Search for articles or Rx savings
Key takeaways
Metformin alternatives like Precose, Januvia, Victoza, Glucotrol XL, and Actos are available for those who cannot tolerate it or have contraindications.
Each glucose-lowering drug class has unique mechanisms of action, dosing, and side effects.
Switching to a metformin replacement or adding another drug to metformin treatment requires consultation with a healthcare provider.
Metformin is a common, safe, and cost-conscious prescription drug used to treat people with Type 2 diabetes mellitus, prediabetes, and other medical conditions. Metformin is a first-line treatment for Type 2 diabetes management, either as monotherapy (for people with an A1C below 9%) or in combination with another antidiabetic drug (for people with an A1C above 9%). Metformin reduces blood glucose levels by lowering hepatic glucose production, decreasing glucose absorption from food, and increasing insulin sensitivity. Unfortunately, not everyone will be a candidate for metformin therapy, and for others, metformin may not be enough. In those cases, doctors will prescribe an alternative antidiabetic drug or add it to metformin treatment.
Save up to 80% on Metformin with SingleCare Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
RELATED: Diabetes coupons & discount diabetic supplies
Metformin alternatives cost comparison |
|||
|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Metformin | $131 for 60, 500 mg tablets | $6 for 60, 500 mg tablets of generic metformin at Kroger | See latest prices |
| Ozempic (semaglutide) | $1,405 for 1, 3 mL prefilled 2 mg/3 mL multidose pen | $844 for 1, 3 mL prefilled 2 mg/3 mL multidose pen of brand-name Ozempic at Publix | See latest prices |
| Jardiance (empagliflozin) | $823 for 30, 25 mg tablets | $255 for 30, 25 mg tablets of brand-name Jardiance at Kroger | See latest prices |
| Januvia (sitagliptin) | $695 for 30, 100 mg tablets | $286 for 30, 100 mg tablets of brand-name Januvia at Kroger | See latest prices |
| Glucotrol XL (glipizide) | $133 for 90, 5 mg tablets | $16 for 90, 5 mg tablets of generic Glucotrol XL at Kroger | See latest prices |
| Actos (pioglitazone) | $2,111 for 90, 30 mg tablets | $26 for 90, 30 mg tablets of generic Actos at Publix | See latest prices |
| Lantus
(insulin glargine) |
$287 for 1, 10 mL of 100 unit/mL vial | $65 for 1, 10 mL of 100 unit/mL vial at Kroger | See latest prices |
Top 5 metformin alternatives
GLP-1 RAs: Ozempic, Victoza, Trulicity, Mounjaro, Rybelsus
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been a significant advance in the quest for the most effective treatment for Type 2 diabetes. These drugs stimulate insulin release, slow gastric emptying, and suppress appetite. GLP-1 RAs also carry an indication for reducing cardiovascular events such as heart attack, heart failure, and stroke. These drugs are mostly injectables and come in a variety of dosages. Victoza is a once-daily injection, while Ozempic, Trulicity, and Mounjaro are once-weekly injections. Ozempic is also available as a once-daily tablet, as is Rybelsus. Both contain the same active ingredient, semaglutide. Doses are typically increased slowly to reduce GI side effects such as nausea and diarrhea.
SGLT-2 inhibitors: Jardiance, Farxiga, Invokana, Steglatro, Brenzavvy
Sodium-glucose cotransporter 2 inhibitors are, next to metformin and GLP-1 RAs, some of the most commonly prescribed antidiabetic drugs. These drugs also protect the heart, so they are now FDA-approved to treat heart failure and protect the kidneys and the cardiovascular system, even in people without diabetes. Side effects are relatively infrequent, though they do carry a risk for serious urinary tract infections. These drugs also have relatively few drug interactions. SGLT-2 inhibitors decrease blood glucose levels by increasing the body’s elimination of blood sugar through the urine.
