Is it safe to take Ozempic and metformin together?

In recent years, the treatment of diabetes has seen tremendous gains in options and effectiveness. It should come as no surprise that drug manufacturers have invested a lot of time and effort into diabetes treatments, as almost 12% of the U.S. population lives with diabetes. That is nearly 40 million Americans.

It can be challenging to control blood sugar with Type 1 or Type 2 diabetes. While a controlled diet, weight loss, and lifestyle changes are key parts of diabetes management, prescription medications will likely be a part of the regimen.

Ozempic and metformin are two highly utilized medications in treating Type 2 diabetes. They treat diabetes in two different ways, but both have been proven highly effective.

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Are Ozempic and metformin the same thing?

Ozempic (semaglutide) is a prescription medication used to treat Type 2 diabetes. It is currently only available as a brand-name drug, and no generic form exists. Ozempic is a glucagon-like peptide-1 (GLP-1) drug indicated as a first-line treatment. This means it is an appropriate first drug choice upon diagnosing Type 2 diabetes. It works by enhancing the body’s insulin secretion. It can be combined with other drugs in treating diabetes, such as various types of insulin or metformin, among others. Ozempic carries an additional FDA-approved indication for the reduction of cardiovascular mortality and cardiovascular events in Type 2 diabetes patients who have established cardiovascular disease. Other GLP-1 drugs for Type 2 diabetes include Trulicity (dulaglutide), Bydureon Bcise (exenatide), and Victoza (liraglutide).

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Metformin is also a first-line treatment prescription drug used to treat Type 2 diabetes. Metformin is a generic drug that has been on the market for many years. The original branded metformin was known as Glucophage. It was initially an immediate-release formulation only, then other formulations, including various extended-release forms, were developed. Metformin works by increasing the body’s sensitivity to insulin. Like Ozempic, it can be combined with other diabetes drugs, including Ozempic.RELATED: Metformin alternatives

Ozempic and metformin can be safely taken together under the supervision of a healthcare provider. A prescriber will monitor blood pressure, body weight, and labs, such as fasting glucose or hemoglobin A1C, to determine treatment success. It is important to understand the differences between the two drugs and their appropriate uses.

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Is Ozempic or metformin better?

Ozempic and metformin are both effective medications in the treatment of diabetes, and both are approved as first-line treatment choices. The guidelines from the American Diabetes Association (ADA) still list metformin as the preferred first treatment option. Other guidelines, such as those from Europe, now prefer a GLP-1 like Ozempic as the initial treatment. When deciding which drug is best, a healthcare provider may consider other factors such as drug administration, concurrent heart disease, price, or the severity of the diabetes diagnosis.

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Drug class

Ozempic is a GLP-1 receptor agonist medication that promotes the body’s ability to produce insulin. It is an injectable drug, but it is not insulin. It is an injection given once a week. All GLP-1 drugs similar to Ozempic are still relatively new to the market, and currently, there is no generic GLP-1 drug.

Metformin belongs to a drug class known as oral biguanides. Metformin increases the sensitivity to insulin in the body. Metformin is an oral drug typically taken twice daily. Metformin is the generic version of the older brand-name drug Glucophage and has been on the market for many years.

Standard dosages

Ozempic is available in pre-filled pens for injection. Patients will start at 0.25 mg once weekly for four weeks, then increase to 0.5 mg. After four additional weeks at 0.5 mg, the dose can be increased to 1 mg and 2 mg four weeks later if needed. Pens are designed for maintenance dosing at 1 mg and 2 mg per injection once the maintenance dose is reached.

Metformin is available in several doses and release mechanisms. The immediate-release tablet formulation is available in 500 mg, 850 mg, and 1000 mg. Several time-release formulations are available in tablet form in doses of 500 mg, 750 mg, and 1000 mg. Some patients find extended-release metformin easier to tolerate due to less severe gastrointestinal side effects. A doctor may initially prescribe a lower dose and build it up until the desired blood glucose control is reached.

