Drug & supplement interaction

Betel Nut + Metformin

Metformin brand names: Glucophage, Metformin.

No Known Interaction

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Updated July 2026 · Pair last verified Sep 13, 2026

The bottom line No known interaction

We found no known interaction between Betel Nut and Metformin in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Betel Nut and Metformin

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Metformin and Betel Nut in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Betel Nut safety at a glance

Betel Nut overall Avoid Regular betel nut use is linked to oral cancer, addiction, and other serious harms.

Pregnancy Likely Unsafe When used orally. Betel nut has carcinogenic potential as well as central nervous system (CNS) stimulant and cholinergic properties and might adversely affect p... Read the full pregnancy detail

Breastfeeding Likely Unsafe When used orally. Betel nut has carcinogenic potential as well as central nervous system (CNS) stimulant and cholinergic properties and might adversely affect p... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Metformin and Betel Nut? Ask Dr. Brian Staiger, PharmD, BCPS directly ›

How we checked

Why No Interaction Is Listed for Metformin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Metformin is filed under 5 classifications — including organic cation transporter 2 (oct2) substrates, antidiabetes drugs, oral drugs. Betel Nut has documented interactions with 4 drug classes — the most serious being anticholinergic drugs (moderate), cholinergic drugs (moderate) and doxorubicin (adriamycin, others) (moderate) — and none of Metformin’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Betel Nut Does Interact With Other Medications

Betel Nut has 229 moderate known drug interactions in our database — Metformin isn’t one of them. If you take anything else, check it against the full list below.

Moderate 229 No known interaction 2,601 (incl. Metformin)

Taking anything else?

Check Another of Your Medications Against Betel Nut

Covers the 2,830 medications we’ve checked against Betel Nut. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Betel Nut and Metformin May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 2 of them are worth acting on rather than waiting out — marked below.

Chest pain Worth acting on Additional detail
Betel Nut
“Betel nut is generally regarded as unsafe for use. Any benefits of therapy may not outweigh the risk of toxicity. Orally, betel nut use is associated with precancerous lesions and carcinoma in long-term users.”

Betel Nut · Natural Medicines adverse-effect record, reported in arrhythmia.
6 sources cited

35216. Tsai, J. F., Chuang, L. Y., Jeng, J. E., Ho, M. S., Hsieh, M. Y., Lin, Z. Y., and Wang, L. Y. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study. Br J Cancer 3-2-2001;84(5):709-713. PubMed

35238. Sheikh, M. Y., Rizvi, I. H., and Ahmed, I. Oesophageal carcinoma caused by betel nut. J Pak.Med Assoc 1992;42(6):145-146.

35240. Chitra, S., Ashok, L., Anand, L., Srinivasan, V., and Jayanthi, V. Risk factors for esophageal cancer in Coimbatore, southern India: a hospital-based case-control study. Indian J Gastroenterol. 2004;23(1):19-21.

35296. Chakrabarti, R. N., Dutta, K., Ghosh, K., and Sikdar, S. Uterine cervical dysplasia with reference to the betel quid chewing habit. Eur J Gynaecol.Oncol 1990;11(1):57-59.

35312. Fendell, L. D. and Smith, J. R. Betel-nut-associated cancer: report of case. J Oral Surg 1970;28(6):455-456.

35321. Chen, G. S. and Chen, C. H. [A statistical analysis of oral squamous cell carcinoma]. Gaoxiong.Yi Xue.Ke.Xue.Za Zhi 1995;11(10):582-588.
“Chewing betel nut has been associated with short-term chest pain, ventricular arrhythmias, tachycardia or a slight increased heart rate, palpitations, hypotension, and myocardial infarction. Increased systolic blood pressure has occurred in new chewers of betel nut.”

Betel Nut · Natural Medicines adverse-effect record, reported in arrhythmia.
6 sources cited

35224. Deng, J. F., Ger, J., Tsai, W. J., Kao, W. F., and Yang, C. C. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360. PubMed

35294. Frewer, L. J. The effect of betel nut on human performance. P N G Med J 1990;33(2):143-145.

35327. Chu, N. S. Cardiovascular responses to betel chewing. J Formos.Med Assoc 1993;92(9):835-837.

35351. Hung, D. Z. and Deng, J. F. Acute myocardial infarction temporally related to betel nut chewing. Vet.Hum.Toxicol. 1998;40(1):25-28.

