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Metformin for Potential or Acute COVID
General Information
This 14 day treatment is to be taken during acute COVID infection to help reduce the risk of developing Long COVID. This study found an approximate 40% reduction in developing Long COVID when taking this 14 day treatment. We can also prescribe this treatment ahead of time to have on hand in case of an acute COVID infection. Metformin has been used in healthcare for decades, has a great safety profile, and affordable generics available. It is a cornerstone in Type 2 diabetes treatment, but can also be used off-label for reducing your risk of developing Long COVID.
Dosing Instructions
Please carefully follow your dosing instructions in your RTHM dashboard.
Ideally, you will start within 3 days of COVID symptoms or a positive test. Don’t worry if you miss this window, just start as soon as you can.
Please read this treatment guide in its entirety for additional important information.
General Metformin Tips
  • Take metformin with food, such as in the middle of a meal, to help reduce any gastrointestinal symptoms.
  • If metformin causes smelly gas despite taking with food, we recommend wearing underwear designed to neutralize the smell of flatulence (like Tootles).
What To Do If I Miss a Dose
If you miss a dose, take it as soon as possible. If you are close to the time of your next dose, wait to take the next dose and then resume your normal dosing schedule. Do not “double-up” the dose.
Precautions When Starting Metformin
  • If you require diagnostic testing, such as x-rays, MRIs, and CT scans that require contrast, inform your provider that you are taking metformin. You may need to stop taking this medication for a day or two before having these tests as the interaction increases the risk of lactic acidosis.
  • If you develop an infection or stomach bug that reduces your intake of fluids or increases loss of fluids, via severe diarrhea, vomiting or loss of appetite, you may need to stop metformin until you recover.
  • Do not take any new medications, including over the counter cold remedies, without first talking with your provider or pharmacist as they can interact with metformin.
  • Metformin can lower your blood sugar, so if you are going on a highly restrictive caloric diet, or you are doing intense physical activity, you may need to adjust your dose of metformin. Please work with your primary care if this is the case.
  • We recommend not drinking alcohol while taking metformin. Alcohol can increase your risk of low blood sugar as well as developing lactic acidosis, or a buildup of lactic acid in the bloodstream.
  • Metformin can increase the chance of becoming pregnant in those with female reproductive organs who have not yet gone through menopause. If this applies to you, please consider speaking with your primary care provider or OB/Gyn about birth control options.
Potential Side Effects
For some medications, it’s common to experience mild side effects as your body adjusts during the first few months of use. Mild side effects can occur when taking ketotifen and usually diminish as your body adjusts to the treatment. These side effects can include:
  • Diarrhea
  • Passing gas
  • Nausea
  • Heartburn
  • Loss of strength or energy
  • Low blood sugar
  • Muscle pain
  • Unpleasant metallic taste
If these side effects won’t go away, tell your doctor.
When to Seek Medical Attention
Take medication only as directed. In the event of an accidental overdose, contact emergency services immediately.
Serious side effects with metformin are very uncommon, especially at the low doses we prescribe, but they can occur. If you experience any of these symptoms, call your healthcare provider right away or seek emergency medical care.
  • Difficulty breathing or breathing too faste
  • Abnormal or irregular heartbeat
  • Sever sleepiness or sedation
  • Feeling excessively cold
  • Dizziness or fainting
  • Significant weight loss (~20 lbs in a month)
  • Severe muscle pain or cramps
  • Severe abdominal pain
  • Vomiting
  • Hives, rashes or anaphylaxis
Taking more metformin than prescribed can lead to a buildup of lactic acid in the blood, which, in rare cases, can be fatal. This is very rare at the low doses that we prescribe. The onset of metformin-associated lactic acidosis is often subtle, accompanied by non-specific symptoms such as muscle aches, trouble breathing, fatigue, sleepiness, and abdominal pain. Seek emergency care if you start developing these symptoms.
Interactions with Metformin
  • You should not take metformin if you are on any of the following medications. If your provider wants to start you on any of these medications, make sure to tell your provider you are taking metformin.
