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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Ozempic and metformin are both medications that help people with type 2 diabetes manage their blood sugar levels. They can be prescribed separately or together. Let’s explore.
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What is Ozempic?
Ozempic (the brand name for semaglutide) is a pre-filled prescription injection pen that helps people with type 2 diabetes control their blood sugar levels. A person uses the pen to inject the medicine into their abdomen, upper arm, or thigh weekly. Ozempic can be taken with or without meals (DailyMed, 2022).
Ozempic is primarily used to treat type 2 diabetes. It may be used in combination with lifestyle changes like diet and exercise, or with other diabetes medications, such as metformin or insulin (CADTH, 2019; Chamberlin, 2019). In addition to lowering blood sugar levels, Ozempic also reduces the risk of cardiovascular events—such as stroke, heart attack, or death—in people with type 2 diabetes and heart disease (DailyMed, 2022).
Because Ozempic reduces appetite, it may be prescribed off-label to help people with overweight or obesity to lose weight. Though it’s not yet FDA-approved for this purpose, studies show that, when combined with diet and exercise, Ozempic can improve weight loss (O’Neil, 2018; Wilding, 2021).
Side effects of Ozempic
Common side effects of Ozempic include nausea, vomiting, and diarrhea, which are experienced by around one in three people (Chamberlin, 2019). Less frequent side effects include abdominal pain or constipation. Some people may experience discomfort or redness at the spot where they injected Ozempic (DailyMed, 2022).
Who shouldn’t take Ozempic?
Using Ozempic may increase your risk of hypoglycemia (low blood sugar), especially if taken with other diabetes medications like insulin. Ozempic may also increase your risk of developing diabetic retinopathy (vision loss caused by diabetes), gallbladder problems, or gastrointestinal disorders (Wilding, 2021; DailyMed, 2022). Ozempic should not be used by children or by people who (Chamberlin; 2019; DailyMed, 2022):
- Have pancreatitis
- Have a personal or family history of thyroid cancer
- Have multiple endocrine neoplasia syndrome type 2
- Are currently pregnant or breastfeeding
The US Food and Drug Administration (FDA) has issued a “black box” warning for Ozempic. This is the most severe advisory they issue for a medication. Animal studies have found that Ozempic increases the risk of thyroid tumors in humans. While it is not known if it has the same effect in humans, people with a personal or family history of thyroid cancer, or who have multiple endocrine neoplasia syndrome type 2, should not use Ozempic (FDA, 2020; DailyMed, 2022).
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What is metformin?
Metformin is used to treat type 2 diabetes mellitus in adults and children ten years and older. It is a daily oral medication that should be taken with meals to avoid an upset stomach. Metformin may be prescribed from the outset of diagnosis, or if lifestyle changes like diet and exercise do not effectively lower blood sugar levels. It may also be prescribed off-label to treat polycystic ovary syndrome (PCOS) and gestational diabetes, and to prevent PCOS and type 2 diabetes (Corcoran, 2022).
Like Ozempic, Metformin is only used to treat type 2 diabetes, and not type 1 diabetes. Unlike Ozempic, metformin is taken orally (Corcoran, 2022).
Side effects of metformin
Similar to Ozempic, metformin is generally considered safe. A little less than one in three people may experience gastrointestinal side effects, such as diarrhea, nausea, and vomiting. Less common side effects include (Corcoran, 2022):
- Chest discomfort
- Excessive sweating
- Hypoglycemia (low blood sugar)
- Runny nose
With long-term use of metformin, some people may develop a vitamin B12 deficiency and need to take supplements (Corcoran, 2022).
Metformin: interactions, side effects, and warnings
Who shouldn’t take metformin?
People who are pregnant, younger than ten years old, or with reduced kidney or liver function should not use metformin (Corcoran, 2022).
Metformin comes with a “black box” warning. One in 30,000 people who take metformin may experience lactic acidosis, a condition that causes lactic acid to build up in the body. Lactic acidosis can lead to hypotension (low blood pressure), hypothermia, and death. People at increased risk of developing lactic acidosis when taking metformin include people who (DailyMed, 2021):
- Are older
- Have poor kidney or liver function
- Have hypoxia (low oxygen levels)
- Have surgery
- Abuse alcohol
Should you take metformin and Ozempic for weight loss?
Obesity has been linked to insulin resistance in people without diabetes. Because metformin lowers insulin resistance, metformin can help people with overweight and obesity—including those without type 2 diabetes—lose weight, perhaps by improving their insulin sensitivity (Seifarth, 2013).