DPP-4 inhibitors: Januvia, Tradjenta, Onglyza, Nesina
Januvia, Tradjenta, and Onglyza are dipeptidyl peptidase-4 (DPP-4) inhibitors. There is a hormone in the gastrointestinal tract called glucagon-like peptide 1 (GLP-1), which augments insulin release. It is susceptible to rapid breakdown, but DPP-4 inhibitors slow the degradation of GLP-1 in the gut, allowing for better glucose control through its longer action. There is a low risk of hypoglycemia. DPP-4 inhibitors are oral tablets taken once daily, and each comes in a variety of strengths.
Sulfonylureas: Glucotrol XL
Sulfonylureas treat Type 2 diabetes by stimulating insulin secretion from pancreatic beta cells. After taking sulfonylureas for an extended period, the liver also begins to produce less glucose, and there is increased insulin receptor activity. The risk for severe hypoglycemia with sulfonylureas is greater than with many other treatment options available. Sulfonylureas, like Glucotrol XL, are available as oral tablets in multiple strengths. They typically start with a lower dose taken before breakfast and may increase to higher doses taken twice daily.
Thiazolidinediones: Actos
Thiazolidinediones, such as Actos (pioglitazone), are oral medications given once daily. They bind to receptors in fat cells, thereby increasing insulin sensitivity by reducing circulating fat complexes. Unfortunately, weight gain and increased peripheral fat mass are side effects of thiazolidinediones.
People with Type 2 diabetes may also need to use short-acting or long-acting insulin at some point in time to control blood sugars. It is often used alongside other oral or injectable medications for Type 2 diabetes.
Natural alternatives to metformin
All treatment plans for diabetes care should include diet and lifestyle changes. The American Diabetes Association recommends key actions to improve your diabetes control. Choose foods rich in unsaturated fats, such as fish and olive oil. Decrease intake of saturated fats, such as beef and butter. Decreasing carbohydrate intake is important for blood glucose control. Exercise is a key component of lifestyle modifications, glucose control, and weight loss. Even modest weight loss can convey significant changes in blood glucose levels.
There are claims that some natural supplements, such as berberine, glucocil, and CinSulin, help with blood sugar levels. These supplements have not been studied and approved by the Food and Drug Administration (FDA). Supplements do not require the rigorous testing and manufacturing oversight that prescription and over-the-counter medications undergo. Before using these supplements, please discuss them with your healthcare professionals, such as your healthcare provider or pharmacist.
How to switch to a metformin alternative
If you feel that metformin is not the right therapeutic choice for your diabetes, start by talking to your healthcare provider. Metformin is a first-line therapy because it is highly effective and cost-efficient. Do not stop taking metformin until you have gotten medical advice from your prescriber. Abrupt discontinuation of metformin could lead to high blood sugar. The only reason to abruptly stop taking metformin would be if you have an allergic reaction.
There are a few reasons why you might need add-on drugs or alternatives to metformin. The most important thing is if blood sugar remains stubbornly high even at the maximally tolerated metformin dose. In those cases, another medication may need to be added to treatment or substituted for metformin.
Some people may need a metformin alternative due to ongoing GI side effects or kidney disease. Make sure your labs are up to date so that your healthcare provider can monitor your kidney function. If the decision to switch is made, your healthcare provider will go over your options based on your physical findings and needs. Things to consider will be whether or not you are willing to inject your medication, potential common side effects of other treatments, cost, and the current state of your glycemic control. New medications will likely require dose titration and adjustment for a period of time. Keep in mind it may take some time to find the therapy plan that is right for you.
- Breaking down diabetes: drugs for diabetes, starting with the best—metformin, Stanford Medicine
- Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2024, Diabetes Care (2023)
- Ozempic oral semaglutide tablet/Rybelsus oral semaglutide tablet prescribing information, DailyMed (NIH National Library of Medicine) (2026)
- Pioglitazone hydrochloride tablet prescribing information, DailyMed (NIH National Library of Medicine) (2025)
- Standards of Medical Care in Diabetes—2018, Diabetes Care Supplement 1 (2018)
- Prescription patterns for sodium glucose cotransporter-2 inhibitors in U.S. health systems, DailyMed (NIH National Library of Medicine) (2025)