Metformin and Ozempic are popular prescription medicines that are used to help people manage their diabetes.

Many people may be prescribed metformin or Ozempic alone, but sometimes a doctor may prescribe both drugs at once as a kind of combination therapy.

Because these drugs work in different ways and their use together is relatively new, you may have questions about how they interact, what the side effects may be, and how well they work together.

This article will explore what you need to know about taking metformin and Ozempic together.

Key Points:

  • Metformin and Ozempic can be prescribed together as part of a combination therapy to manage diabetes. Because each drug works differently, using them in tandem can improve blood sugar control.
  • Both drugs, while having distinct mechanisms, can contribute to weight loss and improved cardiovascular health.
  • Clinical trials indicate that taking metformin and Ozempic together is generally safe. However, potential side effects, especially gastrointestinal issues, may be more pronounced when these drugs are used in combination.

Table of Contents

How do metformin and Ozempic differ?

To help understand why you might be prescribed one drug, the other, or both at once, it’s important to know a little bit about each medication and how they differ.

Ozempic and metformin are different in several ways. To start with, metformin is a daily (or twice-daily) oral medication that usually comes in pill form, while Ozempic is a once-weekly injectable drug.

The two drugs have different active ingredients and act on the body in different ways, too.

Metformin

Metformin is among the most prescribed medicines in the world. Metformin’s most common use is as a first-line treatment for type 2 diabetes. 

Metformin reduces the amount of glucose released by the liver, decreases the amount of glucose absorbed in the intestines, and increases insulin sensitivity, allowing individual cells in the body to consume more sugar and use that sugar more efficiently.

It has also been demonstrated to have a wide range of other health benefits. Increasingly, metformin is being prescribed for people with:

Metformin has also been shown to help people lose weight in some circumstances. 

Ozempic 

Ozempic is the brand name for the most common drug that uses the active ingredient semaglutide, which is predominately used to help manage diabetes. Ozempic is made by the pharmaceutical company Novo Nordisk.

Other drug companies also make medications with the same active ingredient as Ozempic (these include the brand names Rybelsus and Wegovy).

Ozempic is a glucagon-like peptide-1, or GLP-1, agonist. It mimics hormones in the body that help to regulate blood sugar levels.

Ozempic increases the body’s natural insulin production, decreases the liver’s production of glucose, slows the emptying of food out of the stomach into the small intestines, and reduces appetite, which tends to lead to weight loss. 

While Ozempic is a relatively new drug, having been FDA-approved in 2017, metformin has been on the market in the United States since 1994. Both drugs have seen significant increases in their use since their introduction.

Why would I be prescribed metformin and Ozempic?

The primary reason these drugs are prescribed is to help manage blood sugar levels.

Metformin and Ozempic help most people lower their average blood sugar levels as measured by an HbA1c (A1C) blood test (a measure of glucose control over the previous 2 to 3 months). The effects are quite significant. 

Clinical trials have established that, at its maximum dose, metformin can help decrease A1C levels by 1.5%, while an average dose of Ozempic can decrease A1C by 1.4%.

If you’re currently on metformin and it’s not providing its full benefits anymore, your healthcare provider might consider prescribing Ozempic. This could be to assess how well it works as a sole treatment instead of metformin, or to use alongside your existing metformin regimen as a supplementary therapy.

There are other reasons you may be prescribed metformin or Ozempic. However, these uses tend to be off-label (not approved by the U.S. Food and Drug Administration [FDA]).

Both metformin and Ozempic have been shown to help with weight loss in addition to their primary function of lowering average blood sugar levels. While neither drug is FDA-approved for weight loss, it can be a helpful effect, especially for people who have type 2 diabetes and difficulty maintaining a healthy weight.

Both drugs are also established to decrease the risk of major cardiovascular events, such as heart attacks.

While many of these off-label effects may be helpful, metformin and Ozempic are generally not prescribed solely for these reasons.

Can you safely take metformin and Ozempic together?

In most cases, the answer is yes. Clinical trials have established that it is generally safe to take metformin and Ozempic together. 

Not only is it generally safe, but it is actually becoming common to prescribe these drugs together as a combination therapy, since they complement one another in helping manage blood sugar levels.

The medicines also can help with cardiovascular health and weight loss in ways that may reinforce one another.

Taking metformin and Ozempic together can be an effective way to manage blood sugar levels, especially for people with type 2 diabetes.

What side effects are there to taking both metformin and Ozempic?

While both of these medications can be effective at controlling blood glucose levels, they can also have side effects, and taking them together may increase the risk of certain adverse and unwanted effects.