Since Ozempic may reduce appetite, it may further improve blood glucose levels and weight loss in people with type 2 diabetes (Wilding, 2021). Combining metformin and Ozempic may enhance the effectiveness of both drugs (Bennett, 2011).
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. Usually, they include mild to moderate gastrointestinal issues like nausea or diarrhea (Hausner, 2017).
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Ozempic vs. metformin: how do they compare?
Ozempic and metformin are both medications that treat type 2 diabetes by lowering blood sugar levels, with similar side effects. Key differences include how you take the medicine and their interactions with other drugs and alcohol.
Metformin is a daily oral medication, while Ozempic is a pre-filled pen that you inject weekly. While Ozempic can be injected with or without meals, you should always take metformin with meals (DailyMed, 2022; Corcoran, 2022).
Excessive alcohol consumption should be avoided while taking metformin, as it can increase the risk of developing lactic acidosis (Corcoran, 2022). The effects of alcohol on Ozempic are not known. However, alcohol can affect blood sugar levels and lead to hypoglycemia, so people with type 2 diabetes are advised to consume alcohol in moderation and to avoid drinking alcohol on an empty stomach to lower their risk. People with type 2 diabetes and certain other conditions, such as high blood pressure or liver problems, should avoid drinking alcohol entirely (Asif, 2014).
Both Ozempic and metformin may change how you use other diabetes drugs. For example, Ozempic and insulin can be more effective together in improving glycemic control and weight loss, but the insulin dosage may need to be adjusted to avoid hypoglycemia (Chamberlin, 2019). Additionally, metformin may interact with certain drugs, increasing the risk of developing lactic acidosis or hypoglycemia (Corcoran, 2022).
Let’s review how these drugs compare:
If you are interested in learning more about Ozempic and metformin, for diabetes management or weight loss, talk to your healthcare provider.
- Asif, M. (2014). The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion, 3, 1. doi:10.4103/2277-9531.127541. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24741641/
- Bennett, W. L., Maruthur, N. M., Singh, S., et al. (2011). Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Annals of Internal Medicine, 154(9), 602–613. doi:10.7326/0003-4819-154-9-201105030-00336. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21403054/
- Canadian Agency for Drugs and Technologies in Health (CADTH). (2019). Clinical review report: semaglutide (Ozempic): (Novo Nordisk Canada Inc.). Canadian Agency for Drugs and Technologies in Health. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31305971/
- Chamberlin, S. & Dabbs, W. (2019). Semaglutide (Ozempic) for type 2 diabetes mellitus. American Family Physician, 100(2), 116–117. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31305048/
- Corcoran, C., & Jacobs, T. F. (2022). Metformin. StatPearls. Retrieved on June 29, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK518983/
- DailyMed. (2022). OZEMPIC-semaglutide injection, solution. National Library of Medicine. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79
- DailyMed. (2021). Metformin ER, 500mg tablet. National Library of Medicine. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b857eccf-b9ff-45ba-8241-f47f5caada2a
- Food and Drug Administration (FDA). (2020). Drug trial snapshot: Ozempic. Food and Drug Administration. Retrieved from https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-ozempic
- Frías, J. P., Auerbach, P., Bajaj, H. S., et al. (2021). Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial. The Lancet. Diabetes & Endocrinology, 9(9), 563–574. doi:10.1016/S2213-8587(21)00174-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34293304/
- Hausner, H., Derving Karsbøl, J., Holst, A. G., et al. (2017). Effect of semaglutide on the pharmacokinetics of metformin, warfarin, atorvastatin and digoxin in healthy subjects. Clinical Pharmacokinetics, 56(11), 1391–1401. doi:10.1007/s40262-017-0532-6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28349387/
- Maideen, N. M. P. (2019). Pharmacologically relevant drug interactions of Glucagon-like peptide-1 receptor agonists. Journal of Analytical & Pharmaceutical Research, 8(2), 51‒53. doi:10.15406/japlr.2019.08.00311. Retrieved from https://www.researchgate.net/publication/333746529_Pharmacologically_relevant_drug_interactions_of_Glucagon-like_peptide-1_receptor_agonists
- O’Neil, P. M., Birkenfeld, A. L., McGowan, B., et al. (2018). Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet (London, England), 392(10148), 637–649. doi:10.1016/S0140-6736(18)31773-2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30122305/
- Seifarth, C., Schehler, B., & Schneider, H. J. (2013). Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. Experimental and Clinical Endocrinology & Diabetes, 121(1), 27–31. doi:10.1055/s-0032-1327734. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23147210/
- Wilding, J., Batterham, R. L., Calanna, S., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33567185/