Can you take metformin and Wegovy together?

Can you take metformin and Wegovy together? Yes — if your healthcare provider prescribes both. In fact, combining metformin and semaglutide (the active ingredient in Wegovy and Ozempic) may even help you score better blood sugar control or weight loss results. 

Whether you're already taking one or considering both, here’s what to know about how they work, why they’re sometimes prescribed together, and how they compare.

Yes, you can take metformin and Wegovy together — that is, as long as they’re prescribed by  (and you’re under the care of) a qualified healthcare provider.

Wegovy can slow gastric emptying (i.e. how fast food moves through the digestive tract), which can impact the way your body processes other medications, but studies show it doesn’t appear to affect how metformin works in the body. While the two drugs are typically prescribed for different reasons, they can work together to support blood sugar control and weight management. In fact, research suggests that pairing the two together may be more effective at reducing blood sugar levels and body weight than metformin alone (at least in people with type 2 diabetes).

Let’s quickly review the basics, shall we? 

Wegovy is a once-weekly injectable medication for weight loss. 

• It’s approved by the United States Food and Drug Administration (FDA) for weight management and to reduce the risk of serious heart problems in certain people with obesity or overweight. 

• Its active ingredient is semaglutide, a GLP-1 receptor agonist that mimics a natural hormone involved in regulating insulin release, blood sugar, and appetite. 

• It also slows how quickly food leaves your stomach, which can help you feel full longer and eat less, making it an effective tool for weight loss.

Metformin is an oral medication commonly prescribed to manage type 2 diabetes. 

• It lowers blood sugar by reducing the liver’s production of glucose, decreasing how much sugar the body absorbs from food, and improving how well your cells use insulin.

• It’s available in both immediate-release (IR) and extended-release (ER) forms, and it’s typically taken once or twice daily with meals. 

Metformin is usually considered “weight neutral,” which means it doesn’t typically cause weight gain. It may even lead to weight loss of a few pounds in some people. This may be due in part to its ability to slightly increase the body’s production of GLP-1 (the natural hormone that Wegovy mimics), which helps regulate appetite and blood sugar. Of course, the effects of metformin on GLP-1 are considered modest and should not be considered similar to the effects of actual GLP-1 agonists. 

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Healthcare providers may prescribe metformin and Wegovy together, but not always.

“I don’t usually prescribe them together off the bat, but I do have patients come to me on metformin and will add a GLP-1 medication such as Wegovy,” says Tzvi Doron, DO, DABFM, DABOM, a board-certified obesity and family medicine specialist in New York. 

Metformin is commonly used as a first-line treatment — along with diet and exercise — for those just diagnosed with type 2 diabetes. But if it doesn’t do enough to manage your blood sugar, healthcare providers often add another medication into the mix. While there are other options available, one category that has gained attention recently is GLP-1 medications like Wegovy. 

A recent review found that pairing metformin with oral semaglutide can be especially effective at controlling blood sugar in people with type 2 diabetes and obesity or overweight. Not only that, but the combination of drugs also leads to impressive reductions in body weight that were significantly higher than the weight loss experienced with metformin alone. 

Another review looked at how well different GLP-1 receptor agonists worked when added to metformin in people with type 2 diabetes. The analysis found that injectable semaglutide, the active ingredient in Wegovy, was one of the most effective options; it lowered A1c by nearly 2% and body weight by about 13 pounds. Though the research didn’t directly compare Wegovy to metformin, the results suggest that the combination can be beneficial.

“If I’m treating a diabetic patient on metformin who wants to try semaglutide, I usually add it and continue metformin until I see how their glucose levels respond,” says Jennifer Brown, DO, ABOM, ABFM, a board-certified obesity and family medicine specialist at Maxwelton Health Center in West Virginia. 

Both Wegovy and metformin can affect the digestive system, so taking them together might increase the chance of side effects. Keyword being “might.” Dr. Brown, for example, says she hasn’t “noticed an increase in GI problems when patients take both medicines, but it is theoretically possible.”

Side effects often improve over time as your body adjusts, but combining the two could make it harder to tolerate one or both.

• The most common side effects of metformin are gastrointestinal (GI), including diarrhea, nausea, and abdominal discomfort.

