Metformin vs. Ozempic: Which Should You Take?

Key Points

• Metformin is a diabetes medication taken daily; Ozempic is a weekly injection.
• Metformin is a generic drug; Ozempic is made with semaglutide, a GLP-1 receptor agonist.
• Which drug is right for you depends on your individual symptoms and your doctor's recommendation.

Metformin and Ozempic® are two of the leading diabetes treatments. But how do you know which is right for you?

These are two very different drugs. Metformin is a daily drug taken via oral tablet, whereas Ozempic is a once-weekly injection.

They use different active ingredients that work differently in your body.

So when it comes to Metformin vs. Ozempic, which is right for you? Let's explore.

What is metformin?

Metformin is a generic drug prescribed for type 2 diabetes management. You take metformin up to three times a day (depending on the dose) to manage blood sugar levels.

The recommended starting dose of metformin hydrochloride tablets is 500 mg orally twice a day or 850 mg once a day, given with meals.

The dosage is increased every one or two weeks depending on glycemic control and tolerability, up to the maximum dose of 2550 mg total per day.

Metformin is also available in extended release form. Many people are able to tolerate the extended release tablet better than the standard formulation, which leads to better adherences (and better outcomes).

Metformin has been shown to be effective for both preventing and treating type 2 diabetes in clinical trials. In one clinical trial, metformin was found to reduce the incidence of type 2 diabetes by 31%.

Another meta review found metformin improved blood glucose levels and lowered the risk of acquiring diabetes by 18% over 10 years.

Metformin treatment is widely considered one of the leading diabetes treatments.

What is Ozempic?

Ozempic is another diabetes medication. It is an injectable medication made from semaglutide.

Ozempic helps with blood sugar control by increasing insulin production, preventing excessive blood sugar, and slowing down food leaving your stomach.

Ozempic is administered once per week via subcutaneous (under the skin) injection. it starts at a .25 mg dose for four weeks, followed by a .5 mg dose for another four weeks. From there, your healthcare provider will decide if you need to increase your dose for additional blood sugar control. The maximum dose is 2 mg.

Semaglutide, Ozempic's active ingredient, is a GLP-1 receptor agonist.

How GLP-1 drugs work

Semaglutide is in the GLP-1 drug class. They are named for the GLP-1 hormone. This hormone is naturally produced by the body in response to food consumption, controlling insulin and digestion.

GLP-1 drugs like Ozempic help lower blood sugar levels with synthetic GLP-1 that offer additional insulin secretion as well as delayed gastric emptying.

This means food moves more slowly through the digestive tract, leading to a prolonged sense of fullness. It also influences the part of the brain that controls appetite, leading to decreased appetite.

There are other GLP-1 receptor agonist drugs like Ozempic's active ingredient semaglutide, such as tirzepatide (Mounjaro), dulaglutide (Trulicity), and liraglutide (Victoza).

What is the difference between Ozempic & metformin?

While Ozempic and Metformin are both diabetes treatments, they are very different medications.

"Metformin is well-established, affordable, and effective in managing blood sugar, though it may cause gastrointestinal side effects," says Sarah Nash, RD. "Ozempic, on the other hand, helps lower blood sugar and promotes weight loss but can be costly and may have more serious side effects, including gastrointestinal distress and rare risks like thyroid tumors. Clients need to work with their healthcare team to choose the right option based on their individual needs."

How to take Ozempic & metformin

Metformin is an oral tablet taken a few times a day while Ozempic is a once-weekly injection. Metformin can be taken by both adults and children aged 10 and older, while Ozempic is only approved for type 2 diabetes treatment in adults.

How Ozempic & metformin are prescribed

Ozempic is FDA-approved for both type 2 diabetes and chronic kidney disease to reduce the risk of kidney disease worsening, kidney failure (end-stage kidney disease), and death due to cardiovascular disease. Metformin is only approved for type 2 diabetes.

Which drug is easier to access?

Metformin has been around for decades and thus is easy to access and relatively affordable. Ozempic, on the other hand, is a newer drug and is sometimes in short supply. It is also quite costly, averaging $1,000 per month out of pocket.

