Metformin and Ozempic are popular prescription drugs 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 these drugs interact, what the side effects may be, and how well they work together.
This article will explore what you need to know about taking Ozempic and metformin together.
How do Ozempic and metformin 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, Ozempic is a once-weekly injectable drug, while metformin is a daily (or twice daily) oral medication that usually comes in pill form.
But the two drugs have different active ingredients and act on the body in different ways, too.
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 drug company Novo Nordisk.
Other drug companies also make medications with the same active ingredient as Ozempic (these include the brand names Wegovy and Rybelsus).
Ozempic is a glucagon-like peptide 1 (known as “GLP-1”) agonist. The drug mimics hormones in the body that help to regulate blood sugar levels.
Ozempic increases your body’s natural insulin production, decreases the liver’s production of glucose, slows the emptying of food out of your stomach into the small intestines, and it also reduces your appetite, which tends to lead to weight loss.
Metformin
Metformin is among the most prescribed drugs in the world. Metformin’s most common use is as a first-line treatment for type 2 diabetes.
Metformin increases insulin sensitivity and has been demonstrated to have a wide range of other health benefits. Increasingly, metformin is being prescribed for people with prediabetes, gestational diabetes, type 1 diabetes, and polycystic ovary syndrome (PCOS).
Metformin lowers the amount of sugar produced by the liver, decreases sugar absorption in the intestines, and allows individual cells in the body to consume more sugar and use that sugar more efficiently.
Similarly to Ozempic, metformin has also been shown to help people lose weight in some circumstances.
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 Ozempic and metformin?
The primary reason these drugs are prescribed is to help manage blood sugar levels.
Ozempic and metformin help most people to lower their average blood sugar levels (as measured by an A1c blood test), and these effects are quite significant.
Clinical trials have established that (at its maximum dose) metformin can help decrease A1c by 1.5%, while an average dose of Ozempic can decrease A1c by 1.4%.
If you are already prescribed metformin and it is no longer having its maximum intended benefit, your doctor or medical care team may write you a prescription for Ozempic to evaluate its effectiveness as a stand-alone replacement for metformin, or as a complementary therapy in addition to your existing metformin prescription.
There are other reasons you may be prescribed metformin or Ozempic. However, these uses tend to be off-label (not approved by the FDA).
Both drugs 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 this use, it can be a helpful effect, especially for people who have type 2 diabetes and struggle to maintain a healthy weight.
Both drugs are also established to decrease the risk of major cardiovascular events, like 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, as both drugs complement one another in helping to manage blood sugar levels.
The drugs 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 Ozempic and metformin?
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 like 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 you to sweat, and experience shakiness, lightheadedness, or confusion. If your blood sugar is low, you also may also feel your heart racing or have rapid changes in your perception or emotions.
If you experience any of these symptoms, it’s important to check your blood sugar levels – and if you’re low, 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. These include the risk of lactic acidosis for metformin and thyroid tumors for Ozempic.
Clinical trials have shown that taking both at 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 Ozempic and metformin 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 frequently integrate metformin plus another drug with a different mechanism of action, because doing this allows both drugs to maximize their effectiveness.
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 and contraindications.
Is metformin safer than Ozempic?
Metformin is often considered to be among the safest and most studied drugs for helping people to manage their blood sugar.
While metformin has been 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 health history and goals.
What foods should be avoided when taking Ozempic and metformin together?
Foods that can cause an upset stomach are best to avoid when taking Ozempic and metformin together. These include heavy, greasy, or fatty foods.
Overly processed foods are also generally best to avoid, and you may also be advised to avoid drinking alcohol when taking metformin and Ozempic.
Follow all guidelines and instructions on any prescription medication, and act accordingly. And remember, 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 Ozempic and metformin together?
It’s important to remember that using Ozempic and metformin 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 Ozempic and metformin 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 a 5% of body weight average weight loss for about a third of people who take the drug, including loss of about 12 – 15 pounds in people who did not have diabetes.
For people who are overweight or obese, Ozempic has been demonstrated to result in weight loss of 14.9% of their body weight.
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