Widespread recalls affect popular diabetes medication Metformin

A common diabetes medication is in the midst of widespread national recalls after researchers found a contaminant that could potentially cause cancer, but local experts say there are plenty of alternative options available for those who take the drug.

Metformin is used to control blood sugar levels in patients with Type 2 diabetes. It comes in two varieties — immediate release and extended release.

The federal Food and Drug Administration found unsafe levels of nitrosodimethylamine in numerous extended-release metformin products.

The substance, also known as NDMA, occurs naturally and can be found in food and drinking water, according to the FDA. However, at high doses, it can increase the risk of cancer.

High levels of NDMA can contaminate medical products during manufacture, according to Dr. Esra Karslioglu French, Endocrine Medical Director for University of Pittsburgh Medical Center.

The FDA began studying NDMA levels in several medications in 2019, turning its attention to metformin late that year.

Numerous pharmaceutical companies have recalled their extended release metformin products over the last several months. The most recent recalls were announced last week by the FDA.

However, experts say people with diabetes have little reason to worry.

“The first thing is that patients give their health care providers a call if they’re uncomfortable or nervous or concerned,” said Michele Axelson, lead diabetes educator with Excela Health.

Metformin is one of the most common diabetes drugs, but most patients are prescribed the immediate release varieties, which don’t have the high NDMA levels of the extended-release products, Axelson said.

The extended-release products are often prescribed for patients who suffer gastrointestinal side effects from immediate-release metformin, she said.

Patients affected by the recalls should be able to switch to other diabetes medication without much trouble, she said.

“There are many options in addition to metformin that are out on the market,” she said.

NDMA only poses a cancer risk when taken in large doses over a long period of time. Those taking extended release metformin should continue to do so until receiving guidance from a doctor or pharmacist, French said.

“Patients shouldn’t stop their medications immediately, because that can create high levels of blood sugars and create an immediate danger to the patient,” French said.

Not all extended-release metformin products have been affected by the recall. “For the patients, the best way to deal with this situation is to check with the pharmacy to see if their medication has been recalled or not,” French said.

The FDA has published a list of all recalled products at fda.gov/drugs/drug-safety-and-availability.