Can You Take Metformin and Ozempic Together?

Craig Primack, MD, FACP, FAAP, FOMA

Reviewed by Craig Primack, MD, FACP, FAAP, FOMA

Written by Hadley Mendelsohn

Published 05/01/2024

Rest assured, you can indeed take metformin and Ozempic® together. This is true whether you’re taking them for diabetes or weight loss. But, it's important to understand that combining these medications can increase your risk of side effects.

Ozempic (semaglutide) and metformin can both cause nausea, diarrhea, and other gastrointestinal issues — so taking them together could potentially worsen the effects.

Ozempic and metformin are both type 2 diabetes medications. People with type 2 diabetes are prescribed both drugs when their blood sugar levels don’t go down enough with one medication alone.

These drugs are also used off-label to help people with overweight and obesity achieve their weight loss goals. Off-label just means that your doctor is prescribing a medication for reasons other than those it was FDA-approved to treat.

Keep reading to learn about these diabetes and weight loss medications in greater detail, including the risks of taking them together, the benefits, and how they actually work to promote weight loss.

It is safe to take Ozempic and metformin together — people living with type 2 diabetes have been doing it for years. It's not uncommon for people to need a combination of medications to help manage their blood glucose levels.

One small study on the pharmacokinetics of semaglutide and metformin found that, once in the bloodstream, the drugs don’t affect each other. Based on their findings, the researchers concluded that people can take these medications together — at the standard doses — without issue.

They noted that while some people experienced mild to moderate gastrointestinal side effects, the effects were no different than those caused by semaglutide alone.

So, in short, it’s safe to take them together. But it is important to be aware of the potential for uncomfortable side effects.

You could take Ozempic and metformin together if you wanted to. But, for weight loss, there may not be much point. That said, we take a multi-pronged approach to weight management and we’re all about supporting you on your unique journey.

Ozempic and metformin do many of the same things, like helping you feel full faster and longer. But, the fact is, GLP-1s like Ozempic appear to help people lose more weight.

Why GLP-1s like semaglutide help people lose more weight than other medications is not fully understood. But many people taking Ozempic say it’s because it quiets the “food noise” in their minds.

This means less time spent thinking about what to eat next. Less time trying to convince yourself to eat something healthy. Less time bargaining with yourself.

Turns out it’s a lot easier to resist food cravings when you don’t have food cravings. Go figure.

Ozempic is a brand name for semaglutide, a GLP-1 agonist used to treat type 2 diabetes. This once-weekly injection works by helping the pancreas regulate insulin to help keep blood sugar levels in a healthy range.

Ozempic works by mimicking the gastrointestinal hormone GLP-1, which is naturally released after you eat. This hormone encourages insulin production, which keeps blood sugar levels in check. It’s also the hormone responsible for signaling to your brain that you’re full once you’ve eaten.

In people with type 2 diabetes, Ozempic also lowers the risk of long-term obesity-related complications.

One study found that patients with type 2 diabetes and a high risk of developing heart problems who were treated with once-weekly semaglutide injections were 26 percent less likely to have fatal heart attacks and 39 percent less likely to have nonfatal strokes than those who didn’t get the same treatment.

Because of the research supporting the weight loss benefits of Ozempic, it’s often prescribed off-label to people with obesity to help with weight management.

Ozempic Costs & Alternatives

Ozempic is a brand name for the medication semaglutide. Ozempic is intended for people with type 2 diabetes, which means you can only get it prescribed for weight loss off-label. When you take a medication off-label, it’s usually not covered by your insurance company.

Semaglutide is also available to qualifying individuals with obesity under the brand name Wegovy.

Wegovy is an injection approved to help treat obesity in adults and children ages twelve and older. It’s often recommended to adults with weight-related medical problems, like diabetes and heart disease. Although Wegovy is FDA-approved for weight loss, many insurance providers do not cover the medication. (Some justify this by saying it’s a “cosmetic” drug — which is completely ridiculous.)

Semaglutide is also sold under the name Rybelsus®. Approved for the management of type 2 diabetes, the difference is that it’s an oral medication. Another key difference is that there haven’t been enough studies to show that it offers the same benefit of reducing the risk of heart conditions in people with type 2 diabetes. If you don’t have diabetes, you would need to take Rybelsus off-label.

