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.
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.
Ozempic has generally been shown to help people lose more weight than metformin, but everyone's experience is different, and weight loss is not guaranteed by either drug – nor is either drug FDA-approved for that purpose.
Possible Ozempic alternatives include Bydureon (exenatide), Victoza (liraglutide), Mounjaro (tirzepatide), Tanzeum (Albiglutide), and Trulicity (dulaglutide).
Can I take Ozempic® with metformin or other diabetes medications? Metformin and Ozempic® (semaglutide) are safe to take together and are often prescribed together for type 2 diabetes and weight management.
But weight loss results on metformin vary. One long term study published in 2019 found that 28.5% of those taking metformin lost about 5% or less of their body weight during the first year. And those who lost weight on metformin during the first year had the greatest success with weight loss during years 6-15 (14).
Additionally, beinaglutide decreased serum insulin levels and ameliorated insulin resistance. Conclusions Beinaglutide is more efficient than metformin at reducing weight and fat mass in patients who are overweight/obese and non-diabetic.
Mounjaro is a more effective drug than Ozempic. As demonstrated above, tirzepatide (the active ingredient in Mounjaro) leads to more clinically significant weight loss and blood sugar reductions than semaglutide (the active ingredient in Ozempic).
Ozempic stimulates the release of insulin and lowers blood sugar. When you abruptly stop using it, the amount of glucose in your body can spike, especially if you have diabetes. Some may end up in the ER due to sheer exhaustion from the blood sugar spikes and crashes.
You're not losing weight or you've gained weight
However, if you're eating healthy and exercising regularly in conjunction with taking Metformin, but your weight hasn't budged or you've gained weight, this could be a sign that you may need to increase your dose or seek an alternative.
An early study of people with diabetes and morbid obesity found significant weight loss after 28 weeks of metformin alongside a healthy diet.
Between these two medications, semaglutide produces more significant weight loss than metformin, but metformin tends to be a more affordable option. But patients can also opt to combine these drugs to maximize their effects with a proper treatment plan.
You've hit a plateau
It's normal to eventually hit a point where your weight loss slows down, especially if you're not working on keeping or building up your muscle mass. Losing muscle along with fat slows your metabolism and can slow down your weight loss.
Ozempic isn't approved for weight loss. But because of how it works, some people taking Ozempic lose weight as a side effect. If you don't have diabetes, taking Ozempic for weight loss is considered an off-label use. Wegovy, a higher-dose version of Ozempic, is approved to help people manage their weight.
For most people, stopping Ozempic cold turkey is not recommended. When to stop Ozempic is an individual decision you should come to with the help of your healthcare provider. If your health provider agrees it's time to stop taking Ozempic, they will provide you with instructions for tapering off your dose.
Novo says oral version of Ozempic leads to 15% weight loss
In the study, which enrolled nearly 700 adults classified as having overweight or obesity, patients treated with a daily semaglutide tablet lost 15.1% of their body weight over the course of 17 months, while those on placebo lost 2.4%, Novo Nordisk said.
Mail order prescription services like CVS Caremark, OptumRX, or Express Scripts may provide Ozempic at lower prices. They can supply a 90-day supply versus 30 days at retail, which may reduce costs depending on your insurance. However, there are delays as medication is shipped to you.
Conclusions: Metformin has no clinically significant effect in reducing visceral fat mass, although it does have a beneficial effect on lipids. This trial lends support to the growing evidence that metformin is not a weight loss drug.
More serious side effects are rare. They include severe allergic reactions and a condition called lactic acidosis, a buildup of lactic acid in the bloodstream. The risk for this is higher among people with significant kidney disease, so doctors tend to avoid prescribing metformin for them.
Current evidence suggests that the weight change associated with metformin is more likely to be due to decreased caloric intake versus increases in energy expenditure. Metformin appears to impact appetite regulation both directly and indirectly due to its gastrointestinal side effects.
The use of metformin by non-diabetics stems from some evidence that metformin can decrease inflammation, protect against cardiovascular disease and cognitive impairment, minimize cancer risk and progression, and prolong life.
Some individuals may actually gain more weight after stopping an obesity drug than they initially lost, Conde-Knape added. Studies have similarly shown weight rebound in people who stop taking Ozempic.
The initial dose is generally 500 to 1000 mg per day, taken with your evening meal. The dose may be increased by 500 mg weekly as tolerated. The maximum dose of extended-release metformin is 2000 mg/day.