What's the Difference Between Ozempic and Metformin, and Which One Is Right for You?

Ozempic vs. metformin

Though Ozempic launched into the pop culture lexicon in late 2022, the drug, once known for its catchy commercial jingle, achieved Food & Drug Administration approval for A1C management in 2017. However, another drug designed to assist with type 2 diabetes treatment, metformin, had a 13-year head start, receiving FDA approval in 2004.

Though the two drugs can help people with the same chronic condition, they're markedly different. Is metformin like Ozempic? Which is better, metformin or Ozempic? Regarding the last question (which is better) the answer is personal to the patient. However, knowing the differences between Ozempic vs. metformin is important in taking the reins of diabetes care.

"Understanding the differences in medications allows you to make a smart decision about which medication is the best option for you," says Dr. Avantika Waring, MD, with 9amHealth. "Depending on your specific concern, challenge or medical condition, one medication’s mechanism of action may be a better fit."

OK, so better question: Which is better for you? Doctors settled the score between Ozempic vs. metformin with insights to help advocate for a customized approach to your care.

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What Is Ozempic, and How Does It Work?

Ozempic is a GLP-1 medication approved by the FDA for treating Type 2 diabetes.

"It is a brand name version of semaglutide, which is also in Wegovy, and is sometimes prescribed off-label for weight loss," Dr. Spencer Nadolsky, DO, an obesity and lipid specialist and the medical director of WeightWatchers. "Insurances generally only cover if someone has a diagnosis of type 2 diabetes." Ozempic can cost about $1,000 out of pocket.

Quick detour: Wegovy and Ozempic refer to the same generic drug (semaglutide) produced by Novo Nordisk but are distinct. Dr. Waring notes that Wegovy has a higher maximum dose (2.4 mg) than Ozempic (2 mg). It's also approved for weight loss and to reduce the risk of heart events in people at higher weights, while Ozempic is technically only for diabetes treatment. How does Ozempic help with diabetes treatment and weight?

"Ozempic increases the level of GLP-1 hormone in the body, which works in a few different ways," explains Dr. Waring. "GLP-1 hormone stimulates the pancreas to produce insulin when food is in the system, which helps reduce blood sugar levels."

Though not approved for weight loss, stimulating the GLP-1 receptor helps in that regard.

"This induces satiety and slows the emptying of the stomach, making the person feel full for longer," says Dr. Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center.

Participants lost an average of nearly 15% of their body weight after 68 weeks in trials for the Wegovy dose of semaglutide.

Speaking of dose, Dr. Nadolsky says a person will take Ozempic once weekly. "Ozempic is delivered via an injectable pen," Dr. Nadolsky says. "The needle is ultra-fine and small, so typically, you won’t even feel it."

Related: The Top 6 Ozempic Alternatives Worth Trying, According to a Weight Loss Expert

What Is Metformin, and How Does It Work?

Metformin is approved for type 2 diabetes, though it's prescribed for other reasons. "Metformin is...sometimes used off-label for weight loss and weight-related conditions like polycystic ovarian syndrome, also known as PCOS," Dr. Nadolsky says. "It is also being studied for longevity purposes."

Is metformin like Ozempic? Not really. "Metformin and Ozempic are both medications used to treat type 2 diabetes, but they differ significantly in their composition, mechanisms of action, effectiveness for weight loss, side effects and cost," Dr. Nadolsky says.

For instance, 60 metformin tablets can cost less than $20, compared to the four-figure price tag for Ozempic without insurance. Brand names of this medication include Diabex, Diaformin, Metex and Glucophage.

Also, unlike Ozempic, metformin is taken orally and more frequently. "It comes in two forms, a regular version, which is typically taken twice a day, and an extended-release version, which is taken once a day," Dr. Waring explains.

Dr. Ali echoes sentiments that metformin works differently than Ozempic. "Metformin works by reducing glucose production in the liver and intestinal absorption, as well as increasing insulin sensitivity," Dr. Ali says.

Metformin vs. Ozempic: What Are the Similarities and Differences?