35353. Chiang, W. T., Yang, C. C., Deng, J. F., and Bullard, M. Cardiac arrhythmia and betel nut chewing--is there a causal effect? Vet.Hum.Toxicol. 1998;40(5):287-289.

102879. Li DF, Xu ZL, Yao J. A rare cause of esophageal mucosal and submucosal lesions. Rev Esp Enferm Dig 2020;112(2):158. PubMed
Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›
Shortness of breath Worth acting on Additional detail

Betel Nut

Recorded for Betel Nut in the same Natural Medicines adverse-effect record shown under Chest pain above.

Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›
Sweating / Stomach upset Additional detail
Betel Nut
“Orally, betel nut has rarely been reported to cause cholinergic crisis with salivation, sweating, eye tearing, urinary incontinence, diarrhea, gastrointestinal upset, and vomiting. Dizziness, numbness, and coma have also been reported rarely. In a case report, seizures were related to intake of betel nuts.”

Betel Nut · Natural Medicines adverse-effect record, reported in diarrhea.
4 sources cited

35204. Nelson, B. S. and Heischober, B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann.Emerg.Med 1999;34(2):238-243. PubMed

35224. Deng, J. F., Ger, J., Tsai, W. J., Kao, W. F., and Yang, C. C. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360. PubMed

35323. Chu, N. S. Effect of betel chewing on RR interval variation. J Formos.Med Assoc 1995;94(3):106-110.

35232. Huang, Z., Xiao, B., Wang, X., Li, Y., and Deng, H. Betel nut indulgence as a cause of epilepsy. Seizure. 2003;12(6):406-408. PubMed
Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›
Dizziness Additional detail

Betel Nut

Recorded for Betel Nut in the same Natural Medicines adverse-effect record shown under Chest pain above.

Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›
Diarrhea / Vomiting Additional detail
Betel Nut
“Orally, consuming betel nut may cause vomiting, nausea, stomach pain, and diarrhea (6,35224). Chewing betel nut causes red-stained mouth, lips, and feces (18,35233).

Population research in adult males has found that chewing betel nut is associated with 59% to 70% greater odds of having diverticulosis when compared with non-users.

Betel nut chewing can also cause oral submucous fibrosis (OSMF) in susceptible individua…”

Betel Nut · Natural Medicines adverse-effect record, reported in diarrhea.
6 sources cited

6. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.

35224. Deng, J. F., Ger, J., Tsai, W. J., Kao, W. F., and Yang, C. C. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360. PubMed

18. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

35233. Yin, X. M., Peng, J. Y., and Gao, Y. J. [Clinical study on the relationship between tooth abrasion and the habits of chewing betel nut]. Hunan.Yi.Ke.Da.Xue.Xue.Bao. 2003;28(2):171-173.

109488. Liu YH, Chen WL. Association between Betel Nut and Presence of Diverticulum in Male: A Cross-Sectional Study. Biomed Res Int 2021;2021:6669792. PubMed

327. Cox SC, Walker DM. Oral submucous fibrosis. A review. Aust Dent J 1996;41:294-9. PubMed
Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›
Nausea Additional detail

Betel Nut

Recorded for Betel Nut in the same Natural Medicines adverse-effect record shown under Diarrhea / Vomiting above.

Metformin

Listed in the ADVERSE REACTIONS section of the FDA label for Metformin. Read the label on DailyMed ›

Reported for Betel Nut but not commonly for Metformin: a heart attack, kidney problems, a fast or pounding heartbeat and loss of bladder control.

Effects for Metformin come from the ADVERSE REACTIONS section of its FDA label; effects for Betel Nut come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Betel Nut in Pregnancy & Breastfeeding

Pregnancy And Lactation Likely Unsafe

When used orally. Betel nut has carcinogenic potential as well as central nervous system (CNS) stimulant and cholinergic properties and might adversely affect pregnancy and nursing infants; avoid using. Neonatal withdrawal has occurred following chronic use by the mother while pregnant.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

Overlapping uses

What Metformin Is Prescribed For, and What Betel Nut Has Been Studied For

These two come up together because they touch the same health topic — not because they do the same job. Metformin is a prescription medicine with approved uses on its FDA label. Betel Nut is a supplement: what follows is what researchers have looked at it for, and how strong that evidence is.

