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Main differences | Conditions treated | Efficacy | Coverage and cost | Side effects | Interactions | Warnings | FAQs
People who live with diabetes have several options available when it comes to treatment. Ozempic and metformin are medications prescribed to help manage high blood sugar levels. By improving blood sugar levels, these medications may help reduce the risk of complications, such as diabetic retinopathy, kidney disease, and heart disease.
In addition, Ozempic and metformin may benefit people with Type 2 diabetes who are obese or overweight. Ozempic and metformin have been shown to promote weight loss as a side effect. However, these medications are not approved by the FDA for sole use as part of a weight management plan.
Continue reading to learn more about Ozempic, metformin, and the similarities and differences between the two.
What are the main differences between Ozempic and metformin?
In people with diabetes, the main goal is to manage blood sugar or glucose levels in the bloodstream. Although Ozempic and metformin are approved to help lower blood sugar levels in people with Type 2 diabetes, they work in different ways, have different formulations, and cause different side effects.
Mechanism of action
Ozempic is a brand-name medication that contains the active ingredient semaglutide. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. Semaglutide mimics the action of a hormone called GLP-1, which stimulates the pancreas to produce insulin and reduces glucagon production.
Metformin belongs to the biguanide drug class. It is a generic medication that decreases the amount of glucose the liver produces and improves glucose absorption into the body’s cells.
Dosage forms
Ozempic is a brand-name drug given as a weekly subcutaneous injection, with or without meals. It is injected under the skin of the thigh, stomach area, or upper arm. There are currently no generic versions of Ozempic available.
On the other hand, metformin is a generic oral tablet, extended-release tablet, or liquid that is usually taken one to three times daily with meals. It is available as a generic and brand-name drug. The brand names of metformin include Glucophage and Riomet.
| Ozempic | Metformin | |
| Drug class | GLP-1 agonist | Biguanide |
| Brand/generic status | Brand only | Brand and generic version available |
| What is the generic or brand name? | Brand name: Ozempic
Generic name: Semaglutide |
Brand name: Glucophage, Riomet, Fortamet
Generic name: Metformin |
| What form(s) does the drug come in? | Subcutaneous injection | Oral tablet, extended-release tablet, liquid oral suspension |
| What is the standard dosage? | 0.25 injected under the skin once weekly for four weeks. Then, the dosage is increased to 0.5 mg once weekly.
The dosage may be increased to 1 mg once weekly after four weeks on the 0.5 mg dosage and then increased again to 2 mg once daily after 4 weeks on the 1 mg dosage, depending on the treatment response. |
Immediate-release: 500 mg twice daily or 850 mg once daily with meals
Extended-release: 500 to 1000 mg once daily with an evening meal Dosage may be increased as needed and tolerated. |
| How long is the typical treatment? | Long-term | Long-term |
| Who typically uses the medication? | Adults 18 years and older | Adults and children 10 years and older |
Conditions treated by Ozempic and metformin
Both Ozempic and metformin are FDA-approved for the treatment of Type 2 diabetes mellitus when used along with a diet and exercise plan. However, Ozempic is only approved for adults, while metformin is approved for adults and children 10 years or older. Ozempic is also approved to reduce the risk of major cardiovascular events, such as heart attack, stroke, and death, in adults with Type 2 diabetes and heart disease.
Both Ozempic and metformin may be recommended off-label for weight loss. For example, these medications may be prescribed for people with obesity or those who are overweight with weight-related problems, such as high blood pressure or high cholesterol. Metformin is sometimes prescribed to manage weight gain caused by certain medications, such as antipsychotics.
These medications are not approved to treat Type 1 diabetes.
| Condition | Ozempic | Metformin |
| Type 2 diabetes | Yes | Yes |
| Lower the risk of major cardiovascular events, such as heart attack, stroke, and death | Yes | No |
| Weight loss | Off-label | Off-label |
Is Ozempic or metformin more effective?
Ozempic and metformin are effective treatment options for managing blood sugar levels. They generally lower A1c levels by 1% to 2%. Metformin is typically a first-line treatment option along with lifestyle changes. Semaglutide, the active ingredient in Ozempic, is one of the most potent GLP-1 receptor agonists.
Ozempic can be used alone or in combination with other diabetes medications, such as metformin or sulfonylureas. Therefore, a healthcare provider may recommend a combination of Ozempic and metformin if blood sugar levels are not controlled with either medication alone.
Clinical trials show that Ozempic and metformin can be effective for weight loss. One study found that semaglutide reduced body weight by around 15% after over a year. In contrast, metformin reduces body weight by an average of 5%. These medications need to be used in combination with a healthy diet and exercise plan for the best results.
Other diabetes medications, such as Rybelsus (semaglutide oral), Trulicity (dulaglutide), and Victoza (liraglutide), are available to treat Type 2 diabetes. The best treatment option will depend on your overall medical condition and other medications you may be taking.
Coverage and cost comparison of Ozempic vs. metformin
Ozempic and metformin are prescription drugs that Medicare and insurance plans usually cover. Without insurance, the retail price may be expensive. The costs can vary depending on the pharmacy location and the quantity prescribed. A SingleCare coupon may help reduce the cost of Ozempic and metformin. Sometimes, the cost with a SingleCare coupon may be lower than the price with insurance.
| Ozempic | Metformin | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Quantity | 1 prefilled injection pen | 60, 500 mg tablets |
| Typical Medicare copay | $25-$979 | $0-$8 |
| SingleCare cost | $800 | $2 |
Common side effects of Ozempic vs. metformin
Ozempic and metformin share similar side effects. The most common side effects of Ozempic include gastrointestinal side effects, such as nausea, vomiting, diarrhea, an upset stomach, and constipation. The most common side effects of metformin include headache, weakness (asthenia), nausea, vomiting, diarrhea, and an upset stomach.
