Ozempic vs. metformin: Differences, similarities, and which one is better for you

In this article:

• Frequently asked questions about Ozempic vs. metformin
• What are the main differences between Ozempic and metformin?
• Conditions treated by Ozempic and metformin
• Is Ozempic or metformin more effective?
• Coverage and cost comparison of Ozempic vs. metformin
• Common side effects of Ozempic vs. metformin
• Drug interactions of Ozempic vs. metformin
• Warnings of Ozempic and metformin

In this article

• Frequently asked questions about Ozempic vs. metformin
• What are the main differences between Ozempic and metformin?
• Conditions treated by Ozempic and metformin
• Is Ozempic or metformin more effective?
• Coverage and cost comparison of Ozempic vs. metformin
• Common side effects of Ozempic vs. metformin
• Drug interactions of Ozempic vs. metformin
• Warnings of Ozempic and metformin

People who live with diabetes have several options available when it comes to treatment. Ozempic and metformin are two examples of medications prescribed to help manage high blood sugar levels. By improving blood sugar levels, these medications may help reduce the risk of complications, such as diabetic retinopathy, kidney disease, and heart disease.

In addition, Ozempic and metformin may benefit people with Type 2 diabetes who are obese or overweight. Ozempic and metformin have been shown to promote weight loss as a side effect. However, the Food and Drug Administration (FDA) does not approve these medications solely for weight management.

Continue reading to learn more about Ozempic, metformin, and the similarities and differences between the two. 

	Ozempic	Metformin
Drug class	GLP-1 agonist	Biguanide
Brand/generic status	Brand only	Brand and generic versions available
What is the generic or brand name?	Brand name: Ozempic Generic name: Semaglutide	Brand name: Glucophage, Riomet, Fortamet Generic name: Metformin
What form(s) does the drug come in?	Subcutaneous injection	Oral tablet Extended-release tablet Liquid oral solution
What is the standard dosage?	0.25 injected under the skin once weekly for 4 weeks. Then, the dosage is increased to 0.5 mg once weekly.  The dosage may be increased to 1 mg once weekly after 4 weeks on the 0.5 mg dosage and then increased again to 2 mg once daily after 4 weeks on the 1 mg dosage, depending on the treatment response.	Immediate-release: 500 mg twice daily or 850 mg once daily with meals Extended-release: 500 to 2000 mg once daily with an evening meal Dosage may be increased as needed and tolerated.
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Adults 18 years and older	Adults and children 10 years and older

Frequently asked questions about Ozempic vs. metformin

Are Ozempic and metformin the same?

Ozempic and metformin are used to treat Type 2 diabetes, but they are not the same. They work differently and have different formulations. Ozempic is a brand-name drug that contains semaglutide, while metformin is a generic drug. Ozempic is a GLP-1 receptor agonist, while metformin is a biguanide. 

Can I take metformin and Ozempic together?

Yes, you can take metformin and Ozempic together with a doctor’s guidance. They work differently to control blood sugar levels in Type 2 diabetes—metformin reduces sugar production in the liver, and Ozempic helps release insulin and slows stomach emptying. A healthcare provider may prescribe both if blood sugar is not adequately controlled on one. 

Is Ozempic or metformin better?

Ozempic may be more appropriate for someone with Type 2 diabetes and heart disease because it can reduce the risk of cardiovascular problems. However, metformin is a common first-line diabetes medication. A healthcare provider will determine the best option based on a person’s overall health. In some cases, Ozempic and metformin may be used together. 

Can Ozempic or metformin be used for weight loss?

Ozempic may be prescribed for weight loss, as it helps reduce appetite and promotes feelings of fullness. Metformin is not specifically approved for weight loss, but it may be prescribed off-label for this purpose in some cases, particularly for people with insulin resistance. Doctors may recommend these medications off-label for weight management if lifestyle changes alone are not enough.

Can I use Ozempic or metformin while pregnant?

Ozempic should not be used during pregnancy due to an increased risk of harmful effects on unborn babies. Metformin appears to have a low risk of causing birth defects and is considered safer than Ozempic for use during pregnancy. However, it is important to consult a healthcare provider for medical advice while pregnant or breastfeeding. 