Metformin is prescribed for: Metformin is used to improve blood sugar (glucose) control in people with type 2 diabetes mellitus. It is always used together with diet and exercise, not instead of them. Metformin hydrochloride tablets and oral solution are approved for adults and children 10 years and older. Metformin hydrochloride extended-release tablets — including brands such as Fortamet, Glumetza, and Metformin Hydrochloride Extended Release — are approved for adults only.

Betel Nut has been studied for:

Stroke studied, not established Betel Nut has been studied for this. Natural Medicines rates the evidence: Insufficient Reliable Evidence To Rate Read what the research shows
Betel Nut for stroke
Preliminary clinical research suggests that taking an aqueous solution containing betel nut extract 2.125 grams appears to improve speech, strength, and bladder function in stroke patients compared with placebo.
1 source cited

35368. Mannan MA, Mohammad QD, Haqua A, and et al. Role of areca-catechu (betel-nut) in cerebrovascular disease: a double blind clinical trial. Bangladesh J Neuro 1988;4(2):46-51.

Effectiveness ratings and the research summaries above are the verbatim record from the Natural Medicines database, which grades evidence from “Effective” down to “Insufficient Reliable Evidence To Rate”. A rating below the top of that scale means researchers have looked at it — not that it works, and never that it can stand in for a prescribed medicine. Do not stop or replace Metformin on your own; if you are taking Betel Nut for the same health topic, tell your prescriber, especially if the medicine is being adjusted to a target.

From our Q&A

Questions About Betel Nut or Metformin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Betel Nut or Metformin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Metformin

This page covers Betel Nut only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Metformin page lists 258 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Siberian Cocklebur (major), Acai (moderate), African Wild Potato (moderate) and Agaricus Mushroom (moderate).

By severity: 2 major · 217 moderate · 39 minor.

From our pharmacist’s overview on the Metformin page

“Siberian cocklebur is the ingredient I most want anyone taking metformin (Glucophage) to know about. It has caused severe low blood sugar in people, documented in humans, and it should not be combined with any glucose-lowering medication.”

Reviewed by 2 · Jul 18, 2026

Open the Metformin interaction page

How much people look this up

Where Betel Nut and Metformin Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Betel Nut

Steady interest

#1,275 of 1,452 supplements looked up here in the last 7 days

29 days ago today

Medication Metformin

Top 1%

#29 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?

Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Betel Nut reference on this page ↓
Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Betel Nut and Metformin records this page draws on were last updated July 10, 2026.
What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.

Data structure & sourcing designed and verified by Dr. Brian Staiger, PharmD, BCPS.

Supplement

About Betel Nut

What is Betel Nut?

Stimulant or 'pick-me-up'
Chewed after meals as a digestive aid
Freshening the breath
Traditional and social/cultural use
Folk treatment for intestinal worms

Betel nut is the seed of the areca palm and is chewed by millions of people across Asia and the Pacific as a stimulant. It is not a safe supplement: regular use is strongly linked to mouth cancer, addiction, and other serious health problems, so it is best avoided.

Areca catechu · Arecaceae · Seed (nut) of the areca palm · Chewed raw or dried nut, often wrapped in betel leaf with slaked lime ('paan' or 'betel quid'); also sold as cut or powdered nut

An interaction check asks whether these two react with each other — it does not ask whether Betel Nut is a good idea for someone in your situation. Here is what our Betel Nut record says about it on its own.

Betel Nut: dosing

There is no safe or established dose of betel nut, and it is not recommended as a supplement. They can help you find safer options and support quitting if needed.

From our Betel Nut monograph — the full record covers uses, side effects and every documented interaction.

Read the full Betel Nut monograph & all interactions

Medication

About Metformin

What Is Metformin Used For?

Brand names: Glucophage, Metformin

Metformin is used to improve blood sugar (glucose) control in people with type 2 diabetes mellitus. It is always used together with diet and exercise, not instead of them.

Metformin hydrochloride tablets and oral solution are approved for adults and children 10 years and older. Metformin hydrochloride extended-release tablets — including brands such as Fortamet, Glumetza, and Metformin Hydrochloride Extended Release — are approved for adults only.

See full Metformin drug information

Keep checking

Other Drugs & Betel Nut

Browse every other medication we’ve checked against Betel Nut — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major

229Moderate

0Minor

2,600No known interaction

229 Moderate 2,600 No interaction

Moderate

229 interactions

Showing 60 of 229 moderate interactions — see all 229 on the Betel Nut page.

No interaction 2,600 drugs checked — show the list

We also checked Betel Nut against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,600 medications checked with no known interaction — see the full Betel Nut list.

