Written on July 30, 2023 by Gillian (Gigi) Singer, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Both Ozempic® and metformin are medications that treat type 2 diabetes, but recently Ozempic® has also been used for weight management. The Mayo Clinic reports that there are currently over 150 million people worldwide using metformin.
Ozempic®, a semaglutide injection, is often used together with diet and exercise to help control your blood sugar. This medicine is also used to lower the risk of heart attack, stroke, or death in patients with type 2 diabetes and heart or blood vessel disease. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist.
Metformin is “used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. With this type of diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body where it can work properly. Using metformin alone, with a type of oral antidiabetic medicine called a sulfonylurea, or with insulin, will help to lower blood sugar when it is too high and help restore the way you use food to make energy.”
Both medications are considered long-term treatments and are best and most effective when combined with diet and exercise plans.
Additionally, “both Ozempic® and metformin may be recommended off-label for weight loss. For example, these medications may be prescribed for people with obesity or those who are overweight with weight-related problems, such as high blood pressure or high cholesterol. Metformin is sometimes prescribed to manage weight gain caused by certain medications, such as antipsychotics.”
While taking either metformin or Ozempic®, “It is not typically recommended to drink alcohol… Drinking alcohol could increase the risk of hypoglycemia while taking diabetes medications, as alcohol can affect blood sugar levels. Heavy alcohol use is a risk factor for lactic acidosis with metformin. Consult a healthcare provider before drinking alcohol with any medications.”
Despite both medications working to manage high blood sugar levels that are caused by type two diabetes, the drugs have many differences.
Ozempic® is a GLP-1 agonist, subcutaneous injection, whose active ingredient is semaglutide. It is only FDA-approved to treat type 2 diabetes for typical adults over the age of 18 years old. This drug is “also approved to reduce the risk of major cardiovascular events, such as heart attack, stroke, and death, in adults with type 2 diabetes and heart disease.” There is no generic form of Ozempic®.
Metformin is a biguanide medication that can come in the form of an extended-release tablet or as a liquid oral suspension. This drug, which has brand name and generic versions available, can be taken by adults and children starting at ten years old. Metformin is not shown to decrease the risk of major cardiovascular problems, such as heart attack, stroke, and/or death.
Ozempic® is a long-acting medication, whereas metformin is an immediate-release or an extended-release medication. Immediate-release metformin entails taking five hundred milligrams twice daily or eight hundred and fifty milligrams once per day. Extended-release metformin includes between 500 milligrams and 1,000 milligrams once per day in the evening with food.
For Ozempic®: 0.25 mg of the solution is injected under the skin once per week for four weeks. Following these first four weeks, the dosage is increased to 0.5 mg once weekly. After four more weeks, the dosage may be increased to 1 gm per week. Finally, after four more weeks, depending on the treatment response, the dose may be increased again to 2 mg. 
Ozempic® is typically more expensive than metformin. For one prefilled injection pen of Ozempic®, a typical Medicare copay can fall between $25 and almost $1,000. For 6,500 mg tablets of metformin, a typical Medicare copay can be from $0 to $8.
Some side effects overlap between the two drugs, but not all of them. The following are side effects of Ozempic®: nausea, vomiting, diarrhea, abdominal pain, constipation, and indigestion. Metformin may cause nausea, vomiting, diarrhea, abdominal pain, constipation, and indigestion in addition to weakness and headache.
Regarding interactions with other medications :
Regarding their use during pregnancy, Ozempic® should not be used during pregnancy due to an increased risk of harmful effects on unborn babies. Metformin has a low risk of causing congenital disabilities and is considered safer than Ozempic® for use during pregnancy. However, it is important to consult a healthcare provider for the best treatment options while pregnant or breastfeeding.
With telehealth via Everlywell's GLP-1 weight loss program option, you are just three simple steps away from talking to a provider that can prescribe Ozempic®, if appropriate: