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Metformin / repaglinide Side Effects

In Summary

Commonly reported side effects of metformin/repaglinide include: lactic acidosis, diarrhea, hypoglycemia, and nausea. Other side effects include: decreased vitamin b12 serum concentrate. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to metformin / repaglinide: oral tablet

In addition to its needed effects, some unwanted effects may be caused by metformin / repaglinide. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking metformin / repaglinide:

More common:
  • Anxiety
  • blurred vision
  • body aches or pain
  • chills
  • cold sweats
  • coma
  • confusion
  • cool, pale skin
  • cough
  • depression
  • difficulty in breathing
  • dizziness
  • ear congestion
  • fast heartbeat
  • fever
  • headache
  • increased hunger
  • loss of voice
  • nasal congestion
  • nausea
  • nervousness
  • nightmares
  • runny nose
  • seizures
  • shakiness
  • slurred speech
  • sneezing
  • sore throat
  • unusual tiredness or weakness

Minor Side Effects

Some of the side effects that can occur with metformin / repaglinide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Diarrhea
  • vomiting

For Healthcare Professionals

Applies to metformin / repaglinide: oral tablet


Very common (10% or more): Gastrointestinal system disorder (33%), diarrhea (19%), nausea (15%)

Very common (10% or more): Gastrointestinal system disorder (36%)
Common (1% to 10%): Diarrhea, nausea
Postmarketing reports: Pancreatitis

Very common (10% or more): Gastrointestinal system disorder (48%), diarrhea (30%)
Common (1% to 10%): Nausea[Ref]


Postmarketing reports: Severe hepatic dysfunction including jaundice and hepatitis[Ref]

Nervous system

Frequency not reported: Headache[Ref]


Very common (10% or more): Upper respiratory tract infection (11%)

Very common (10% or more): Upper respiratory tract infection (11%)

Common (1% to 10%): Upper respiratory tract infection (11%)[Ref]


Postmarketing reports: Hemolytic anemia[Ref]


Postmarketing reports: Stevens-Johnson syndrome, alopecia[Ref]


Cardiovascular events were evaluated in trials comparing repaglinide to sulfonylureas. Serious cardiovascular events including ischemia with this drug were higher at 4% (51/1228) than for sulfonylurea drugs (3%; 13/498). No excess mortality was associated with this increase. Selected cardiovascular events including hypertension, abnormal EKG, MI, arrhythmias, and palpitations were observed at 1% or less and no more frequently with this drug than with comparator drugs.

Across 7 repaglinide clinical trials, 6 serious events of myocardial ischemia occurred in combination use with NPH-insulin compared with 1 event in patients using insulin alone. Repaglinide should not be used in combination with NPH insulin.

Common (1% to 10%): myocardial ischemia, angina, chest pain
Frequency not reported: Hypertension, abnormal EKG, MI, arrhythmias, palpitations


The most frequently reported adverse reactions included hypoglycemia and headache.


Very common (10% or more): Symptomatic hypoglycemia (33%)

Very common (10% or more): Symptomatic hypoglycemia (11%)

Common (1% to 10%): Subnormal vitamin B12 levels
Rare (less than 0.1%): Lactic acidosis


1. "Product Information. PrandiMet (metformin-repaglinide)." Novo Nordisk Pharmaceuticals Inc, Princeton, NJ.

Not all side effects for metformin / repaglinide may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.