See the full Betel Nut interactions page

See every supplement checked against Metformin, ranked by severity

Evidence & sources

Betel Nut References

The 61 references that drive our Betel Nut monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.
Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
Cox SC, Walker DM. Oral submucous fibrosis. A review. Aust Dent J 1996;41:294-9. PubMed
Gupta PC, Sinor PN, Bhonsle RB, et al. Oral submucous fibrosis in India: a new epidemic? Natl Med J India 1998;11:113-6.
VanWyk CW. Oral submucous fibrosis. The South African experience. Indian J Dent Res 1997;8:39-45.
Gilani, A. H., Ghayur, M. N., Saify, Z. S., Ahmed, S. P., Choudhary, M. I., and Khalid, A. Presence of cholinomimetic and acetylcholinesterase inhibitory constituents in betel nut. Life Sci 10-1-2004;75(20):2377-2389. PubMed
Lopez-Vilchez, M. A., Seidel, V., Farre, M., Garcia-Algar, O., Pichini, S., and Mur, A. Areca-nut abuse and neonatal withdrawal syndrome. Pediatrics 2006;117(1):e129-e131. PubMed
Nelson, B. S. and Heischober, B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann.Emerg.Med 1999;34(2):238-243. PubMed
Dar, A. and Khatoon, S. Behavioral and biochemical studies of dichloromethane fraction from the Areca catechu nut. Pharmacol Biochem Behav. 1-1-2000;65(1):1-6. PubMed
Mannan, N., Boucher, B. J., and Evans, S. J. Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London. Br J Nutr 2000;83(3):267-273.
Tsai, J. F., Chuang, L. Y., Jeng, J. E., Ho, M. S., Hsieh, M. Y., Lin, Z. Y., and Wang, L. Y. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study. Br J Cancer 3-2-2001;84(5):709-713. PubMed
Deng, J. F., Ger, J., Tsai, W. J., Kao, W. F., and Yang, C. C. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360. PubMed
Huang, Z., Xiao, B., Wang, X., Li, Y., and Deng, H. Betel nut indulgence as a cause of epilepsy. Seizure. 2003;12(6):406-408. PubMed
Yin, X. M., Peng, J. Y., and Gao, Y. J. [Clinical study on the relationship between tooth abrasion and the habits of chewing betel nut]. Hunan.Yi.Ke.Da.Xue.Xue.Bao. 2003;28(2):171-173.
Taylor, R. F., al-Jarad, N., John, L. M., Conroy, D. M., and Barnes, N. C. Betel-nut chewing and asthma. Lancet 5-9-1992;339(8802):1134-1136. PubMed
Sheikh, M. Y., Rizvi, I. H., and Ahmed, I. Oesophageal carcinoma caused by betel nut. J Pak.Med Assoc 1992;42(6):145-146.
Chitra, S., Ashok, L., Anand, L., Srinivasan, V., and Jayanthi, V. Risk factors for esophageal cancer in Coimbatore, southern India: a hospital-based case-control study. Indian J Gastroenterol. 2004;23(1):19-21.
Tung, T. H., Chiu, Y. H., Chen, L. S., Wu, H. M., Boucher, B. J., and Chen, T. H. A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Di PubMed
Chang, W. C., Hsiao, C. F., Chang, H. Y., Lan, T. Y., Hsiung, C. A., Shih, Y. T., and Tai, T. Y. Betel nut chewing and other risk factors associated with obesity among Taiwanese male adults. Int J Obes.(Lond) 2006;30(2):359-363. PubMed
Epstein, R. J., Leung, T. W., and Cheung, P. S. Panmucositis and chemosensitisation associated with betel quid chewing during dose-dense adjuvant breast cancer chemotherapy. Cancer Chemother.Pharmacol 2006;58(6):835-837. PubMed
Yen, A. M., Chiu, Y. H., Chen, L. S., Wu, H. M., Huang, C. C., Boucher, B. J., and Chen, T. H. A population-based study of the association between betel-quid chewing and the metabolic syndrome in men. Am J Clin Nutr 2006;83(5):1153-1160. PubMed
Chung, F. M., Chang, D. M., Chen, M. P., Tsai, J. C., Yang, Y. H., Shieh, T. Y., Shin, S. J., Chen, T. H., Tai, T. Y., and Lee, Y. J. Areca nut chewing is associated with metabolic syndrome: role of tumor necrosis factor-alpha, leptin, and white blood ce DOI
Chatrchaiwiwatana, S. Dental caries and periodontitis associated with betel quid chewing: analysis of two data sets. J Med Assoc Thai. 2006;89(7):1004-1011.
Lan, T. Y., Chang, W. C., Tsai, Y. J., Chuang, Y. L., Lin, H. S., and Tai, T. Y. Areca nut chewing and mortality in an elderly cohort study. Am J Epidemiol. 3-15-2007;165(6):677-683. PubMed
Gerreth, K. [Tooth wear in Hindu betel nut chewers]. Przegl.Lek. 2006;63(10):882-886.
Guh, J. Y., Chen, H. C., Tsai, J. F., and Chuang, L. Y. Betel-quid use is associated with heart disease in women. Am J Clin Nutr 2007;85(5):1229-1235. PubMed
Yen, A. M., Chen, L. S., Chiu, Y. H., Boucher, B. J., and Chen, T. H. A prospective community-population-registry based cohort study of the association between betel-quid chewing and cardiovascular disease in men in Taiwan (KCIS no. 19). Am J Clin Nutr 2 PubMed
Frewer, L. J. The effect of betel nut on human performance. P N G Med J 1990;33(2):143-145.
Chakrabarti, R. N., Dutta, K., Ghosh, K., and Sikdar, S. Uterine cervical dysplasia with reference to the betel quid chewing habit. Eur J Gynaecol.Oncol 1990;11(1):57-59.
