause hair loss much more often than metformin described in this article. These preparations include, first of all:

  • antimalarial drugs - substances such as chloroquine, amodiaquine and primaquine should be mentioned here. In addition to malaria, these drugs have found application in the treatment of many rheumatic diseases,
  • methotrexate - a drug that suppresses the response of the immune system (immunosuppressive) used in many autoimmune diseases, including the treatment of psoriasis or rheumatoid arthritis. This drug is also used to treat certain types of cancer,
  • azathioprine - like methotrexate, it is an immunosuppressive substance. Azathioprine is used, among others, in the treatment of inflammatory bowel diseases (e.g. ulcerative colitis), as well as in the treatment of rheumatoid arthritis, systemic lupus erythematosus or autoimmune hepatitis,
  • glucocorticosteroids - drugs commonly used in the treatment of many inflammatory and autoimmune diseases, similar to the above-described methotrexate or azathioprine, suppress the activity of the immune system,
  • Mycophenolate Mofetil - an immunosuppressive drug used inprevention of acute organ transplant rejection in recipients of organ transplants,
  • statins - these are drugs commonly used in the treatment of lipid disorders, i.e. in the case of increased values ​​of the so-called bad cholesterol (LDL cholesterol). These drugs rarely cause hair loss, but such a relationship has been noted,
  • retinoids - substances used in the treatment of acne, and sometimes also psoriasis,
  • certain anticoagulants - such as warfarin or heparin
  • some β-blockers - these are substances used in the treatment of arrhythmias, as well as in the treatment of arterial hypertension,
  • certain antifungal drugs - mention the frequently used fluconazole here.

These are not all medications that can lead to baldness, but in the event of hair loss, you should definitely analyze the composition of your first aid kit. Metformin leads to hair loss less frequently than other drugs, but as case reports show, it is possible.

If you have problems with hair loss, please consult your doctor and look for the cause of the condition together. The doctor who deals with the problems of hair loss most often is a dermatologist.

There is also a branch of medicine that deals with this kind of problem - called trichology. It is not worth underestimating hair loss, because this symptom is part of the clinical picture of many diseases and is not always only a side effect of the medications we use.

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