Insurance coverage and cost

Insurance may partially cover the cost of Ozempic, though that will be dependent on the plan. Many insurance plans may have a formulary and predetermine which GLP-1 drugs will be covered. It is best to speak with the provider of the plan to determine coverage and copay details. Without insurance, Ozempic may be cost-prohibitive for some. The retail price averages over $1,200 per month without insurance. SingleCare can help significantly with savings. With a SingleCare prescription discount card, there may be savings of more than $400 off the retail price at participating pharmacies.

Metformin treatment is much more cost-efficient due to its generic availability. Metformin is covered by most insurance plans at the lowest copay tier. Even without insurance, metformin is affordable compared to many diabetes drugs. SingleCare makes it possible to get a one-month supply for less than $2. This may be cheaper than the insurance copay.

Side effects

Metformin’s most common side effects involve the gastrointestinal system. Over half of the patients taking metformin will experience diarrhea, which can affect day-to-day living. Nausea, vomiting, flatulence (gas), and indigestion also occur in many patients. These adverse events cause some patients to discontinue metformin. A GLP-1 drug like Ozempic may be a better first-line treatment choice for those patients.

Ozempic can cause gastrointestinal side effects, but they are not as prevalent with Ozempic as with metformin. Diarrhea only occurs in about 8% of patients. Nausea, vomiting, and abdominal pain are also possible. Because Ozempic is an injection, injection-site reactions like swelling, pain, or redness may occur.

Gastrointestinal side effects with both drugs tend to improve with consistent use.

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Risks and restrictions

Do not take either Ozempic or metformin if a known allergy to one of their components exists, or if an allergic reaction to another drug in the same class has occurred. 

Those who cannot take Ozempic are those with a personal or family history of thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN2). Ozempic has been linked to certain types of cancer, and patients should monitor for the development of certain symptoms like persistent hoarseness of the voice, a mass or tumors in the neck, or dysphagia.

Ozempic may be linked to pancreatitis, and it should not be used in patients with a history of pancreatitis. If persistent, severe abdominal pain with or without vomiting after starting a GLP-1 drug occurs, stop the drug and seek care immediately.

Ozempic and metformin are only to be used in the treatment of Type 2 diabetes. They cannot be used for Type 1 diabetes.

Metformin should not be used in patients with metabolic acidosis.

Hypoglycemia, or low blood sugar, is a risk with diabetic treatment, and anyone taking diabetes medications should monitor their glucose levels regularly. Be sure to tell the prescriber about all medications and supplements that are being taken so they can monitor for drug interactions. Make sure the doctor is informed of complete medical history so they can choose the appropriate therapy. 

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Taking Ozempic and metformin together

Achieving adequate glycemic control with Type 2 diabetes mellitus can require more than one medication in some patients. Ozempic and metformin can be taken together with a prescriber’s approval and supervision. These two drugs can work very well together. While Ozempic promotes the body’s ability to produce insulin, metformin works to help the body better use the insulin that is present. Ozempic and metformin can work well as a team to help in achieving optimal blood sugar levels.

Ozempic is a once-weekly injection that should be taken at the same time each week. Metformin is a once-daily or twice-daily oral medication regimen. Ozempic can be given without consideration of meals, but metformin may be better tolerated by patients when taken with meals.

Concerns may arise about the combined potential for side effects. Ozempic and metformin cause similar gastrointestinal concerns, and their occurrence may increase when taking both. This can be minimized with slow-tailored dosing. Many of these effects will subside after consistent use. A doctor will tailor the dose of each medication to control side effects and get the best results from its use. 

The addition of Ozempic to metformin has produced superior results compared to other combinations, including metformin. There is a currently ongoing clinical trial, the SEmaglutide randomized PRAgmatic (SEPRA) trial, which will compare the effects of adding Ozempic to other antidiabetic drugs, including metformin and sulfonylureas. 

Only a healthcare provider can decide what is best for the treatment of diabetes. This article is not intended to be medical advice. Make sure to disclose all medical history and discuss any concerns about adverse events with a doctor.