Talonu, N. T. Observations on betel-nut use, habituation, addiction and carcinogenesis in Papua New Guineans. P.N G.Med J 1989;32(3):195-197.
Wiesner, D. M. Betel-nut withdrawal. Med J Aust. 4-20-1987;146(8):453. PubMed
Fendell, L. D. and Smith, J. R. Betel-nut-associated cancer: report of case. J Oral Surg 1970;28(6):455-456.
Chen, G. S. and Chen, C. H. [A statistical analysis of oral squamous cell carcinoma]. Gaoxiong.Yi Xue.Ke.Xue.Za Zhi 1995;11(10):582-588.
Chu, N. S. Effect of betel chewing on RR interval variation. J Formos.Med Assoc 1995;94(3):106-110.
Dowse, G. K. Betel-nut chewing and diabetes in Papua New Guinea and elsewhere. Diabetologia 1994;37(10):1062-1064. PubMed
Chu, N. S. Cardiovascular responses to betel chewing. J Formos.Med Assoc 1993;92(9):835-837.
Pickwell, S. M., Schimelpfening, S., and Palinkas, L. A. 'Betelmania'. Betel quid chewing by Cambodian women in the United States and its potential health effects. West J Med 1994;160(4):326-330.
van Wyk, C. W., Stander, I., Padayachee, A., and Grobler-Rabie, A. F. The areca nut chewing habit and oral squamous cell carcinoma in South African Indians. A retrospective study. S.Afr.Med J 1993;83(6):425-429.
Wu, K. D., Chuang, R. B., Wu, F. L., Hsu, W. A., Jan, I. S., and Tsai, K. S. The milk-alkali syndrome caused by betelnuts in oyster shell paste. J Toxicol Clin Toxicol 1996;34(6):741-745. PubMed
Hung, D. Z. and Deng, J. F. Acute myocardial infarction temporally related to betel nut chewing. Vet.Hum.Toxicol. 1998;40(1):25-28.
Chiang, W. T., Yang, C. C., Deng, J. F., and Bullard, M. Cardiac arrhythmia and betel nut chewing--is there a causal effect? Vet.Hum.Toxicol. 1998;40(5):287-289.
Mannan MA, Mohammad QD, Haqua A, and et al. Role of areca-catechu (betel-nut) in cerebrovascular disease: a double blind clinical trial. Bangladesh J Neuro 1988;4(2):46-51.
Cimolai N and Cimolai T. Severe iron deficiency anemia and gastrointestinal dysfunction associated with ingestion of pan masala. Journal of Dietary Supplements (J DIET SUPPL) 2008;5(3):305-309. PubMed
Akhtar S, Sheikh AA, Qureshi HU. Chewing areca nut, betel quid, oral snuff, cigarette smoking and the risk of oesophageal squamous-cell carcinoma in South Asians: a multicentre case-control study. Eur J Cancer. 2012;48(5):655-61. PubMed
Chiu CS, Tsai YL. Cheilitis granulomatosa associated with allergic contact dermatitis to betel quid. Contact Dermatitis. 2008;58(4):246-7. PubMed
Chen YY, Fang WH, Wang CC, et al. Detrimental association between betel nut chewing and colorectal polyps in adult populations. PLoS One 2018;13(10):e0206383. PubMed
Wang M, Yu SY, Lv ZT, Yao Y. Betel nut chewing and the risk of chronic kidney disease: evidence from a meta-analysis. Int Urol Nephrol 2018;50(6):1097-1104. PubMed
Li DF, Xu ZL, Yao J. A rare cause of esophageal mucosal and submucosal lesions. Rev Esp Enferm Dig 2020;112(2):158. PubMed
Chen SY, Tsai YS, Wu YH, Wang ST, Kang TW, Tseng CA. Betel-Nut Chewing Increases Difficulty in Tracheal Intubation. Asian J Anesthesiol 2020;58(4):138-145.
Yuwanati M, Ramadoss R, Kudo Y, Ramani P, Senthil Murugan M. Prevalence of oral submucous fibrosis among areca nut chewers: A systematic review and meta-analysis. Oral Dis 2022.
Gupta R, Mariano LC, Nethan ST, et al. Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis. Ann Glob Health 2022;88(1):5. PubMed
Wang CP, Chen TC, Hsu WL, et al. Rising incidence of HPV positive oropharyngeal cancer in Taiwan between 1999 and 2014 where betel nut chewing is common. BMC Cancer 2022;22(1):296. PubMed
Huang YC, Geng JH, Wu PY, et al. Betel Nut Chewing Increases the Risk of Metabolic Syndrome and Its Components in a Large Taiwanese Population Follow-Up Study Category: Original Investigation. Nutrients 2022;14(5):1018. PubMed
Chang CK, Lee JI, Chang CF, et al. Betel Nut Chewing Is Associated with the Risk of Kidney Stone Disease. J Pers Med 2022;12(2):126. PubMed
Chou YT, Sun ZJ, Shen WC, et al. Cumulative Betel Quid Chewing and the Risk of Significant Liver Fibrosis in Subjects With and Without Metabolic Syndrome. Front Nutr 2022;9:765206. PubMed
Liu YH, Chen WL. Association between Betel Nut and Presence of Diverticulum in Male: A Cross-Sectional Study. Biomed Res Int 2021;2021:6669792. PubMed
Yang J, Wang ZY, Huang L, et al. Do betel quid and areca nut chewing deteriorate prognosis of oral cancer? A systematic review, meta-analysis, and research agenda. Oral Dis 2021;27(6):1366-1375. PubMed
Huang TC, Wu WT, Chen YC, Yang FM, Tsai WC, Lee CH. Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms. Int J Environ Res Public Health 2020;17(20):7472. PubMed
Hu Y, Zhong R, Li H, Zou Y. Effects of Betel Quid, Smoking and Alcohol on Oral Cancer Risk: A Case-Control Study in Hunan Province, China. Subst Use Misuse 2020;55(9):1501-1508. PubMed
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Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Related: nutrient depletion

