Ozempic vs. metformin: can you take Ozempic and metformin together?

Ozempic (semaglutide) and metformin are both medications prescribed to help people with type 2 diabetes manage their blood sugar levels. They can also be prescribed off-label for weight loss. So, can you take Ozempic and metformin together? The answer is yes. The drugs can be prescribed separately or together. 

Continue reading to learn more about taking Ozempic vs. metformin or Ozempic and metformin together for weight loss.

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Yes, you can take Ozempic and metformin together for weight loss. In fact, studies show that combining metformin and semaglutide or similar medications is safe and may enhance the effectiveness of both drugs. 

• Metformin improves insulin sensitivity and is associated with modest weight loss.

• Ozempic reduces appetite, encourages the release of insulin, and promotes significant weight loss.

Obesity has been linked to insulin resistance — a condition in which your body becomes less sensitive to the hormone insulin — in people without diabetes. Because metformin improves insulin sensitivity, it can help people with overweight and obesity — including those without type 2 diabetes — lose weight. 

Ozempic can also lead to weight loss — up to 15 pounds in 10 months, according to research. And if you’re taking it for type 2 diabetes, it can improve your blood sugar levels at the same time. (Ozempic works by slowing down digestion and managing the release of insulin and glucagon.)

You can take Ozempic and metformin together or separately. When taken together, the side effects are usually the same as those experienced when taking these medications on their own. They typically include mild to moderate gastrointestinal issues, such as nausea or diarrhea. 

Ozempic is injected once a week subcutaneously (under the skin), while metformin is an oral medication you take by mouth, usually once or twice daily.

Yes, it is generally safe to take Ozempic and metformin together, according to multiple studies and clinical trials. There typically isn’t any need to adjust the dosing of metformin when you start taking Ozempic.

Metformin is usually considered the first-line treatment for type 2 diabetes because it’s inexpensive and works well for most people. But if your blood sugar levels don’t adequately decrease on metformin, your healthcare provider may recommend taking Ozempic, too. 

Ozempic is normally recommended as a second-line treatment. Iin other words, after first trying metformin.

 But your healthcare provider may recommend Ozempic and metformin together as a first-line approach if losing weight would help with your overall treatment plan — and to potentially help you reach your treatment goals faster.

When considering Ozempic, metformin, or both, it’s important to share your full medical history with your healthcare provider, including any medications you are taking. This information can help them determine whether either or both drugs will be safe for you. 

• Ozempic should not be taken by anyone with a personal or family history of certain thyroid tumors. 

• Metformin shouldn’t be taken by those with severe kidney impairment or metabolic acidosis (acid buildup in your body). 

With both drugs, certain health conditions may require extra caution or dosing adjustments.

Ozempic and metformin are both medications that treat type 2 diabetes by lowering blood sugar levels, with similar side effects. Key differences between the two include their formulation and drug interactions. 

 Here’s a quick look at the similarities and differences between Ozempic and metformin. 

Similarities between Ozempic and metformin:

• What they treat: Both drugs treat type 2 diabetes by lowering blood sugar levels.

• What side effects they cause: Both cause similar gastrointestinal side effects, including nausea, vomiting, and diarrhea.

• How they interact with insulin: Taking either or both may require you to lower the dosage of insulin in order to avoid hypoglycemia (low blood sugar). 

Key differences between Ozempic and metformin:

• How you take them: Metformin is an oral medication that’s usually taken once or twice daily, while Ozempic is a pre-filled pen that you inject weekly. 

• When you take them: While Ozempic can be injected with or without meals, you should always take metformin with meals to help reduce stomach or bowel side effects.

• Whether they’re safe to mix with alcohol: Excessive alcohol consumption should be avoided while taking metformin, as it can increase the risk of developing lactic acidosis. The effects of alcohol on Ozempic are not known. However, alcohol can affect blood sugar levels and lead to hypoglycemia, which can happen on Ozempic.

• Drug interactions: Ozempic does not have any specific drug interactions, while metformin has a long list of drug interactions. Many of these interactions can raise the risk of metformin side effects.

• Serious warnings: Ozempic carries a boxed warning for thyroid tumors, and should not be taken in people with a personal or family history of certain thyroid cancers. Metformin carries a boxed warning for lactic acidosis and should not be taken by people with severe renal impairment or acute or chronic metabolic acidosis.

If you’re making the decision between Ozempic vs. metformin (or both), the potential risk for side effects may affect your decision. Both medications are considered safe when taken as instructed, but they can cause potential side effects.

Common side effects when taking Ozempic and metformin together

Ozempic and metformin share many common side effects. 

Here’s a look at the most common side effects for Ozempic and metformin (extended release tablets), including how many people reported them in separate clinical trials:

Who shouldn’t take Ozempic?

The US Food and Drug Administration (FDA) has issued a “black box” warning for Ozempic due to an increased risk of thyroid tumors. 

Ozempic should not be used by anyone who:

• Has a personal or family history of thyroid cancer

• Has multiple endocrine neoplasia syndrome type 2 (MEN2)

• Has pancreatitis

• Is currently pregnant or breastfeeding

Who shouldn’t take metformin?

Metformin comes with a “black box” warning for lactic acidosis, a condition in which acid builds up in the body. It can lead to hypotension (low blood pressure) and hypothermia. 

Metformin should not be used by anyone who:

• Is pregnant or breastfeeding

• Has poor kidney or liver function

• Has hypoxia (low oxygen levels)

• Has acute or chronic metabolic acidosis, with or without coma

If you cannot take Ozempic, metformin, or both, there are alternatives for treating type 2 diabetes or losing weight that might be worth considering. 

Other GLP-1 medications that treat type 2 diabetes include

• Mounjaro (tirzepatide), a weekly injection

• Victoza (liraglutide), a daily injection 

• Rybelsus (semaglutide), a daily oral tablet containing the same active ingredient as Ozempic

GLP-1s that are FDA-approved for weight loss include:

• Zepbound (tirzepatide), a weekly injection

• Saxenda (liraglutide), a daily injection

• Wegovy (semaglutide), a weekly injection containing the same active ingredient as Ozempic

Get started

Ozempic and metformin are two of the most common medications prescribed for type 2 diabetes — and they can be taken together safely and effectively. Here’s what to keep in mind: 

• Many people will start by taking metformin independently. They may then add Ozempic if their blood sugar or weight loss goals aren’t being met.

• Taking Ozempic and metformin together can enhance the benefits of each treatment. Metformin helps your body use insulin more efficiently to lower blood sugar, while Ozempic slows digestion, curbs appetite, and also helps manage blood sugar levels. 

• The two medications share several side effects, including nausea, vomiting, and diarrhea, which usually improve with time.

• Ozempic is a once-weekly injection, while metformin is an oral tablet that should be taken with food. 

Just like any other prescription medication, both Ozempic and metformin have their own drug interactions and potential warnings. Inform your healthcare provider of your complete medical history before starting either (or both) drugs.