Does metformin help with weight loss?

One study found that after one year, 28.5% of participants taking metformin achieved at least 5% weight loss. Further, among those with this degree of weight loss, the group originally randomized to metformin had the greatest success with weight loss during years 6–15, meaning metformin may help in maintaining lower body weight over time.

Another long-term study involving people with diabetes assessed weight loss over 15 years.

Researchers found that for people who lost more than 5% of body weight in the first year, those taking metformin had greater success in maintaining weight loss in years 6 to 15. Metformin patients lost 2.1 kg (4.6 pounds) on average.

It's important to note that, without any other dietary or lifestyle changes, metformin or similar drugs may not lead to weight loss. Any weight change you may experience might only last as long as you are on the medication.

Due to the modest and inconsistent effects of weight loss, metformin is not FDA-approved for weight loss.

Whatever effect metformin may have on weight is likely due to its influence on appetite regulation. It appears to influence gut bacteria and may also influence appetite-related activity in the brain.

How Ozempic & metformin impact blood sugar

Metformin helps to lower high blood sugar levels by reducing how much sugar is produced by the liver, which in turn helps to reduce fasting blood sugar levels. It also makes your body more sensitive to insulin, an important hormone that counteracts blood sugar.

Ozempic helps manage blood sugar levels by reducing the amount of sugar made by the liver and helping your pancreas produce more insulin.

Both Ozempic and metformin help boost your insulin sensitivity so that your body uses its own insulin more efficiently, further helping to lower A1C levels.

Should I take Ozempic or metformin?

When it comes to choosing between Ozempic or metformin, the decision is ultimately up to your healthcare provider.

"As a registered dietitian, I collaborate with healthcare providers to help clients understand their options," says Sarah Nash, RD. "Metformin is typically prescribed as a first-line treatment for type 2 diabetes due to its effectiveness in lowering blood sugar and improving insulin sensitivity. Ozempic (semaglutide) is often prescribed when additional support is needed, especially for weight management and reducing cardiovascular risks."

Your doctor will determine which drug is right for you based on your symptoms, health history, risk factors, and what other medications you might take.

What are the side effects of Ozempic & metformin?

Just like other diabetes medications, both metformin and Ozempic have potential side effects.

Metformin's potential adverse effects include vitamin B12 deficiency and hypoglycemia (low blood sugar) when used in combination with insulin. Other side effects include diarrhea, nausea/vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache.

Metformin may cause an excess of lactic acid, leading to lactic acidosis.

Ozempic's most common side effects are nausea, diarrhea, vomiting, stomach pain, and constipation.

You may experience allergic reactions to either medication.

Do not take Ozempic if you have a personal or family history of MEN2 or MTC.

Ozempic treatment may cause thyroid tumors or thyroid cancer.

If you experience dehydration while taking Ozempic, it could lead to serious kidney problems.

Discuss any adverse effects with your doctor and follow their guidance. Do not stop taking medication without consulting your healthcare provider.

Metformin drug interactions

Metformin has a few notable drug interactions, including

• Carbonic anhydrase inhibitors (typically used for glaucoma, altitude sickness, epilepsy, or congestive heart failure) may increase risk of lactic acidosis
• Drugs like tranolazine, vandetanib, dolutegravir, and cimetidine may increase the accumulation of metformin
• Excessive alcohol intake can cause harmful effects

Work with an expert diabetes dietitian

Whether you are planning to start taking Ozempic or metformin, or simply want to get your diabetes under control, a registered dietitian is the perfect partner.

A dietitian can work with the rest of your care team to determine proper diabetes treatment and help you improve your A1C levels.

When you work with a professional diabetes RD with Fay, you get a completely custom meal plan to help achieve your goals. If you need to lose weight or make other lifestyle changes, your RD will work with you directly to make slow, sustainable changes for lasting results.

It's easy to connect with a qualified diabetes dietitian with Fay. Simply filter the search results for your concerns and look through the options based on your insurance coverage.

Connect with an expert diabetes dietitian now.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.