Ozempic vs. Metformin: 8 Differences You Should Know About

Despite being first introduced in the 1950s, metformin remains a cornerstone treatment in the modern-day management of Type 2 diabetes. Though, there are other medications, like Ozempic (semaglutide), that have emerged in recent years and are worth considering.

Both Ozempic and metformin work well to lower blood glucose (sugar), but there are key differences between them. How they work, how you take them, and the potential benefits and risks are just a few examples of categories in which they differ.

Below are eight differences between Ozempic and metformin, as well as info about how these distinctions might influence your treatment plan.

1. Metformin is a more common first-choice medication than Ozempic

Metformin works well to lower hemoglobin A1C (HbA1C or A1C), or your average blood glucose levels over 3 months. It’s also available as a lower-cost generic. Because of this, metformin is usually a good medication option for most people when lifestyle changes alone aren’t enough to manage Type 2 diabetes.

Ozempic isn’t right for everyone, but there are a few reasons why it may be a good fit for some people. If you need help managing your body weight, Ozempic can cause more weight loss than metformin. And if you have diabetes and heart disease, it can lower your risk of major cardiovascular events (heart attack, stroke, or cardiovascular death). Ozempic also has proven benefits for adults with both Type 2 diabetes and chronic kidney disease (CKD).

Your prescriber will consider your treatment goals, health risks, preferences, and more when making recommendations about which options may be best for you.

2. Ozempic and metformin work differently to lower blood glucose levels

Ozempic belongs to a class of medications called glucagon-like peptide-1 (GLP-1) agonists that work by mimicking a gut hormone called GLP-1. After you eat, Ozempic stimulates your pancreas to release insulin. It also blocks your liver from making extra glucose and slows down how quickly food leaves your stomach.

Metformin is a biguanide medication. It doesn’t cause your pancreas to release insulin, like Ozempic. But it helps your body use its own insulin more effectively. Metformin also decreases the amount of glucose your body makes and absorbs.

Ozempic and metformin work in different but complementary ways. In addition to carrying a low risk of hypoglycemia (low blood glucose), these medications have their own potential benefits. For this reason, it’s possible that you may be prescribed Ozempic and metformin together.

3. Ozempic and metformin are taken differently

One of the most obvious differences between Ozempic and metformin is how they’re taken. Ozempic is available as a once-weekly injection. And metformin is an oral diabetes medication that’s usually taken once or twice a day. There are both immediate-release (IR) and extended-release (ER) metformin products available.

As a longer-acting medication, Ozempic may be more convenient for people who don’t want to remember to take a daily pill. But not everyone is comfortable giving themselves injections. And it’s important to follow the injection steps closely to ensure the full dose is administered, which may be more challenging for those who have arthritis or difficulty seeing.

Interested in Ozempic’s benefits but don’t like injections? Semaglutide, the active ingredient in Ozempic, is available as an oral pill called Rybelsus.

4. Metformin is approved for use in children, but Ozempic is only approved for adults

Metformin is approved to treat Type 2 diabetes in adults and children ages 10 and older. Until 2023, it was the only oral diabetes medication approved for this range of ages.

Ozempic is only approved to treat Type 2 diabetes in adults. However, a few other GLP-1 agonists are approved as diabetes management options for children. These include Trulicity (dulaglutide), Victoza (liraglutide), and Bydureon BCise (exenatide).

If you’re weighing diabetes medication options for your child, metformin is usually the treatment of choice. But if metformin isn’t effective enough, your child’s provider may recommend adding a GLP-1 agonist to their treatment plan. For now, Ozempic isn’t one of those add-on options. 

5. Ozempic and metformin each have their own unique risks

Ozempic and metformin both have reputations for causing digestion-related side effects, including nausea, vomiting, and diarrhea. But they also have their own unique risks to consider.