Can I use Ozempic or metformin with alcohol?

It is not typically recommended to drink alcohol while taking Ozempic, metformin, or other diabetes medications. Drinking alcohol with diabetes treatment could increase the risk of hypoglycemia or low blood sugar levels. Heavy alcohol use is also a risk factor for lactic acidosis with metformin. Consult a healthcare provider before drinking alcohol with any medications. 

What are the main differences between Ozempic and metformin?

In people with diabetes, the main goal is to manage glucose levels in the bloodstream. Although Ozempic and metformin are approved to help lower blood sugar levels in people with Type 2 diabetes, they work in different ways, have different formulations, and cause different side effects. 

Mechanism of action

Ozempic is a brand-name medication that contains the active ingredient semaglutide. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. It works by mimicking the action of a hormone called GLP-1, which stimulates the pancreas to produce insulin and reduces glucagon production. 

Metformin belongs to the biguanide drug class. It is a generic medication that decreases the amount of glucose the liver produces and improves glucose absorption into the body’s cells. 

Dosage forms

Ozempic is a brand-name drug given as a weekly injection, with or without meals. It is injected under the skin of the thigh, stomach area, or upper arm. There are currently no generic versions of Ozempic available. 

On the other hand, metformin is a generic oral tablet, extended-release tablet, or liquid that is usually taken one to three times daily with meals. It is available as a generic and brand-name drug. The brand names of metformin include Glucophage and Riomet. 

Conditions treated by Ozempic and metformin

Both Ozempic and metformin are FDA-approved for the treatment of Type 2 diabetes mellitus when used along with a diet and exercise plan. However, Ozempic is only approved for adults, while metformin is approved for adults and children 10 years or older with Type 2 diabetes. Ozempic is also approved to reduce the risk of major cardiovascular events, such as heart attack and stroke, in adults with Type 2 diabetes and heart disease. 

Both Ozempic and metformin may be recommended off-label for weight loss. For example, these medications may be prescribed for people with obesity or those who are overweight with weight-related problems, such as high blood pressure or high cholesterol. Metformin is sometimes prescribed to manage weight gain caused by certain medications, such as antipsychotics. 

These medications are not approved to treat Type 1 diabetes.

Condition	Ozempic	Metformin
Type 2 diabetes	Yes	Yes
Lower the risk of major cardiovascular events, such as heart attack, stroke, and death	Yes	No
Weight loss	Off-label	Off-label

Is Ozempic or metformin more effective?

Ozempic and metformin are effective treatment options for managing blood sugar levels. They generally lower A1c levels by 1% to 2%. Metformin is typically a first-line treatment option along with lifestyle changes. Semaglutide, the active ingredient in Ozempic, is one of the most potent GLP-1 receptor agonists and may be a first-line option, especially in people with heart disease or obesity.

Ozempic can be used alone or in combination with other diabetes medications, such as metformin or sulfonylureas. Therefore, a prescribing doctor may recommend a combination of Ozempic and metformin if blood sugar levels are not controlled with either medication alone. 

Clinical trials show that Ozempic and metformin can be effective for weight loss. One study found that semaglutide reduced body weight by around 15% after over a year. In contrast, metformin reduces body weight by an average of 5% after six months. These medications need to be used in combination with a healthy diet and exercise plan for the best results. 

Other diabetes medications, such as Rybelsus (semaglutide oral), Trulicity (dulaglutide), and Victoza (liraglutide), are available to treat Type 2 diabetes. The best treatment option will depend on your overall medical condition and other medications you may be taking. 

Coverage and cost comparison of Ozempic vs. metformin

Ozempic and metformin are prescription drugs that Medicare and insurance plans usually cover. Without insurance, the price may vary depending on the pharmacy location and the quantity prescribed. A SingleCare coupon may help reduce the cost of Ozempic and metformin. Sometimes, the cost with a SingleCare coupon may be lower than the price with insurance. 

	Ozempic	Metformin
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	1 prefilled injection pen	60, 500 mg tablets
Typical Medicare copay	$45-$335	$0
SingleCare cost	$750	$3

Common side effects of Ozempic vs. metformin

Ozempic and metformin share similar side effects. The most common side effects of Ozempic include gastrointestinal side effects, such as nausea, vomiting, diarrhea, an upset stomach, and constipation. The most common side effects of metformin include headache, weakness (asthenia), nausea, vomiting, diarrhea, and an upset stomach.

Serious side effects of Ozempic and metformin can vary. However, using either medication may increase the risk of hypoglycemia. Symptoms of hypoglycemia include shaking, sweating, dizziness, and confusion. 

	Ozempic		Metformin
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Nausea	Yes	16%	Yes	26%
Vomiting	Yes	5%	Yes	26%
Diarrhea	Yes	9%	Yes	53%
Abdominal pain	Yes	7%	Yes	6%
Constipation	Yes	5%	No	–
Weakness	No	–	Yes	9%
Indigestion	Yes	4%	Yes	7%
Headache	No	–	Yes	6%

This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Ozempic), DailyMed (Metformin)

Drug interactions of Ozempic vs. metformin

Ozempic and metformin can interact with other medications, leading to potentially serious side effects. Taking Ozempic or metformin with insulin or insulin secretagogues like sulfonylureas may increase the risk of hypoglycemia.

Certain medications, such as corticosteroids, oral contraceptives, diuretics, and calcium channel blockers, can affect the body’s ability to manage blood sugar levels. The use of Ozempic or metformin should be monitored while taking other medications that can affect blood sugar control. 

Metformin can interact with carbonic anhydrase inhibitors, leading to an increased risk of lactic acidosis. Lactic acidosis is a buildup of lactic acid in the bloodstream that can disrupt the body’s acid-base balance. This rare condition can be serious and cause symptoms such as weakness, muscle pain, dizziness, shortness of breath, and diarrhea. 

Ozempic delays gastric emptying, which may affect the absorption of oral medications. However, clinical trials have not shown that Ozempic affects the absorption of other medications in a clinically significant way. 

Drug	Drug Class	Ozempic	Metformin
Topamax (topiramate) Diamox (acetazolamide) Zonegran (zonisamide)	Carbonic anhydrase inhibitor	Yes	Yes
NovoLog (insulin aspart) Humalog (insulin lispro) Lantus (insulin glargine)	Insulin	Yes	Yes
Glucotrol (glipizide) Amaryl (glimepiride)	Sulfonylurea	Yes	Yes
Microzide (hydrochlorothiazide) Lozol (indapamide) Thalitone (chlorthalidone)	Diuretic	Yes	Yes
Orapred (prednisolone) Deltasone (prednisone) Decadron (dexamethasone)	Corticosteroid	Yes	Yes
Estrostep (ethinyl estradiol) Micronor (norethindrone) Prometrium (progesterone)	Estrogens and oral contraceptives	Yes	Yes
Norvasc (amlodipine) Calan (verapamil) Procardia (nifedipine) Cardizem (diltiazem)	Calcium channel blocker	Yes	Yes

Consult a healthcare professional for other possible drug interactions

Warnings of Ozempic and metformin

Animal studies have shown that Ozempic may increase the risk of thyroid cancer. People with a personal or family history of thyroid tumors or multiple endocrine neoplasia syndrome type 2 (MEN 2) should avoid Ozempic. The use of Ozempic is linked to other warnings, including: 

• Increased risk of pancreatitis
• Vision problems from diabetic retinopathy
• Acute kidney injury
• Gallbladder problems
• Hypoglycemia

Cases of lactic acidosis have been reported in people using metformin, which may be a potentially life-threatening condition. Risk factors include kidney problems, liver impairment, age over 65, heart failure, and heavy alcohol use. Other metformin warnings include:

• Vitamin B12 deficiency
• Hypoglycemia

Allergic reactions are possible while taking these medications. Signs and symptoms of an allergic reaction include hives, rash, swelling of the face or throat, and trouble breathing. Seek immediate medical attention if you experience an allergic reaction.