Is Ozempic better than metformin?
Key Points
- Ozempic (semaglutide) and metformin are both used to treat type 2 diabetes, but they have not been directly compared in clinical trials.
- Both medications lower hemoglobin A1C levels by a similar percentage in separate studies.
- The choice between Ozempic and metformin depends on factors such as administration method, side effects, and cost.
- Ozempic is brand-name only, while metformin is available in generic versions, making it more affordable.
How do metformin and Ozempic work?
Ozempic (semaglutide) and metformin both help manage blood sugar levels but work in different ways:
Metformin
Metformin is a biguanide that is taken by mouth up to a few times daily. It works in different ways to manage blood glucose levels:
- Reduces glucose production in the liver
- Improves insulin sensitivity
- Slows down absorption of glucose from the intestines
Ozempic
Ozempic is glucagon-like peptide 1 (GLP-1) receptor agonist that is injected under the skin once a week. It works by:
- Stimulating insulin release to lower blood sugar
- Slowing digestion, increasing fullness and reducing appetite
How Effective Are Metformin and Ozempic?
Though no direct comparison studies exist, separate trials show both medications effectively lower hemoglobin A1C (HbA1c) levels:
- Ozempic lowered HbA1c by 1.4-1.6% over 30 weeks (study of 388 patients).
- Metformin lowered HbA1c by 1.4% over 29 weeks (study of 286 patients).
Individual responses vary based on dose, lifestyle, and concurrent medications.
Metformin vs. Ozempic for Weight Loss
Neither Ozempic nor metformin are FDA-approved for weight loss, but both have been associated with modest weight reduction.
Metformin and Weight Loss
Experts classify metformin as a weight-neutral treatment option for patients with type 2 diabetes. It has the potential to cause a small amount of weight loss in some patients.
- Patients lost 0.6 kg (1.4 lbs) in a 29-week clinical trial.
- Another study showed a 2.9 kg (6.4 lbs) loss over five years.
Ozempic and Weight Loss
Because Ozempic slows down how fast food moves through your digestive tract, it can decrease your appetite and result in lower calorie consumption. This can lead to weight loss in some patients.
In a 30-week study:
- Ozempic 0.5 mg users lost 3.8 kg (8.3 lbs).
- Ozempic 1 mg users lost 4.7 kg (10.3 lbs).
- Placebo users lost 1.2 kg (2.6 lbs).
Related questions
- Mounjaro vs Ozempic: Which is right for you?
- Ozempic Side Effects to Watch For
- What are the long-term side effects of Ozempic?
Can You Take Metformin and Ozempic Together?
Yes. Studies show no interaction between the two medications. Since they work differently, they are often prescribed together for better blood sugar control.
During clinical studies submitted to the FDA for approval, some patients with type 2 diabetes took both Ozempic and metformin. If your blood sugar is not well controlled with one medication alone, your healthcare provider may recommend adding on another medication.
Side Effects of Metformin and Ozempic
Both medications commonly cause gastrointestinal side effects. Additionally, metformin can raise the risk for lactic acidosis. Some patients have reported pancreatitis while taking Ozempic.
Common Side Effects of Metformin (>5%)
- Diarrhea
- Nausea/vomiting
- Excessive gas
- Feeling weak
- Indigestion
- Stomach discomfort
- Headache
Common Side Effects of Ozempic (≥5%)
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Constipation
Serious Risks
- Metformin: Risk of lactic acidosis (rare but serious condition).
- Ozempic: Reports of pancreatitis and ileus in some users.
Key Takeaways
Ozempic and metformin are both effective for type 2 diabetes, but they work differently. Metformin is usually the first-line treatment due to its long-standing safety profile and affordability, while Ozempic may be considered when additional blood sugar or weight management is needed.
This is not all the information you need to know about metformin and Ozempic for safe and effective use and does not take the place of talking to your doctor about your treatment. Review the full product information here, and discuss this information and any questions you have with your doctor or other health care provider.
References
Hausner, H., et. al. (2017). Effect of Semaglutide on the Pharmacokinetics of Metformin, Warfarin, Atorvastatin and Digoxin in Healthy Subjects. In: Clinical Pharmacokinetics. DOI: https://doi.org/10.1007%2Fs40262-017-0532-6
Kahn, S. E., et. al. (2006). Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy. In: The New England Journal of Medicine. DOI: https://doi.org/10.1056/nejmoa066224
Metformin [package insert]. (Updated 01/2023). ScieGen Pharmaceuticals Inc. Accessed 07/04/2024 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4e4c4ba9-65c6-4273-8f6b-2423ab521dad
Ozempic [package insert]. (Updated 09/2023). Novo Nordisk. Accessed 07/04/2024 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79
Van Gaal, L., et. al. (2015). Weight Management in Type 2 Diabetes: Current and Emerging Approaches to Treatment. In: Diabetes Care. DOI: https://doi.org/10.2337/dc14-1630
Read next
How do Ozempic, Mounjaro, Wegovy, Zepbound compare for weight loss?
Ozempic, Mounjaro, Wegovy and Zepbound can all lead to long-term weight loss, but only Wegovy and Zepbound are approved by the FDA for this use. In studies, Zepbound has led to a 21% weight loss in adults using the highest dose, while Wegovy has led to about a 15% weight loss. Continue reading
How long does it take for Ozempic to work?
Your blood glucose (sugar) levels should start to fully decline within the first week after you start using Ozempic (semaglutide) at your regular dose. However, the full effect can take 8 weeks or longer, as this is a long-acting medication that is injected only once per week. Continue reading
Wegovy vs Ozempic: Which is Right for You?
Both Wegovy and Ozempic contain semaglutide, but Wegovy is prescribed for long-term weight management while Ozempic is used to control blood sugar levels in type 2 diabetes and help protect kidney function. They both lower the risk for heart-related complications, but they differ in other approved uses, doses, target populations and costs. Continue reading
See also:
Aimovig
Learn about Aimovig (erenumab-aooe) a once-monthly, injectable medication that can be ...
Botox
Botox is used for cosmetic purposes and to treat overactive bladder symptoms, urinary incontinence ...
Ozempic
Learn about Ozempic (semaglutide) for type 2 diabetes treatment, weight management, cardiovascular ...
Nurtec ODT
Nurtec ODT (rimegepant) is used to treat acute migraines and prevent episodic migraines, by ...
Vyepti
Vyepti (eptinezumab-jjmr) is used for the preventive treatment of migraine. Includes Vyepti ...
Depakote
Depakote is used to treat various types of seizure disorders. Learn about side effects ...
Topamax
Topamax (topiramate) is used to prevent seizures in adults and children and to prevent migraine ...
Emgality
Emgality (galcanezumab-gnlm) is a CGRP antagonist for the preventive treatment of migraine and for ...
Inderal
Inderal (propranolol) is used to treat angina, high blood pressure and heart rhythm disorders ...
Related medical questions
- How many doses are in an Ozempic pen?
- Do Ozempic, Wegovy, Mounjaro & Zepbound cause hair loss?
- How does Ozempic work for weight loss?
- What happens when you stop taking Ozempic?
- Can you switch between Ozempic and Mounjaro?
- Does Ozempic need to be refrigerated?
- Saxenda vs Ozempic: For Weight Loss?
- Will my insurance cover the cost of Ozempic?
- Can you buy Ozempic over the counter?
- When is the best time of day to take Ozempic?
- Why am I not losing weight on Ozempic?
- Does Ozempic cause muscle loss and how to prevent it?
- Where and how should Ozempic be injected?
- Rybelsus vs Ozempic for weight loss: Which to choose?
- Are there natural alternatives to Ozempic for weight loss?
- Ozempic Face: What causes it and how to prevent it?
- How long does Ozempic last in your system?
- How long can you stay on Ozempic?
- How does Ozempic affect blood pressure?
- Do GLP-1 drugs like Ozempic and Mounjaro cause sulfur burps?
- Trulicity vs Ozempic: Which is right for you?
- Taking Ozempic: What foods should you avoid?
- Do GLP-1 drugs like Ozempic or Wegovy affect bone density?
- How long does metformin take to work?
- When is the best time to take metformin?
- What is the safest diabetes medication?
- Why does metformin cause diarrhea?
- Can you take metformin without food?
- What is A1C? Normal vs dangerous levels, and how to lower It
- Does metformin lower A1C, if so how much?
Drug information
Related support groups
- Ozempic (107 questions, 223 members)
- Metformin (199 questions, 728 members)
- Diabetes, Type 2 (502 questions, 1,428 members)