Drug interactions
metformin + proton pump inhibitor (class)
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Chronic concomitant use may increase risk of vitamin B12 deficiency, potentially worsening anemia or neuropathy.
Mechanism of action
PPIs reduce gastric acidity needed for B12 release/absorption; metformin impairs calcium-dependent ileal B12 uptake → additive B12 depletion.
Clinical management
If used long term, reassess PPI need and use the lowest effective dose/duration. Check vitamin B12 (± CBC) at baseline and periodically (e.g., every 1–2 years) or if symptoms; supplement B12 if low.
Drug reference
References
- Metformin (Glucophage) Prescribing Information — Warnings and Precautions: Vitamin B12 levels — FDA Label
- Omeprazole Prescribing Information — Warnings and Precautions: Cyanocobalamin (Vitamin B12) deficiency — FDA Label
- Proton pump inhibitors: Overview of adverse effects — UpToDate
Frequently asked questions
Can I take metformin with proton pump inhibitor (class)?
The interaction is rated: Moderate. Chronic concomitant use may increase risk of vitamin B12 deficiency, potentially worsening anemia or neuropathy.
How serious is the interaction between metformin and proton pump inhibitor (class)?
The interaction is rated: Moderate. Evidence level: Moderate.
How is the interaction between metformin and proton pump inhibitor (class) managed?
If used long term, reassess PPI need and use the lowest effective dose/duration. Check vitamin B12 (± CBC) at baseline and periodically (e.g., every 1–2 years) or if symptoms; supplement B12 if low.
Why do metformin and proton pump inhibitor (class) interact?
PPIs reduce gastric acidity needed for B12 release/absorption; metformin impairs calcium-dependent ileal B12 uptake → additive B12 depletion.
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