Ozempic vs Metformin: Which Is Right for You?
If you've been diagnosed with type 2 diabetes, chances are your doctor has mentioned Metformin or Ozempic — or both. These are two of the most widely prescribed diabetes medications in the world, but they work very differently and come with very different price tags.
Here's a straightforward comparison based on FDA-approved prescribing information to help you understand the key differences.
Quick Comparison
| Feature | Ozempic (semaglutide) | Metformin |
|---|---|---|
| Drug Class | GLP-1 receptor agonist | Biguanide |
| How Taken | Weekly injection | Oral tablet, 1-2x daily |
| Primary Use | Type 2 diabetes | Type 2 diabetes |
| Weight Loss | Significant (avg 10-15%) | Modest (avg 2-5%) |
| Generic Available | No | Yes |
| Approximate Cost | $900-1,000/month | $4-20/month (generic) |
| A1C Reduction | 1.0-1.8% | 1.0-1.5% |
| FDA Approved Since | 2017 | 1994 |
How They Work
Metformin
Metformin is the first-line treatment for type 2 diabetes worldwide and has been for decades. It works primarily by reducing the amount of glucose your liver produces and improving your body's sensitivity to insulin. It does not cause your body to make more insulin, which means it rarely causes hypoglycemia (low blood sugar) on its own.
Ozempic
Ozempic (semaglutide) is a GLP-1 receptor agonist — it mimics a hormone your body naturally produces after eating. This slows stomach emptying, reduces appetite, and stimulates insulin release when blood sugar is high. The appetite suppression effect is why Ozempic has become famous for weight loss, though its FDA-approved indication is specifically for type 2 diabetes.
Side Effects Comparison
Common Side Effects of Metformin
- Nausea, especially when starting
- Diarrhea and stomach cramps
- Gas and bloating
- Metallic taste in mouth
- Vitamin B12 deficiency (long-term use)
Most gastrointestinal side effects improve over the first few weeks. Taking metformin with food and using the extended-release (ER) formulation significantly reduces stomach issues.
Common Side Effects of Ozempic
- Nausea (most common, 15-20% of patients)
- Vomiting and diarrhea
- Constipation
- Abdominal pain
- Injection site reactions
Weight Loss
This is where the two drugs differ dramatically. Ozempic produces significant weight loss — clinical trials showed average losses of 10-15% of body weight. Metformin produces more modest weight effects, typically 2-5% body weight loss, mainly because it doesn't increase appetite like some other diabetes drugs.
Cost
The cost difference is enormous. Generic metformin is one of the cheapest prescription drugs available — often $4-20 per month, and it's included on most pharmacy discount lists. Ozempic, with no generic alternative, runs $900-1,000 per month without insurance.
Many insurance plans cover Ozempic for diabetes (though often with prior authorization), but coverage for weight loss use specifically is less common. Patient assistance programs from the manufacturer (Novo Nordisk) may help reduce out-of-pocket costs.
Can You Take Both?
Yes — in fact, many patients take Metformin and Ozempic together. Metformin is often the foundation of diabetes treatment, with Ozempic added when additional blood sugar control is needed. The combination can provide better A1C reduction and weight management than either drug alone.
Which Should You Choose?
Metformin may be better if:
- You're newly diagnosed with type 2 diabetes
- Cost is a significant factor
- You prefer taking a pill over injections
- Your A1C is only moderately elevated
Ozempic may be better if:
- Metformin alone isn't controlling your blood sugar
- Weight loss is an important treatment goal
- You have cardiovascular risk factors (Ozempic has proven heart benefits)
- You don't mind weekly injections