Metformin Is Linked to Lower Levels of 4 Nutrients

Natural Medicines records Metformin as a medicine that can lower these. This is not an interaction with Betel Nut — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:

Read the full Metformin nutrient depletion report ›

Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.

Pharmacist Counseling Corner

Taking Betel Nut and Metformin Together: Common Questions

Is it safe to take Betel Nut with Metformin?

We do not list a known interaction between Betel Nut and Metformin. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.

Do Betel Nut and Metformin have any of the same side effects?

Yes — our sources link each of them separately to 8 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.

Are Betel Nut and Metformin used for the same thing?

They overlap in purpose, which usually means the real question is whether you need both rather than whether they are safe together. This page lists the shared uses and how strong the evidence is for Betel Nut in each. That is a conversation for your prescriber, especially if Metformin is being adjusted to a target.

How was the Betel Nut and Metformin combination checked?

Interactions in our licensed database are recorded against drug classes. Metformin is filed under 5 classifications, and Betel Nut has documented interactions with 4 drug classes — none of Metformin's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.

Does Betel Nut interact with any other medications?

Yes. Betel Nut has 229 documented drug interactions in our database — Metformin is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.

Does Metformin interact with any supplements?

Yes. Metformin has documented interactions with 258 supplements in our database — Betel Nut is not one of them. The Metformin interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.