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Ozempic vs. Metformin: Which Medication Is Right for You?

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You’ve probably heard of metformin—the most widely prescribed type 2 diabetes drug in the United States. But Ozempic (also known as semaglutide) may not be on your radar yet. These medications have similarities; both are approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes. 

In addition to Ozempic, semaglutide is also listed under the brand name, Rybelsus—the pill version of the medication. Both are glucagon-like peptide-1receptor agonists (GLP-1s)— we’ll get into the details about what that means in a little bit—while metformin belongs to a different drug class called biguanides. 

Ozempic is often given when metformin—which is first in line to be prescribed— doesn’t work for someone with type 2 diabetes mellitus. 

Healthcare professionals also prescribe Metformin and Ozempic off-label to treat overweight and obesity as part of a holistic approach to weight care. During your weight loss journey with Found, your health care provider may suggest metformin or Ozempic (or in combination). This gives you the most sustainable options to meet your goals in combination with lifestyle changes. 

It’s easy to get confused with different drug names on the market, which is best, and how they work—all totally understandable questions! That’s why we’re here to clarify.

If you have questions about Ozempic vs. metformin and which might be best to take, you’re in the right place. 

Ozempic vs. metformin

Both diabetes drugs help lower blood glucose levels in those people who have high blood sugar and may be insulin resistant. But they do vary in quite a few ways. 

What is Ozempic?

To explore Ozempic vs. metformin, we must first pause to review what GLP-1s are.

GLP-1, or glucagon-like peptide 1,  is a hormone your body secretes in your intestines. It helps produce insulin when you eat and naturally lowers blood sugar. Ozempic copycats the effects of this hormone. 

Ozempic for weight loss is possible because it works to stimulate insulin and slow digestion. Because it plays a role in digestion and regulates appetite, it can make you feel full and eat fewer calories.

In 2021 the FDA approved semaglutide — under the brand name Wegovy — for treating type 2 diabetes and those with obesity or overweight (defined as a body mass index (BMI) of 30 or greater, or people with a BMI of 27 who also have at least one weight-related condition like high cholesterol, high blood pressure, and type 2 diabetes). It’s the first of its kind to be approved for weight loss since 2014.  And insurance companies will cover it as a form of obesity treatment. 

This is fantastic news in the fight against the obesity epidemic for the ongoing treatment of the disease.

What is metformin?

Metformin has been an FDA-approved medication to treat type 2 diabetes since 1994. Unlike Ozempic, metformin doesn’t mimic the GLP-1 hormone. It’s a biguanide that lowers the amount of sugar your intestines absorb, helping decrease how much glucose is made in the liver and improving insulin sensitivity. 

Additionally, it’s used off-label for treating obesity, and metformin is proven to be an effective medication for weight loss. One study of metformin and weight loss in 2001 on 31 non-diabetic obese participants found that after 28 weeks, participants lost an average of 16 pounds. Metformin can also be used side-by-side with other diabetes medications, like Glipizide and insulin, to see what works best and to increase efficacy.

Ozempic vs. metformin: How are they taken?

Good question. Ozempic comes in a prefilled pen that is injected under the skin—usually weekly. Metformin is a pill taken in either immediate or extended-release form, once or twice daily. Your Found health care provider will decide which medication and dosages may be right for you.

Ozempic vs. metformin: Side effects

Like any prescription medication, there can be side effects. Here are some of the most common ones that participants in controlled trials have reported, according to the FDA:

Metformin

  • Low blood sugar (hypoglycemia)

  • Nausea

  • Diarrhea

Ozempic

  • Nausea

  • Diarrhea

  • Vomiting

  • Stomach pain

  • Constipation

  • Gastrointestinal issues

  • Bloating

Metformin vs. Ozempic: Warnings

We want you to be fully aware of what you’re taking. So here’s the run-down on warnings to consider in your metformin vs. Ozempic debate:

Ozempic

In Ozempic drug trials, although extremely rare, thyroid tumors have developed when taking it. If you have trouble swallowing, develop hoarseness, or feel swelling or a lump in your neck—contact your Found health care provider immediately. 

The FDA also warns not to take Ozempic if you have or have a family history of multiple endocrine neoplasia syndrome type 2, medullary thyroid cancer, insulin-dependent diabetes, or diabetic ketoacidosis. So if that’s you, Ozempic isn’t a right fit.

Metformin

The FDA also has a “blackbox warning” on metformin as it carries a serious safety risk of lactic acidosis. This rare but potentially fatal condition causes too much lactic acid in the blood. It can lead to low blood pressure, breathing issues,  heart failure, and even death.

