Ozempic vs Metformin: Differences, Similarities, and More

By Robynn Lowe
Medically reviewed checkmarkMedically reviewed
August 18, 2022

Managing type 2 diabetes through healthy lifestyle changes is ideal; however, it is not always possible. Sometimes people with type 2 diabetes need medications to control their blood sugar. There are several medications available, Ozempic and metformin being two of them. 

Ozempic is a once-a-week injection, whereas metformin is an oral pill, usually taken twice a day. Both medications help control blood sugar; however, they work differently in the body.

This article explores the differences and similarities between Ozempic and metformin.

Ozempic vs. Metformin

While both medications keep blood sugar in check, there are several differences.

What is Ozempic?

Ozempic’s design is similar to a naturally occurring hormone called GLP-1.

Ozempic works to:

  • Slow down digestion
  • Stimulate insulin release
  • Lower the amount the glucose the liver releases

It comes in a pre-filled injection pen that is easy to use and disposable.

The recommendation is to use Ozempic along with diet and exercise to improve glucose levels in people with type 2 diabetes. However, this medicine does not treat type 1 diabetes

Ozempic is usually only given after a person with diabetes tries other medications.

This medicine also reduces the risk of major heart problems such as heart attack, stroke, or death in people with type 2 diabetes mellitus with a history of heart disease. 

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What is metformin?

People with type 2 diabetes have used metformin for years to manage their disease. 

Metformin works to:

  • Decrease sugar absorption from the intestines
  • Lower the amount of glucose made in the liver
  • Improve insulin sensitivity

It is available in immediate and extended-release tablets, along with oral suspensions. 

This medicine is meant for use along with healthy lifestyle changes such as regular exercise, following a balanced diet, and maintaining a healthy weight. Along with metformin, people can use other diabetes medicines such as insulin and other non-insulin injectables to manage their sugar levels.

Metformin does not treat type 1 diabetes. 

Uses of Ozempic and Metformin

Ozempic and metformin share some similar uses, as discussed below.

Uses of Ozempic

Ozempic is prescribed for treating type 2 diabetes in adults. 

Consider it for people who:

  • Cannot tolerate metformin
  • Have a hemoglobin A1c greater than 1.5% over their target
  • Do not reach their target A1c in three months
  • Have atherosclerosis, heart failure, or chronic kidney disease

In 2014, the Federal Drug Association (FDA) approved Ozempic for chronic weight management.

Those who qualify are adults with obesity or overweight who also have a weight-related condition such as type 2 diabetes, high blood pressure, or high cholesterol

Uses of metformin

The FDA approved metformin as an antidiabetic medication in 1994.

According to the American Diabetes Association (ADA), metformin is usually the first medication prescribed when diagnosed with type 2 diabetes. 

Other non-FDA-approved indications include

Currently, researchers are studying metformin for possible antiaging, anticancer, and neuroprotective uses. 

Ozempic and Metformin Dosages

Ozempic dosages

The initial dose of Ozempic is small; then, after four weeks, it is increased.

Ozempic is a once-a-week subcutaneous injection. 

  • Initial dose: 0.25 mg once a week for four weeks
  • Maintenance dose 0.5mg – 1mg once a week

Metformin dosages

For treating type 2 diabetes with the immediate release pills, the initial dose is usually:

  • 500mg once or twice a day
  • 850 mg once a day

The typical maintenance dose is 850 mg or 1000mg twice a day. 

For treating type 2 diabetes with extended-release pills, the daily dose usually starts at 500 mg or 1000mg once a day and is titrated up weekly in increments of 500mg for six weeks. 

The maximum dose for extended-release pills is 2000mg once a day.

Side Effects of Ozempic vs. Metformin

When starting any new medication, get emergency help for signs of an allergic reaction such as:

  • Hives
  • Trouble breathing
  • Swelling of your lips, tongue, or throat
Ozempic Side EffectsMetformin Side Effects
Low blood sugar
Bloating, gas, or burping
Loss of appetite
Diarrhea or constipation
Call your doctor at once if you experience:
Vision changes
Unusual mood changes
Thought about hurting yourself
Pounding heartbeats or fluttering in your chest
Lump in your neck or trouble swallowing
Hoarse voice
Pain in your upper stomach spreading to your back
Clay-colored stools
Yellow skin and eyes
Low blood sugar symptoms
Lower back pain
Urinating less often
Stomach flu symptoms
Low blood sugar
Get emergency help if you experience signs of lactic acidosis:
Unusual muscle pain
Feeling cold
Trouble breathing
Feeling dizzy, light-headed, tired, or very weak
Stomach pain
Slow or irregular heart rate

This is not a complete list of side effects and others may occur. Call your medical provider for medical advice about side effects. 