1. Composition and mechanism

Metformin is a generic oral medication. "It primarily works by reducing glucose production in the liver and improving insulin sensitivity, which helps lower blood sugar levels," Dr. Nadolsky says. "For weight loss, it is believed to reduce appetite and cravings, possibly affecting the gut microbiome."

Meanwhile, Ozempic is a brand name. "It is a GLP-1 receptor agonist and is an injection," he explains. "It helps lower blood sugar by enhancing insulin secretion. It helps with weight loss by targeting brain regions that regulate appetite and food intake, making users feel less hungry and fuller faster."

2. Weight loss

Dr. Nadolsky says metformin has been shown to have some effectiveness in weight loss, especially for people with insulin resistance and PCOS. "However, the weight loss effects are generally modest, whereas Ozempic has demonstrated more significant weight loss effects," he explains.

3. Side effects

The two share some potential side effects. "Common side effects of metformin include gastrointestinal issues such as nausea and loose stools," Dr. Nadolsky says. "These can often be mitigated by taking the medication with meals and avoiding high-fat foods."

Ozempic side effects typically go away with time and can also be mitigated. "Strategies to minimize these side effects include eating slowly, drinking clear liquids and avoiding heavy meals," he says.

4. Cost

Price is a significant differentiating factor between the two.

"Metformin is generally affordable, costing between $20 and $30 a month for cash-paying patients," Dr. Nadolsky says. "Many insurance plans cover it as a step-up medication before more expensive treatments like GLP-1 agonists. Ozempic is more expensive...However, insurance coverage and savings cards from the manufacturer can significantly reduce this cost for eligible patients."

5. Administration

Dr. Nadolsky explains that the two drugs are taken differently. "Metformin is taken orally, typically once daily, with the tablet swallowed whole with water," he says. "Ozempic is administered via an injectable pen, with weekly injections. The injection sites can be the thighs or lower stomach."

Related: Thinking About Trying Mounjaro or Zepbound? Here's What You Can Expect Week by Week

Which is Better, Metformin or Ozempic?

It depends. "Both drugs are terrific tools in our toolkit for treating type 2 diabetes and metabolic conditions," Dr. Waring says. "In general, metformin has more long-term data, and because it’s a pill and very affordable, it is recommended as the first therapy for people with type 2 diabetes."

That said, it comes with side effects like diarrhea that you may not avoid by taking Ozempic. "Ozempic, on the other hand, is newer, and while it is safe, we don’t have quite the length of data on this drug," Dr. Waring explains. "Because it is very expensive, injectable, and sometimes in short supply, it’s usually recommended after metformin if an additional medication is needed to treat type 2 diabetes."

Is it Possible To Take Metformin and Ozempic?

Yes. "Combining metformin with Ozempic can be effective in managing type 2 diabetes when one medication alone isn’t sufficiently controlling blood sugar," explains Dr. Raj Dasgupta, MD, an ABIM Quadruple board-certified physician specializing in internal medicine, pulmonology, critical care and sleep medicine and Medical Reviewer for NCOA. "This combination can improve glucose control and support weight loss. This should only be prescribed under close medical supervision to make sure it is done safely."

Dr. Ali agrees. "For a [person without diabetes], only semaglutide should be used for weight management," he says. "Using two medications that lower blood sugar in a patient who [does not have diabetes] can typically lead to hypoglycemia."

Next up: Every Star Who's Admitted to Using Ozempic, Wegovy and Other Weight Loss Drugs (So Far)

Sources

• Ozempic. FDA.

• Dr. Avantika Waring, MD, with 9amHealth

• Dr. Spencer Nadolsky, DO, an obesity and lipid specialist and the medical director of WeightWatchers

• Dr. Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center

• Once-Weekly Semaglutide in Adults with Overweight or Obesity. NEJM.

• Ozempic. GoodRx.

• Metformin. GoodRx.

• Metformin: Mechanisms in Human Obesity and Weight Loss. Current Obesity Reports.

• Dr. Raj Dasgupta, MD, an ABIM Quadruple board-certified physician specializing in internal medicine, pulmonology, critical care and sleep medicine and Medical Reviewer for NCOA