Additionally, metformin may stimulate ovulation in those who are premenopausal and may increase the risk of unintended pregnancy.  If you’re in a sexual relationship that can result in pregnancy, make sure you use at least one form of birth control unless you’re planning on getting pregnant.

Is it safe to take Ozempic and metformin together?

The short answer is yes. A 2017 study looked at the effects of metformin paired with a semaglutide such as Ozempic. Researchers found there were no drug interactions between the two. And additional research suggests combining Ozempic and metformin may make them more effective. 

Ozempic reduces appetite, and when taken with metformin, it can help lower blood glucose levels further.  If your Found health care provider finds that metformin isn’t working for you, they may also prescribe Ozempic. 

Are there any medication interactions?

When considering metformin vs. Ozempic, it’s important to tell your physician about any medications you may be taking, as serious drug interactions can occur. Here’s what we know.

Metformin

Some drugs can make metformin less effective or increase your risk of lactic acidosis or low blood sugar. 

These are some of the things that can interact with metformin:

  • Insulin

  • Carbonic anhydrase inhibitors

  • Cephalexin

  • Cimetidine

  • Dolutegravir

  • Glycopyrrolate

  • Iodine contrast agents

  • Lamotrigine

  • Ranolazine

  • Topiramate

Ozempic

These are some of the drugs that can interact with Ozempic:

  • Insulin

  • Sulfonylureas (these can cause blood sugar levels to drop dangerously low when combined with Ozempic). 

  • Some birth control pills

  • Trulicity (also known as Dulaglutide—another type 2 diabetes medication).

Whether Found’s health care professionals prescribe metformin or Ozempic, you should not drink alcohol because it lowers your blood sugar. Combined with the medications, it may fall too fast, leading to fainting and dizziness.

Ozempic vs. metformin: Which is best?

It truly depends. Several factors determine whether metformin vs.Ozempic is suitable for you, and Found takes a personalized approach to treatment. We’re here to find the best and most sustainable form of treatment.

Also, some folks prefer taking a pill over a weekly injection, and others may like the ease of only having to remember a medication once a week. 

It’s all about finding the medication that’s just right for you. As you talk to your Found health care provider, they’ll go through a complete medical history check and help in your metformin vs. Ozempic debate.

Found offers a science-backed approach to weight care based on your unique biology, psychology, lifestyle, and prescription medication needs. On average, Found members lose 10% of their body weight during their first 12 months. In total, members have lost 750,000 pounds. To start your journey with Found, take our quiz.

* GLP-1 Note: "Found is not currently prescribing GLP-1 medications for weight loss, but we are considering it as a part of our strategy to help members meet their weight-loss goals in the future. Stay tuned for updates on a potential GLP-1 rollout at Found. Until then, we can still help you meet your weight loss goals with our current online weight loss program."

SOURCES

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Corcoran C, Jacobs TF. Metformin. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518983/

Glueck CJ, Fontaine RN, Wang P, Subbiah MT, Weber K, Illig E, Streicher P, Sieve-Smith L, Tracy TM, Lang JE, McCullough P. Metformin reduces weight, centripetal obesity, insulin, leptin, and low-density lipoprotein cholesterol in nondiabetic, morbidly obese subjects with body mass index greater than 30. Metabolism. 2001 Jul;50(7):856-61.

https://pubmed.ncbi.nlm.nih.gov/11436194/

Hausner H, Derving Karsbøl J, Holst AG, Jacobsen JB, Wagner FD, Golor G, Anderson TW. Effect of Semaglutide on the Pharmacokinetics of Metformin, Warfarin, Atorvastatin and Digoxin in Healthy Subjects. Clin Pharmacokinet. 2017 Nov;56(11):1391-1401. doi: 10.1007/s40262-017-0532-6. PMID: 28349387; PMCID: PMC5648738.

Nauck, M. Glucagon-like peptide 1 (GLP-1): a potent gut hormone with a possible therapeutic perspective. Acta Diabetologica 35, 117–129 (1998). https://doi.org/10.1007/s005920050116

Puckey, M., BPharm. (24 May 2022). Metformin. https://www.drugs.com/metformin.html#interactions

Stewart, J., BPharm. (8 June 2022). Ozempic. https://www.drugs.com/ozempic.html#interactions

U.S. Food and Drug Administration. (4 June 2021). FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014

U.S. Food and Drug Administration. (2017). OZEMPIC (semaglutide) injection, for subcutaneous use Initial U.S. Approval: 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/209637lbl.pdf

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