Ozempic warnings

Avoid taking Ozempic if you have:

  • Multiple endocrine neoplasia type 2
  • Personal or family history of medullary thyroid cancer
  • Insulin-dependent diabetes
  • Diabetic ketoacidosis

Call your medical provider if you have signs of a thyroid tumor such as

Metformin warnings

Avoid taking metformin if you have a medical history of severe kidney disease, metabolic acidosis, or diabetic ketoacidosis. 

If you need any diagnostic imaging that requires injection of a dye or contrast, such as an x-ray or CT scan, you must let the medical provider know you are taking metformin.

You may need to stop taking it temporarily. 

Although rare, lactic acidosis is a serious potential side effect of taking metformin. Lactic acidosis is a dangerous build-up of lactic acid in your blood.

Get emergency help if you:

Ozempic and Metformin Interactions

Ozempic InteractionsMetformin Interactions
Ozempic can slow digestion which may cause your body to absorb oral medication slower.

Talk to your medical provider about all medications you take, especially:
Other diabetes medicines

There are a total of 245 known drug interactions

Drinking alcohol is not recommended while taking this medication.
Many drugs may interact with metformin making it less effective or increasing your risk for lactic acidosis. 

Some medications increase your risk for hypoglycemia. 
This includes over-the-counter medications, vitamins, and herbal supplements. 

Talk to your medical provider about all medications you take, especially:
Carbonic anhydrase inhibitors
Iodine contrast agents

There are a total of 355 known drug interactions
Drinking alcohol is not recommended while taking this medication.

Cost of Ozempic and Metformin

The cost of medications depends on several factors:

  • If you have health insurance or are cash paying
  • What your health insurance plan covers
  • Which pharmacy you purchase medications from 
  • If you purchase the generic or brand

According to drugs.com, the price of metformin is significantly lower than Ozempic, but again, check with your insurance provider for details. 

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See if Metformin or Ozempic is right for you.

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Can You Take Ozempic and Metformin Together?

Ozempic and metformin are safe to take together. 

If metformin is not keeping your blood sugar in the target range, your medical provider may also prescribe Ozempic. 

Both medications have a low risk of causing low blood sugar, making them safe to take together. 

Because they have different mechanisms of action, taking both may better control your blood sugar. 

Which Is Best?

Determining which medication is best for you depends on how your body works with the medication. Most people with a new diagnosis of type 2 diabetes start taking metformin first. If you control your sugar well, you may not need to change a thing.

However, if you still struggle to keep your sugar within the target range, you can also try Ozempic. Some people prefer to swallow a pill rather than take an injection. While others prefer the ease of a once-a-week injection over remembering to take a pill once or twice a day. 

Get Metformin or Ozempic Online with K Health

Now you can get Ozempic or Metformin online using K Health for just $29 per month.

It’s just three easy steps:

  1. Answer a few simple questions.
  2. Meet your primary care provider.
  3. Get the care you need.

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Frequently Asked Questions

Do Ozempic and Metformin do the same thing?
Ozempic and metformin treat type 2 diabetes by helping manage the blood sugar levels. However, they have different mechanisms of action. Ozempic slows digestion, stimulates insulin release, and lowers the amount of glucose the liver releases. Metformin decreases how much sugar the intestines absorb, lowers the amount of glucose made in the liver, and improves insulin sensitivity.
Can you take Ozempic and Metformin together?
Ozempic and metformin are safe to take together. If metformin is not helping you meet your blood sugar goals, your medical provider may also recommend you take Ozempic.
What is the safest diabetes medication?
Metformin was FDA approved in 1994 for treating type 2 diabetes. The American Diabetes Association recommends it as the first medication for newly diagnosed type 2 diabetes.
What is the equivalent of Ozempic?
Ozempic is in the GLP-1 class of medications. Other medications in this class include: Dulaglutide (Trulicity), Exenatide extended-release (Bydureon bcise), Exenatide (Byetta), Liraglutide (Victoza, Saxenda), Lixisenatide (Adlyxin), and Semaglutide (Rybelsus).
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Robynn Lowe

Robynn Lowe is a board certified Family Nurse Practitioner with over 15 years in the medical field. Robynn received her Bachelor's and Master's degrees from Florida Atlantic University and has been practicing in rural family medicine since. Robynn is married to her college sweetheart, Raymond and they have three awesome children. When Robynn isn't with patients you can find her shopping, coaching her kids sports teams, or spending time on the water.

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