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Drug Info

Can you take Mounjaro and metformin together?

Understand how Mounjaro and metformin can work together to manage Type 2 diabetes, alongside important information on side effects and drug interactions.
Taneia Surles, MPH
By | Oct. 3, 2024 Medically reviewed by J. Elizabeth Allen, DO, FACEP
Rx pill bottles comparing taking Mounjaro and metformin together

Key takeaways

  • Mounjaro (tirzepatide) and metformin are prescription drugs used to manage Type 2 diabetes, but many healthcare providers prescribe them “off-label” to treat obesity, gestational diabetes, PCOS, and other medical conditions.

  • It is safe to take the injectable medication Mounjaro and the oral drug metformin under a healthcare provider’s supervision, as they can improve blood glucose control and metabolic profiles.

  • Both Mounjaro and metformin have their individual drug interactions with a variety of medications, which is why it is important to share any medications you’re currently taking with your healthcare provider.

In this article:

Mounjaro (tirzepatide) is an injectable prescription medicine used to improve blood sugar levels in adults with Type 2 diabetes mellitus, and metformin is an oral prescription drug that treats high blood sugar levels. According to medical experts, Mounjaro and metformin are safe to take together under a healthcare provider’s supervision. However, it is still important to understand the efficacy and potential interactions that may occur when mixing these medications. 

Can you take Mounjaro and metformin (Glucophage) together?

Mounjaro is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for Type 2 diabetes mellitus and weight loss. “It promotes the release of insulin, improves insulin sensitivity, and suppresses appetite,” says Michael O. McKinney, MD, a family medicine specialist at Healthy Outlook based in Jacksonville, Florida.

Metformin is another prescription medicine FDA approved for managing Type 2 diabetes but is also used off-label for addressing weight gain caused by antipsychotic medications, managing gestational diabetes, preventing Type 2 diabetes, treating polycystic ovary syndrome (PCOS) and preventing ovarian hyperstimulation syndrome in patients with PCOS undergoing assisted reproductive treatments like in vitro fertilization.

According to Dr. McKinney, it’s safe to take Mounjaro and metformin together. “Mounjaro and metformin can be safely co-administered,” he says. If taken together, these medications can help improve glucose control better than if either medication is taken alone. ”Unlike metformin, Mounjaro tackles glucose control from various angles, making for a better approach to managing Type 2 diabetes.”

Benefits of taking both Mounjaro and metformin at the same time 

Taking both of these diabetes drugs rather than just one can provide better Type 2 diabetes management. The advantages of using Mounjaro along with metformin are better blood glucose control and general metabolic profiles such as cholesterol and triglyceride levels “Research is also supporting that such a combination provides more effective regulation of blood sugar levels than the use of one of the drugs only. Dr. McKinney says.

In addition to the benefits these two medications provide together, they also have their own unique qualities that help to improve overall health. In addition to blood sugar control, metformin has been shown to decrease heart-related complications in certain groups and can be used in some patients with PCOS who cannot be managed with oral contraceptives. ” says Akhil Shenoy, MD, an endocrinologist at Aeroflow Diabetes in Arden, North Carolina. “Tirzepatide (brand name Mounjaro) can lead to significant weight loss, which may have major benefits for fatty liver disease, PCOS, heart disease, and other conditions related to excess weight.”

Mounjaro and metformin risks and interactions

Like any medication, there are a few risks to be aware of when it comes to side effects, interactions, and contraindications.

According to Dr. McKinney, there’s a possibility that taking Mounjaro and metformin together could cause side effects like stomach upset, diarrhea and an increased risk of hypoglycemia or low blood sugar. 

Individually, these prescription medications have their own side effects of which to take note. 

The most common side effects of Mounjaro include the following:

  • Gastrointestinal (stomach) issues (nausea, reflux, diarrhea, constipation)
  • Increased heart rate
  • Hair loss
  • Fatigue
  • Injection site reactions

More serious side effects of this injectable medicine are:

  • Gastroparesis (severely delayed stomach emptying)
  • Bowel obstruction
  • Possible risk of thyroid cancer in certain patients 
  • Pancreatitis 
  • Hypoglycemia
  • Serious allergic reactions
  • Kidney problems, such as acute kidney injury
  • Changes in vision in diabetic patients with diabetic retinopathy

If you experience any of these side effects, please reach out to your healthcare provider immediately or seek emergency medical care.

Potential side effects of metformin include:

  • Gastrointestinal issues (diarrhea, flatulence, reflux)
  • A metallic taste in your mouth
  • Weight loss
  • Vitamin B12 deficiency

A possible severe side effect of this medication that some people experience is lactic acidosis, which can require immediate medical attention. Symptoms of lactic acidosis include nausea, vomiting, and weakness.

If you have any questions or concerns about taking these diabetes drugs, please consult your healthcare provider for professional medical information.

Aside from potential side effects, Dr. McKinney says that various factors, such as age, kidney function, and any existing health complications, could affect how these medicines work in your body. “These factors must be controlled and followed regularly to modify the treatment plan,” he says.

Contraindications, or situations in which taking a certain medicine may be unsafe for your health, should also be considered before taking Mounjaro, metformin, or a combination of the two.

Mounjaro should be avoided if you have a family history of medullary thyroid cancer (MTC) or have multiple endocrine neoplasia syndrome type 2 (MEN 2). Mounjaro also should not be taken if you have a history of pancreatitis, are pregnant, breastfeeding or planning to become pregnant. Metformin contraindications include type 1 diabetes, kidney dysfunction, congestive heart failure that requires drug treatment, hypersensitivity to metformin, acute or chronic metabolic acidosis, and impaired liver function.

How long after taking Mounjaro can you take metformin? 

According to Dr. Shenoy, the dosing schedule doesn’t need to be changed if you’re taking both Mounjaro and metformin. “Mounjaro is started at a low dose and increased gradually to a maximum tolerated dose,” he explains. “Metformin can be started at any dose. I start at a low or medium dose and increase the dose to the maximum tolerated.”

Dr. McKinney says the dosing schedule can be adjusted based on the person’s response to the treatment. “The dosing schedules can be easily coordinated in a way that will maximize the positive effects and reduce the side effects,” she says. 

What medications should you not take with Mounjaro or metformin? 

While Mounjaro and metformin work well together with few side effects, there are certain medications that should be avoided to prevent unwanted drug interactions.

“Mounjaro should not be taken with other medicines in the same or similar drug class, such as semaglutide,” Dr. Shenoy says. 

Other Mounjaro drug interactions include:

  • Hypoglycemic agents – Mounjaro can increase the chances of low blood glucose. 
  • Oral contraceptives (birth control pills) – Mounjaro may decrease the effectiveness of oral contraceptives. 
  • Warfarin (Coumadin) – Mounjaro may increase the blood thinning effects of warfarin.

Metformin should not be taken with many drugs including but not limited to:

  • Intravenous (IV) iodine-based dye (used in CT scans)
  • OCT inhibitors 
  • Angiotensin-converting enzyme inhibitors
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Beta blockers
  • Carbonic anhydrase inhibitors
  • Lamictal
  • Antibiotics
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Warfarin 

Be sure to notify your healthcare provider of any drugs you’re currently taking so they can determine if there are any potential drug interactions while taking Mounjaro and metformin simultaneously.

“Mounjaro and metformin have been found useful in the treatment of Type 2 diabetes,” Dr. McKinney says. “Nevertheless, patient characteristics and potential medication interactions should always be taken into consideration. For the best results, patients should be monitored closely and medication can be tailored to their individual needs.

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