Can you take metformin and Ozempic together?
Doctors often prescribe metformin and Ozempic to type 2 diabetes. But they can also help with weight loss. Can you take them together?
With aesthetic med spas offering GLP-1 medications for weight loss, responsible prescribing matters more than ever.
Prescriptions for GLP-1 medications like Ozempic® and Wegovy® are a phenomenon that’s outpacing expectations, even among health industry insiders. Here’s perspective: In 2019, providers wrote 1.3 million prescriptions for GLP-1s to adults in the U.S. without diabetes, according to an analysis by Komodo Health, a health information technology company.
Compare that to the number of prescriptions written between January and May 2023: nearly 5.6 million to adults without diabetes. The demand is so steep, insurers are using methods like step therapy to control costs and pace supply. And in May 2023, the U.S. Food and Drug Administration (FDA) added Ozempic and Wegovy to its Drug Shortages List. (As of August 2024, only one dose of Wegovy is in short supply; otherwise, both Wegovy and Ozempic are available.)
As often as they’re hailed as the most effective medications for weight loss, they’re not for everybody. Yet people looking to take a GLP-1 RA (or glucagon-like peptide 1 receptor agonist) don’t have to see a specialist or even their primary care physician to get their hands on these drugs. Medical spas specializing in nonsurgical aesthetic medical services offer them alongside Botox®. They’ve turned up on mass online marketplaces like Groupon.
These types of irresponsible GLP-1 prescription practices are fueling demand for these medications, sometimes for cosmetic or vanity uses, even when drugs like Ozempic and Wegovy have been in short supply. For qualified candidates, these treatments can be life-changing. But, as with any drug, GLP-1s should be used under the close supervision of a health care professional and sourced from state-licensed pharmacies. This is why you should turn to physicians and providers who write GLP-1 prescriptions responsibly.
If you’re considering weight loss medicine, it’s important to understand who qualifies for GLP-1s.* These medications are intended for people with type 2 diabetes and obesity. Currently, only two GLP-1s are approved by the FDA to treat obesity: Wegovy and Saxenda® (liraglutide). Zepbound®, a GLP-1 / GIP medication, is also FDA approved to treat obesity. Ozempic and other GLP-1 receptor agonists are FDA-approved to treat type 2 diabetes.
To qualify for a GLP-1, you must either have type 2 diabetes, a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with a weight-related medical condition like high blood pressure or heart disease. Often, doctors recommend a drug like metformin as the first line of treatment or suggest weight loss through diet and exercise before introducing a GLP-1 receptor agonist.
So what happens if you get a GLP-1 prescription from a local med spa or any provider that’s not reputable? They may not consider your unique biology or medical history, or offer the support you need to successfully lose weight on these medications. Writing a GLP-1 prescription without medical indication or supervision could lead to adverse reactions and severe side effects for patients, and the physician runs the risk of losing their medical license.
It’s essential for physicians to responsibly prescribe drugs in every field of medicine to make sure they’re doing more benefit than harm while minimizing disease. Responsible prescribing reduces risks for both the patient and the prescriber.
A reputable doctor will do three things before prescribing any medication, including GLP-1 prescriptions:
Additionally, if a physician prescribes a medication off-label for weight loss to a patient who qualifies, they can discuss whether the benefits outweigh the risks. Off-label prescribing is a common practice physicians use to prescribe an FDA-approved drug at different doses or for reasons other than what the drug is approved to treat. Off-label prescribing is based on solid clinical evidence.
GLP-1s are not without risks, especially for people with certain underlying conditions. Common side effects include nausea, vomiting, diarrhea, headaches, and acid reflux.
Less common, more serious side effects can also occur, including pancreatitis, gallbladder disease, or worsening of diabetic eye disease.
Some people should not take GLP-1 prescriptions. People who are pregnant or breastfeeding also should not use GLP-1s. People with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasias should not take GLP-1 medications. That’s why it’s especially important to consult your doctor before using these medications to discuss your medical history and potential risks—and while using them to monitor any side effects.
Using care with prescription weight-loss medications is a critical piece of a responsible modern weight-care program. When it comes to prescribing medications like GLP-1s, it's also important for the program to include, as Found’s does, a review of relevant blood work, a portfolio of medication options, and behavioral change support—such as a guided program focusing on healthy eating and exercise, as well as health coaching to help you build sustainable health habits.
At Found, members receive access to health coaching, providers trained in obesity medicine, check-ins at critical moments, and behavioral change guidance in an app with a supportive community. The Found toolkit includes 12 different medications—from generics to brand name GLP-1s—and more than 60 treatment paths customized to members’ unique biology and needs. To see if Found might be right for you, take the quiz today.
*Access to GLP-1s prescriptions is now available as part of Found's weight-loss program. While GLP-1s are effective for weight loss, they are not clinically appropriate for everyone. Eligibility for a GLP-1 is based on a thorough evaluation of medical history, eating behavior, lab work, and insurance coverage. If a GLP-1 is not appropriate or affordable for you, Found providers can help determine if another effective medication is.
About the author
Rekha Kumar, MD, MS, is the chief medical officer at Found and the former medical director of the American Board of Obesity Medicine. She is a practicing endocrinologist who specializes in treating patients with obesity.
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