• The most common side effects of Wegovy are also GI-related, including nausea, diarrhea, vomiting, constipation, and abdominal pain.

Taking metformin with meals can minimize stomach upset. And the following tips may help manage the side effects of Wegovy: 

• Eat smaller portions more frequently throughout the day

• Skip foods that trigger symptoms (e.g. spicy, greasy, acidic items; you will learn your triggers over time)

• Limit carbonated drinks and alcohol

• Stay hydrated and consider adjusting your intake of fiber-rich foods

Tell your healthcare provider if side effects from metformin or Wegovy don’t go away. They might suggest taking an over-the-counter (OTC) medication for temporary relief, such as a stool softener (for constipation). In some cases, they may recommend a lower metformin dosage or discuss other adjustments to your treatment plan. There are even prescription medications that can help address nausea.

It's hard to say if Wegovy is better than metformin (or vice versa) because the two drugs are usually prescribed for different reasons. The ideal option for you depends on several factors, such as your health goals and current health status, weight, and medical history. 

When it comes to weight loss, Wegovy often reigns supreme. In fact, experts from the American Gastroenterological Association and American Diabetes Association generally recommend GLP-1 medications like semaglutide as a top choice for weight loss. In clinical studies, adults with obesity or overweight (without type 2 diabetes) who took Wegovy lost around 15% of their body weight over 68 weeks.

Metformin, on the other hand, has a much smaller effect on weight. Studies show it may lead to a more modest 2%–5% reduction in body weight. “Wegovy is such a powerful weight loss medication that any effect metformin has is minimal in comparison,” Dr. Brown says.

The difference in blood sugar control is also worth noting. In a large analysis, people with type 2 diabetes who took 1 mg of semaglutide lowered their A1c by an average of 1.77% after 26 weeks compared to 1.09% with the highest dose of metformin. 

However, for many individuals, the choice isn’t either-or. Healthcare providers may prescribe both Wegovy and metformin together in some cases.

Some people who start Wegovy may eventually taper off metformin, particularly if their diabetes improves with weight loss. Significant weight loss has been shown to reverse type 2 diabetes — and eliminate the need for metformin. “Once I start a patient on semaglutide, I ensure their glucose levels are controlled, and then slowly taper them off their metformin,” Dr. Brown says. 

If blood sugar control is your top concern and semaglutide isn’t your preference (due to cost or other reasons), metformin is still a go-to option. According to the American Diabetes Association, it’s been a first-choice treatment for type 2 diabetes for decades. It’s generally considered effective, safe, inexpensive, and widely available. 

Beyond lowering blood sugar, metformin can also help reduce the risk of diabetes complications like nerve damage, kidney issues, and cardiovascular problems.

Here are important questions to ask yourself and discuss with your healthcare provider when deciding if metformin or Wegovy may be right for you:

• Are you comfortable with injections? Wegovy is a weekly shot, while metformin is a daily pill.

• What is your primary goal? Weight loss, blood sugar control, or both?

• Do you have other conditions that may benefit from taking metformin or Wegovy? Examples are heart disease, prediabetes, or polycystic ovary syndrome (PCOS).

• What can you afford? Wegovy can be expensive with or without insurance, while metformin is usually a low-cost medication.

While metformin and Wegovy can both help with weight and blood sugar management, they differ in several key ways:

Metformin and Wegovy work in different ways but can be safely taken together when prescribed by a healthcare provider. This combination may offer added benefits for people living with type 2 diabetes or trying to lose weight. Think either or both may be a fit for you? Consult your healthcare provider and keep these points in mind: 

• Yes, you can take Wegovy and metformin together. Some research suggests adding semaglutide (the active ingredient in Wegovy) to metformin may help improve blood sugar control and lead to more weight loss than metformin alone.  

• Wegovy often results in greater weight loss than metformin. Weight loss results with metformin are usually modest. Lifestyle changes can help you get the most out of either medication.

• Digestive issues are possible with both treatments. The most common Wegovy side effect is nausea, while diarrhea is the most common complaint with metformin. Most people tolerate the combination similar to either drug alone, with no significant increase in side effects.

• There’s no one-size-fits-all decision. When considering the two drugs, think about what matters most to you, such as cost, comfort with injections, convenience, or weight loss expectations. 

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