Both metformin and Ozempic can cause gastrointestinal symptoms such as nausea, vomiting, and diarrhea.

Taking these two drugs together can increase the likelihood and severity of the side effects you may experience.

If you are taking metformin and Ozempic together — or if you are prescribed them in addition to insulin — it is especially important to be aware of the signs of low blood sugar (hypoglycemia).

Low blood sugar levels can cause the following symptoms:

  • Hunger
  • Dizziness
  • Anxiety or irritability
  • Perspiring (sweating)
  • Tremors
  • Tingling sensation in the lips
  • Rapid heartbeat
  • Fatigue or weakness
  • Vision alterations, like blurriness
  • Confusion

If you experience any of these symptoms, it’s important to check your blood sugar levels — and if you’re low, to quickly bring your blood sugar back up to a normal range by eating or drinking something with carbohydrates.

Metformin and Ozempic each have their own potential side effects that are very rare, but important to know about. 

For metformin, these include vitamin B12 deficiency and lactic acidosis, a potentially fatal condition in which lactic acid builds up in the body. 

For Ozempic, this includes thyroid tumors.

Clinical trials have shown that taking both at medicines once does not increase your overall risk of experiencing serious side effects.

It’s important to read any documents that come with your prescription and to talk about each prescription drug and its potential side effects with your doctor.

You can read more about the side effects of each drug here:

Does Ozempic work better than metformin?

Because metformin and Ozempic work in different ways, neither necessarily works better than the other. 

Depending on the dose, either metformin or Ozempic may lower blood sugar levels more than the other drug.

Ozempic has generally been shown to help people lose more weight than metformin, but everyone’s experience is different, and weight loss is not guaranteed by either drug — nor is either drug FDA-approved for that purpose.

Can you take metformin combination drugs with Ozempic?

Combination drugs for people with type 2 diabetes often include metformin paired with another drug that works differently. This approach enhances the overall effectiveness of the treatment, as each drug targets different aspects of diabetes management, thereby improving overall blood sugar control.

Adding an Ozempic prescription on top of a metformin combination drug should only be done in consultation with a doctor, as each of the three (or more) active ingredients can have its own set of side effects, interactions, and contraindications (situations in which the medicine should not be used because it might cause harm).

Is metformin safer than Ozempic?

Metformin is often considered to be among the safest and most studied drugs for helping people manage their blood sugar. 

While metformin has been in common use longer than Ozempic, each drug has undergone extensive, rigorous testing.

However, each person’s risk factors and their own experience of side effects will differ. So it’s important to work with your doctor to understand how each drug’s safety profile, risks, and side effects stack up against its benefits, all within the context of your personal health history and goals.

What foods should be avoided when taking metformin and Ozempic together?

Foods that can cause an upset stomach are best to avoid when taking metformin and Ozempic together. These include greasy, fatty foods and foods high in saturated fat (such as butter, fatty cuts of meat, and cheese). 

It’s generally best to steer clear of refined and highly processed foods as well (such as white bread and packaged goods), and you may also be advised to avoid drinking alcohol when taking metformin and Ozempic. 

Follow all guidelines and instructions on any prescription medications you are taking. It’s always a good idea to talk with your doctor about the diet you should eat and any foods, drinks, or behaviors you should avoid when starting a new prescription. 

You can read more about which foods to avoid here:

How much weight can you lose on metformin and Ozempic together?

It’s important to remember that using metformin and Ozempic together for weight loss is an off-label purpose that isn’t FDA-approved, so it is especially important to work with your doctor to understand the benefits and risks. 

If you’re prescribed metformin and Ozempic for your type 2 diabetes but wish to lose weight, there are FDA-approved weight-loss drugs that are safe for people with diabetes that your doctor may also prescribe.

Clinical trials have shown that metformin alone leads to an average weight loss of about 5% of body weight for roughly a third of people who take the drug, including loss of about 12 to 15 pounds in people without diabetes.

For people who are overweight or obese, Ozempic has been demonstrated to result in an average weight loss of 14.9% of body weight.

Final thoughts

Taking metformin and Ozempic together marks an evolving approach in diabetes management, highlighting the benefits of combination therapy. This pairing, under medical supervision, offers a promising option for people who are not able to manage their blood sugar levels with single-drug treatments. 

The potential added advantages in weight management and cardiovascular health are significant, particularly given the related nature of these health issues with diabetes.

However, it’s important to remember that each person’s response to medication can vary. The decision to use these drugs in combination should be made in close consultation with healthcare providers, taking into account personal health history and specific medical needs.