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

Ozempic and metformin are both medications prescribed to help people with type 2 diabetes manage their blood sugar levels. However, they can also be prescribed off-label to help promote weight loss and keep the weight off, especially when adding lifestyle changes. If you’re interested in metformin or Ozempic to help with your weight loss goals, you may wonder, can I take Ozempic and metformin together? The answer is yes. They can be prescribed separately or together. Continue reading to learn more about taking Ozempic vs. metformin or Ozempic and metformin together.

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 belly, upper arm, or thigh weekly. Ozempic can be taken with or without meals. 

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. 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.

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. 

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.

Like Ozempic, metformin is not insulin, and is only used to treat type 2 diabetes, and not type 1 diabetes. Unlike Ozempic, metformin is taken orally.

Can you take Ozempic and metformin together for weight loss? The answer is yes. In fact, when prescribed together, the medications compliment each other in managing blood sugar levels. 

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 mitigates insulin resistance, metformin can help people with overweight and obesity—including those without type 2 diabetes—lose weight, perhaps by improving their insulin sensitivity. 

Since Ozempic stimulates insulin secretion from the pancreas and reduces appetite, it further improves blood glucose levels and weight loss in people with type 2 diabetes. Combining metformin and Ozempic may enhance the effectiveness of both drugs.

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.

While no foods are strictly forbidden on Ozempic or metformin, some foods may increase your risk of side effects, like nausea. You may want to limit the following foods when taking Ozempic, metformin, or both:

• Greasy, fatty foods

• Foods high in saturated fats (cheese, butter, etc.)

• Refined carbs (white bread, packaged baked goods, etc.)

• Foods high in added sugars

• Excessive, sugary alcohol

When prescribed Ozempic, metformin, or both, talk to your healthcare provider about your diet and lifestyle to learn about any adjustments you may need to make to minimize side effects and maximize efficacy.

If you’re making the decision between Ozempic vs. Metformin (or both), the potential risk for side effects with each medication may be a factor in your decision. While both medications are considered safe when taken as instructed, here are the potential side effects of Ozempic and metformin:

Side effects of Ozempic

Common side effects of Ozempic include nausea, vomiting, and diarrhea, which are experienced by around one in three people. Less frequent side effects include abdominal pain or constipation. Some people may experience discomfort or redness at the spot where they injected Ozempic.

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:

• Chest discomfort

• Excessive sweating

• Headache

• Hypoglycemia (low blood sugar)

• Runny nose

• Weakness

With long-term use of metformin, some people may develop a vitamin B12 deficiency and need to take supplements.

People who are pregnant, younger than ten years old, or with reduced kidney or liver function should not use metformin.

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:

• Are older 

• Have poor kidney or liver function

• Have hypoxia (low oxygen levels)

• Have surgery

• Abuse alcohol

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. Ozempic should not be used by children or by people who:

• 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. 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.

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 to help reduce stomach or bowel side effects.

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, 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 try to not drink alcohol. 

Both Ozempic and metformin may change the dose of other diabetes drugs. For example, if you take Ozempic and insulin, the insulin dosage may need to be adjusted to avoid hypoglycemia. Additionally, metformin may interact with certain drugs, increasing the risk of developing lactic acidosis or hypoglycemia.

Let’s review how these drugs compare:

If you’re interested in learning more about choosing between ozempic vs. metformin or taking ozempic and metformin together,  make an appointment with your healthcare provider.

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Current version

April 13, 2023

Written by

Amelia Willson

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.