    • These medications can increase your risk for lactic acidosis:
      • Anticonvulsants: topiramate (Topamax), zonisamide (Zonegran)
      • Antianginal: ranolazine (Ranexa)
      • Antivirals: dolutegravir (Tivicay), ombitasvir-dasabuvir-paritaprevir (Viekira Pak)
      • H2 Blocker: cimetidine (Tagamet)
      • CXCR4 Antagonist: mavorixafor (Xolremdi)
      • Antifungal: levoketoconazole (Recorlev)
      • Carbonic Anhydrase Inhibitors: acetazolamide (Diamox), methazolamide (Neptazane)
      • Kinase Inhibitor: vandetanib (Caprelsa)
    • These medications, when taken with metformin, can excessively lower your blood sugar:
      • Acetohexamide (Dymelor)
      • Alogliptin (Nesina)
      • Bexagliflozin (Brenzavvy)
      • Carbutamide
      • Chlorpropamide (Diabinese)
      • Gliclazide (Diamicron)
      • Glimepiride (Amaryl)
      • Glipizide (Glucotrol)
      • Glisoxepide
      • Glibornuride (Glutril)
      • Gliquidone (Glurenorm)
      • Glyburide (Diabeta, Glynase, Micronase)
      • Insulin (Humulin, Novolin, Lantus, Levemir, Humalog, Novolog, Apidra)
      • Metahexamide (Not widely marketed, specific trade names may vary by region)
      • Nateglinide (Starlix)
      • Pramlintide (Symlin)
      • Repaglinide (Prandin)
      • Sotagliflozin (Zynquista)
      • Tolazamide (Tolinase)
      • Tolbutamide (Orinase)
    • These other medications, when taken with metformin, can also excessively lower your blood sugar:
      • Abiraterone Acetate (Zytiga)
      • Chloroquine (Aralen)
      • Hydroxychloroquine (Plaquenil)
      • Lanreotide (Somatuline Depot)
      • Octreotide (Sandostatin, Sandostatin LAR)
      • Pasireotide (Signifor, Signifor LAR)
      • Somatrogon-GHLA
      • Thioctic Acid (Alpha-Lipoic Acid, Thioctan and Alipotec)
      • Dulaglutide (Trulicity)
      • Exenatide extended release (Bydureon bcise)
      • Exenatide (Byetta)
      • Liraglutide (Victoza, Saxenda)
      • Lixisenatide (Adlyxin)
      • Semaglutide (Ozempic, Rybelsus)
      • Tirzepatide (Mounjaro)
      • Ciprofloxacin (Cipro)
      • Delafloxacin (Baxdela)
      • Gatifloxacin (Tequin)
      • Gemifloxacin (Factive)
      • Levofloxacin (Levaquin)
      • Lomefloxacin (Maxaquin)
      • Moxifloxacin (Avelox)
      • Norfloxacin (Noroxin)
      • Ofloxacin (Floxin)
      • Sparfloxacin (Zagam)
Who Should Not Take Metformin
You should not take metformin for COVID if you have any of the following conditions as they can affect how metformin works in the body.
  • If you have elevated lactic acid or lactate in your blood or urine. Metformin increases your risk of lactic acidosis, a potentially severe side effect that can be compounded if you are already predisposed to high lactate levels.
  • If you have low blood sugar or take insulin, metformin can excessively lower your blood sugar
  • Severe kidney or liver disease can adversely affect the metabolism of metformin
  • Radiologic procedures that use contrast (dye) can rarely interact with metformin and increase your risk of lactic acidosis. If you require diagnostic testing, such as x-rays, MRIs, and CT scans that require contrast, inform your provider that you are taking metformin. You may need to stop taking this medication for a day or two before having these tests as the interaction increases the risk of lactic acidosis.
  • We recommend not drinking alcohol while taking metformin. Alcohol can increase your risk of low blood sugar as well as developing lactic acidosis, or a buildup of lactic acid in the bloodstream.
  • Metformin can worsen vitamin B6 or B12 deficiencies
  • There is mixed data about metformin’s effect on cardiac arrhythmias, heart disease or heart failure.
What If I Become Pregnant While Taking This Medication?
  • Metformin is well-tolerated during pregnancy and is unlikely to harm a fetus.
  • Metformin is FDA category B
  • Metformin is often used to treat pregnant mothers with gestational diabetes.
Medication Storage
  • Keep this medication in the container provided by the pharmacy. Ensure it is properly closed and out of the reach of children. Store at room temperature and away from excess heat, direct light, and moisture (not in the bathroom).
  • Do not share this medication with anyone else.
  • Do not throw away unwanted or expired medications. Do not flush down the toilet or pour down the drain. Ask your local pharmacist about local drug take back programs to discard your medication
Questions?
If you have questions about this medication, please contact us by using our support form. We generally respond within 2 business days. If you have a more urgent issue, please seek care from your local primary care provider, urgent care or emergency services.
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