While rare, pancreatitis (inflammation of the pancreas) and gallbladder disease have been linked to GLP-1 agonists, including Ozempic. Animal studies have also shown an increased risk of thyroid C-cell tumors with these medications, but this risk hasn’t been confirmed in people. It’s also possible that diabetes-related eye problems may worsen while taking Ozempic.

Lactic acidosis (too much lactic acid in your blood) is a rare but serious metformin side effect. If your kidneys aren’t working very well, the risk of lactic acidosis is even higher. Because of this, your prescriber should monitor your kidneys while you’re taking metformin to ensure it is still a safe option. Depending on your kidney function, your prescriber may have you take a lower dose or have you stop taking metformin.

For most people taking Ozempic and metformin, the benefits of the medications outweigh their potential risks.

6. Ozempic can result in greater weight loss than metformin

As mentioned above, Ozempic can cause weight loss as a side effect. In addition to the way it affects your stomach and makes you feel full, Ozempic also acts on areas of the brain that help regulate appetite.

If you have Type 2 diabetes and need help managing your weight, Ozempic can be a good option. On average, people taking the highest Ozempic dose during clinical trials lost about 15 lbs over 40 weeks (about 9 months).

Experts consider metformin to be a “weight-neutral” medication that has the potential to cause modest weight loss. In other words, some people taking metformin don’t lose any weight, while others may notice a small amount of weight loss — typically up to 6 lbs on average.

Keep in mind: Wegovy, a higher-dose version of semaglutide, is specifically approved for weight loss. People who have diabetes (and people who don’t) may be prescribed the medication for this reason. Unlike Ozempic, Wegovy is approved for use in adults and adolescents ages 12 and older.

7. Metformin is available in combination treatments with other diabetes medications, unlike Ozempic

If your blood glucose levels aren’t effectively managed with metformin alone, your prescriber may add another oral medication to your treatment plan. Since metformin is prescribed so frequently, manufacturers often combine it with other medications, in a single, combination pill.

Combination pills can help you stick to your treatment plan, while cutting down on the number of pills you take every day. If you’re taking metformin with another oral diabetes medication, this may be an option for you. A few examples of these combination treatments are:

• Glipizide / metformin

• Janumet (sitagliptin / metformin)

• Synjardy and Synjardy XR (empagliflozin / metformin)

• Xigduo XR (dapagliflozin / metformin)

There are a few combination injections that contain Ozempic in the works, but none of them are available yet. If you’re prescribed Ozempic and another injection (e.g., insulin), you’ll need to inject the medications separately for now.

8. Metformin is available as a lower-cost generic, and Ozempic is a brand name-only medication

When you’re managing a chronic health condition, such as Type 2 diabetes, costs can be a big deal. Refilling your medications every month, for example, can start to add up. If cost is a barrier to starting or sticking with treatment, metformin may be a better, more affordable option.

Metformin has been around for decades, so there are many lower-cost generic versions available. With a free GoodRx coupon, the price of generic metformin IR may be as low as $9.00 at certain pharmacies. And the price of generic metformin XR may be as low as $11.70.

Ozempic is only available as a brand-name medication. The best way to save on Ozempic is to use insurance if you have it. If the cost is still high because of your copay, manufacturer copay cards can help make your prescription more affordable. If you’re eligible, you could pay as little as $25 a month for Ozempic. A patient assistance program is also available and may be able to help you access Ozempic at no cost.

Another option is using GoodRx. If you're new to using GoodRx for Ozempic savings, pay an introductory price of $199 per month for the first two fills (only available for certain doses). After that, most ongoing fills are priced at $349 per month, depending on the dose.

Can you take Ozempic and metformin together?

Yes, it’s OK to take Ozempic and metformin together if your prescriber recommends this combination. The two medications work in different ways and can have additive beneficial effects.

If you’re taking metformin, for example, your prescriber may add on a medication like Ozempic for its body weight, cardiovascular, or kidney benefits. The right combination for you can depend on your treatment goals, risk factors, and preferences. Insurance coverage can also influence your treatment plan.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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