Serious side effects of Ozempic and metformin can vary. However, using either medication may increase the risk of hypoglycemia (low blood sugar). Symptoms of hypoglycemia include shaking, sweating, dizziness, and confusion.
| Ozempic | Metformin | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Nausea | Yes | 16% | Yes | 26% |
| Vomiting | Yes | 5% | Yes | 26% |
| Diarrhea | Yes | 9% | Yes | 53% |
| Abdominal pain | Yes | 7% | Yes | 6% |
| Constipation | Yes | 5% | No | – |
| Weakness | No | – | Yes | 9% |
| Indigestion | Yes | 4% | Yes | 7% |
| Headache | No | – | Yes | 6% |
This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Ozempic), DailyMed (Metformin)
Drug interactions of Ozempic vs. metformin
Ozempic and metformin can interact with other medications, leading to potentially serious side effects. Taking Ozempic or metformin with insulin or insulin secretagogues like sulfonylureas may increase the risk of hypoglycemia.
Certain medications, such as corticosteroids, oral contraceptives, diuretics, and calcium channel blockers, can affect the body’s ability to manage blood sugar levels. The use of Ozempic or metformin should be monitored while taking other medications that can affect blood sugar control.
Metformin can interact with carbonic anhydrase inhibitors, leading to an increased risk of lactic acidosis. This rare condition can be serious and cause symptoms such as weakness, diarrhea, decreased appetite, and fast breathing.
Ozempic delays gastric emptying, which may affect the absorption of oral medications. However, clinical trials have not shown that Ozempic affects the absorption of other medications in a clinically significant way.
| Drug | Drug Class | Ozempic | Metformin |
| Topiramate
Acetazolamide Zonisamide |
Carbonic anhydrase inhibitors | Yes | Yes |
| Insulin aspart
Insulin lispro Insulin glargine |
Insulin | Yes | Yes |
| Glipizide
Glimepiride |
Sulfonylureas | Yes | Yes |
| Hydrochlorothiazide
Indapamide Chlorthalidone |
Diuretics | Yes | Yes |
| Prednisolone
Prednisone Dexamethasone |
Corticosteroids | Yes | Yes |
| Ethinyl estradiol
Norethindrone Progesterone |
Estrogens and oral contraceptives | Yes | Yes |
| Amlodipine
Verapamil Nifedipine Diltiazem |
Calcium channel blockers | Yes | Yes |
Consult a healthcare professional for other possible drug interactions
Warnings of Ozempic and metformin
Animal studies have shown that Ozempic may increase the risk of thyroid cancer. People with a personal or family history of thyroid tumors or multiple endocrine neoplasia syndrome type 2 (MEN 2) should avoid Ozempic. The use of Ozempic is linked to other warnings including:
- Increased risk of pancreatitis
- Vision problems from diabetic retinopathy
- Acute kidney injury
- Gallbladder problems
Cases of lactic acidosis have been reported in people using metformin. Lactic acidosis is a potentially life-threatening condition that can cause symptoms such as weakness, muscle pain, drowsiness, and abdominal pain. Risk factors include kidney problems, liver impairment, age over 65, heart failure, and heavy alcohol use. Other metformin warnings include:
- Vitamin B12 deficiency
- Hypoglycemia
Allergic reactions are possible while taking these medications. Signs and symptoms of an allergic reaction include hives, rash, swelling of the face or throat, and trouble breathing. Seek immediate medical attention if you experience an allergic reaction.
Frequently asked questions about Ozempic vs. metformin
What is Ozempic?
Ozempic is a medication produced by Novo Nordisk that is taken as a weekly injection. It is used to treat Type 2 diabetes by managing blood sugar levels. It is also approved to reduce the risk of heart attack, stroke, and death in people with Type 2 diabetes and heart disease. The generic name of Ozempic is semaglutide.
What is metformin?
Metformin is a medication commonly used as a first-line agent for Type 2 diabetes. It works by reducing the amount of sugar produced by the liver and improving the absorption of sugar into the body’s cells. Metformin is an oral diabetes drug known by brand names, such as Glucophage and Riomet.
Are Ozempic and metformin the same?
Ozempic and metformin are used to treat Type 2 diabetes, but they are not the same. They work differently and have different formulations. Ozempic is a brand-name drug that contains semaglutide, while metformin is a generic drug. Ozempic is a GLP-1 receptor agonist, while metformin is a biguanide.
Is Ozempic or metformin better?
Ozempic may be more appropriate for someone with Type 2 diabetes and heart disease because it can reduce the risk of cardiovascular problems. However, metformin is a common first-line diabetes medication. A healthcare provider will determine the best option based on a person’s overall health. In some cases, Ozempic and metformin may be used together.
Can I use Ozempic or metformin while pregnant?
Ozempic should not be used during pregnancy due to an increased risk of harmful effects on unborn babies. Metformin has a low risk of causing congenital disabilities and is considered safer than Ozempic for use during pregnancy. However, it is important to consult a healthcare provider for the best treatment options while pregnant or breastfeeding.
Can I use Ozempic or metformin with alcohol?
It is not typically recommended to drink alcohol while taking Ozempic, metformin, or other diabetes medications. Drinking alcohol could increase the risk of hypoglycemia while taking diabetes medications, as alcohol can affect blood sugar levels. Heavy alcohol use is a risk factor for lactic acidosis with metformin. Consult a healthcare provider before drinking alcohol with any medications.
