Drug & supplement interaction

Fasting + Metformin Hydrochloride

Metformin Hydrochloride brand name: Riomet ER.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Fasting has a moderate interaction with Metformin Hydrochloride. Fasting might increase the risk of hypoglycemia if used with antidiabetes drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Fasting and Metformin Hydrochloride

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ANTIDIABETES DRUGS

Why this applies to Metformin Hydrochloride

Metformin Hydrochloride falls under ANTIDIABETES DRUGS — the group Fasting interacts with.

Fasting might increase the risk of hypoglycemia if used with antidiabetes drugs.
Hypoglycemic events have been reported during intermittent fasting, including in patients using antidiabetes drugs. The risk of having a hypoglycemic event is largest for patients taking insulin or sulfonylureas. The risk of hypoglycemic events seems to be lower for patients taking other antidiabetes drugs such as glucagon-like peptide-1 receptor agonist (GLP- 1RA), metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors (DPP4 inhibitors), and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Advise patients to monitor glucose levels closely. Dose or time adjustments may be necessary.
Severity Moderate Likelihood Possible Evidence B

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: when you go without food for a stretch, your blood sugar can dip on its own. Pair that with metformin, and there's a chance your sugar drops lower than you'd like. That said, metformin is one of the gentler diabetes medicines on this front. It mostly lowers how much sugar your liver releases and doesn't push your body to pump out extra insulin, so on its own it rarely causes a true low. The combined risk here is real but modest.

Still, watch for shakiness, sweating, dizziness, or feeling foggy or weak, which can signal a low. The evidence is moderate, not rock-solid, so don't panic. Before starting any fasting routine, check in with your doctor or pharmacist, keep glucose tabs handy, and monitor your readings closely.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Carter S, Clifton PM, Keogh JB. Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with Type 2 diabetes: A randomized noninferiority trial. JAMA Netw Open. 2018;1(3):e180756. PubMed
  2. Cioffi I, Evangelista A, Ponzo V, et al. Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials. J Transl Med. 2018;16(1):371. PubMed
  3. Chowdhury A, Khan H, Lasker SS, Chowdhury TA. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: The East London diabetes in Ramadan survey. Diabetes Res Clin Pract. 2019;152:166-170. PubMed
  4. Grajower MM, Horne BD. Clinical management of intermittent fasting in patients with diabetes mellitus. Nutrients. 2019;11(4):873. PubMed
  5. Ibrahim M, Davies MJ, Ahmad E, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care. 2020;8(1):e001248. PubMed
  6. Wang X, Li Q, Liu Y, Jiang H, Chen W. Intermittent fasting versus continuous energy-restricted diet for patients with type 2 diabetes mellitus and metabolic syndrome for glycemic control: A systematic review and meta-analysis of randomized controlled tria

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Fasting Also Interacts With Other Medications

Fasting has 2 major, 205 moderate known drug interactions in our database — the Metformin Hydrochloride one above is one of them. If you take anything else, check it against the full list below.

Major 2 Moderate 205 No known interaction 2,623 (incl. Metformin Hydrochloride)
Taking anything else?

Check Another of Your Medications Against Fasting

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

Everything else you take

See Every Supplement That Interacts With Metformin Hydrochloride

This page covers Fasting only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Metformin Hydrochloride page lists 257 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 · 38 minor.

From our pharmacist’s overview on the Metformin Hydrochloride page

“Anyone taking metformin hydrochloride (Riomet ER) should treat this list with genuine care, because two of its 257 entries are rated major. Siberian cocklebur has caused severe hypoglycemia in people and should not be combined with metformin at all, and activated charcoal can adsorb the drug in the gut so less reaches your blood.”

Reviewed by 2 · Jul 18, 2026

Open the Metformin Hydrochloride interaction page

How much people look this up

Where Fasting and Metformin Hydrochloride 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 Fasting
Top half

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

29 days ago today
Medication Metformin Hydrochloride
Top half

#1,107 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.

Eating pattern

About Fasting

What is Fasting?

  • Weight loss
  • Blood sugar control
  • Heart health
  • Religious or spiritual practice
  • General wellness and longevity

Fasting means voluntarily going without food (and sometimes drink) for set periods. Some research suggests it may help with weight loss and blood sugar in certain people, but results vary and quality of evidence is mixed. It is not safe for everyone, so check with your doctor or pharmacist before starting—especially if you take medication or have a health condition.

Read the full Fasting monograph & all interactions
Keep checking

Other Drugs & Fasting

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

2Major
205Moderate
0Minor
2,622No known interaction
2 Major 205 Moderate 2,622 No interaction
Major

2 interactions

Moderate

205 interactions

Showing 60 of 205 moderate interactions — see all 205 on the Fasting page.

No interaction 2,622 drugs checked — show the list

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

Showing the 60 most looked-up of 2,622 medications checked with no known interaction — see the full Fasting list.

See the full Fasting interactions page
See every supplement checked against Metformin Hydrochloride, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Fasting monograph › Uses, safety, and every drug interaction in one place Metformin Hydrochloride supplement interactions › Every supplement checked against Metformin Hydrochloride, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Following Fasting While Taking Metformin Hydrochloride: Common Questions

Can you follow Fasting while taking Metformin Hydrochloride?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Fasting and Metformin Hydrochloride interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

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

Still Have a Question About Metformin Hydrochloride and Fasting?

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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.