Since semaglutide is still relatively new, it is not yet available as a generic. This is why the price tags of these drugs can be so punishing.

The good news (for you) is that there have been shortages of these medications. To step in and fill that gap, the FDA allows compounding pharmacies, like Hims & Hers, to produce semaglutide and sell it for a fraction of what the pharmaceutical companies charge.

Other weight loss injections include:

  • tirzepatide (Mounjaro, Zepbound)

  • liraglutide (Victoza)

  • dulaglutide (Trulicity)

Metformin is another common type 2 diabetes mellitus treatment that helps with weight loss. Unlike semaglutide, metformin is an oral medication. It comes as a tablet, an extended-release tablet (which lasts longer), and a liquid solution.

It works by reducing blood glucose levels as well as insulin levels. Essentially, it helps regulate energy and metabolism.

The Diabetes Prevention Program (DPP) found that metformin can also help prevent diabetes in high-risk people. It found that taking metformin reduces the chance of developing diabetes by a whopping 31 percent over three years.

Those who committed to healthier lifestyle modifications saw even better outcomes, with a 58 percent lower chance of developing diabetes.

The same trial also found that people who took metformin lost an average of around 8 pounds in six months. The more they stuck to their treatment routine, the more weight they lost, even over the course of ten years of use. That said, the FDA hasn't approved metformin as a weight loss medication since that level of weight loss is pretty modest (and the numbers are a little inconsistent).

The reason some doctors prescribe it for weight loss is that metformin helps regulate appetite.

One small study looked the efficacy of metformin for weight loss in people who didn’t have diabetes. Participants who took metformin lost an average of almost 13 pounds in six months. Participants in the trial who didn’t take metformin gained weight over that same time period.

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Weight loss treatment that puts you first

Considering that Ozempic and metformin are often used to treat the same conditions, you’re probably wondering how they’re different. One of the primary distinctions is that they’re administered differently, with Ozempic being a once-weekly injection and metformin being an oral medication.

As mentioned earlier, Ozempic is from a drug class known as GLP-1 receptor agonists and works by making you feel fuller after you eat, reducing and regulating blood sugar levels, and increasing insulin production.

Metformin works by reducing the amount of sugar produced by the liver, increasing insulin sensitivity, and encouraging the intestines to absorb less sugar.

If you’re interested in losing weight, talk with a healthcare provider about your weight loss goals. If your provider thinks you could benefit from a weight loss medication, they can talk you through your options and come up with a personalized treatment plan just for you.

If you’re considering taking Ozempic and metformin together, the side effects of both drugs are important to consider. You’ll notice that there’s quite a bit of overlap.

Side Effects of Ozempic

Common side effects of Ozempic include:

  • Gastrointestinal issues like:

    • Indigestion

    • Nausea

    • Vomiting

    • Diarrhea

    • Abdominal pain

    • Constipation

  • Other rarer side effects:

    • Irritation at the injection site

    • Tachycardia

    • Hypoglycemia

    • Acute pancreatitis

    • Medullary thyroid cancer

Side Effects of Metformin

According to the drug label information for metformin, the most common adverse reactions are:

  • Diarrhea

  • Indigestion

  • Nausea

  • Vomiting

  • Gas

  • Abnormal physical weakness and fatigue

  • Abdominal discomfort

  • Headaches

Since the potential side effects of metformin and Ozempic are super similar, as you can see, people who experience side effects from one diabetes medication will probably only experience the same ones if they take both.

Who Shouldn’t Take Ozempic

Anyone who…

  • Has a personal or family history of medullary thyroid cancer

  • Is currently pregnant or breastfeeding

  • Has pancreatitis

Who Shouldn’t Take Metformin

Anyone who…

  • Regularly misuses alcohol and other illicit substances

  • Has low oxygen levels, severe circulation problems, or poor liver or kidney function

Both metformin and Ozempic are great treatment options when it comes to diabetes management and weight management. As always, it’s best to consider the medical advice of a doctor before committing to anything.

14 Sources

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