Table of ContentsView AllTable of ContentsRybelsusMetforminKey DifferencesWhich Works Better?DosingSide EffectsPrecautionsDrug Interactions
Table of ContentsView All
View All
Table of Contents
Rybelsus
Metformin
Key Differences
Which Works Better?
Dosing
Side Effects
Precautions
Drug Interactions
Rybelsus is a glucagon-like peptide-1 (GLP-1) agonist available as a tablet. It is used to treat type 2 diabetes. Metformin is a biguanide drug available as a tablet and an oral liquid. It is also used to treat type 2 diabetes, and is approved to be used in younger people compared to Rybelsus, which is only approved for adults.
Both of these drugs lower blood sugar levels associated with type 2 diabetes, but they work in different ways to control levels, come with a different range of side effects, and may be available at a significant difference in cost depending on your insurance coverage.
This article compares Rybelsus and Metformin, including how they work, their side effects, and their cost.
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What Is Rybelsus?
Rybelsus is indicated for blood sugar control in adults with type 2 diabetes and is used in addition to diet andexercise.
Semaglutide is a drug contained in other products, such asOzempic, an injection used to control blood sugars, andWegovy, an injection indicated for weight loss. All of these semaglutide products are dosed differently. Rybelsus may help you lose some weight, but it is not a weight-loss drug.
How Does Rybelsus Work for Type 2 Diabetes?
What Is Metformin?
Metformin is a type 2 diabetes medication as well, available generically but also sold under many different brand names, such as Glucophage (now discontinued), Glumetza, and Fortamet. Formulations may be tablets or liquid, regular or extended release.
Metformin is indicated for blood sugar control in adults and children 10 years and older with type 2 diabetes, used in addition to diet and exercise. This is very similar to the indication for Rybelsus, but the Rybelsus is only indicated for adults.
How Does Metformin Work for Type 2 Diabetes?
Metformin is the active ingredient in the medication and is the only drug currently available that belongs to thebiguanidedrug class. Metformin works in several different ways to control blood sugar, including:
Rybelsus vs. Metformin: Key Differences
Key differences between Rybelsus and metformin are:
If this decrease is not enough, you may end up taking both of these drugs together or either one with another type of diabetes medication. Some studies have shown that metformin plus another diabetes medication, like a GLP-1 agonist (such as Rybelsus), is more effective at lowering A1c than metformin alone.
Metformin may have an additionalcardiovascular benefitcompared to Rybelsus, but if weight loss is a more important focus, Rybelsus may be the better choice.
Dosing: How to Take Rybelsus and Metformin
Metformin is available as an oral tablet (both regular and extended-release formulas) and an oral liquid. If you take extended-release tablets, you may take them once a day. You may take regular-release tablets or oral liquid up to twice a day.
You will likely start at a metformin dose of around 500 to 1,000 milligrams (mg) once daily, and your healthcare provider may slowly increase your dose as you tolerate it up to 2,500 mg per day. Other tips for taking metformin correctly include:
Rybelsus is available only as an oral tablet, taken once daily. You will most likely start at a dose of 3 mg daily and may increase to 7 or 14 mg daily as needed for additional blood sugar control.
Take Rybelsus first thing in the morning, at least 30 minutes before you take other oral medications or have anything to eat or drink. Tips for taking Rybelsus correctly include:
Can You Take Rybelsus and Metformin Together?
If your blood sugar is not well controlled enough with only one option or the other, you may be prescribed both Rybelsus and metformin. Since these medications work differently, they may be taken at the same time.
Some studies have shown that metformin plus another diabetes medication like a GLP-1 agonist (such as Rybelsus) is more effective at lowering A1c than metformin alone.
The most common side effects that Rybelsus may cause include:
Some safety warnings that should be considered more carefully than the above-listed side effects for Rybelsus include:
Special precautions to be aware of before you start taking metformin include:
These drugs can interact with diabetes medications that lower blood glucose, including each other. If your healthcare provider puts you on multiple drugs to treat diabetes, make sure you have a plan to monitor your glucose regularly and are familiar with signs ofhypoglycemia(low blood sugar).
Remember to take Rybelsus at least 30 minutes before you eat, drink, or take any other oral medications because these can affect its absorption. You want this to be consistent to avoid high and low blood glucose levels. Other interactions include:
The interactions above with chloroquine and fluoroquinolone medications apply to metformin as well.
Metformin comes with a risk oflactic acidosis(high lactic acid levels in the blood). This risk can be increased if you also take medications such as carbonic anhydrase inhibitors such asDiamox(acetazolamide), Tagamet (cimetidine), Ranexa (ranolazine), or Topamax (topiramate).
Another unique interaction is between metformin and contrast media, which may be injected when imaging is needed, such as computed tomography (CT) or positron-emission tomography (PET) scans. Make sure your healthcare provider is aware that you take metformin in this case, as you may need to temporarily stop taking it until your scan is complete.
Summary
Metformin is a first-choice treatment for type 2 diabetes and has been used for decades. It is available as a regular tablet, an extended-release tablet, and an oral liquid.
It effectively lowers blood glucose and A1c levels but may cause side effects that are difficult for some people to tolerate, such as nausea or diarrhea. It is sold under multiple generic and brand-name products and is an affordable medication.
Rybelsus, a GLP-1 agonist, is another popular choice for treating type 2 diabetes. It is available only as a brand-name oral tablet (unlike injectable medications) and may be more expensive for some people. However, it may cause fewer side effects than metformin and may be a good option for people trying to lose weight.
Most people start on metformin first but may end up taking both of these medications if blood sugar is not well enough controlled with metformin alone, as an add-on to diet and exercise.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: Rybelsus—oral semaglutide tablet.Smits MM, Tonneijck L, Muskiet MH, Kramer MH, Cahen DL, van Raalte DH.Gastrointestinal actions of glucagon-like peptide-1-based therapies: glycaemic control beyond the pancreas.Diabetes Obes Metab. 2016;18(3):224-35. doi: 10.1111/dom.12593Lv Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne). 2020;11:191. doi:10.3389/fendo.2020.00191Food and Drug Administration.Riomet ER prescribing information.Almandoz JP, Lingvay I, Morales J, Campos C.Switching between glucagon-like peptide-1 receptor agonists: rationale and practical guidance.Clin Diabetes. 2020;38(4):390-402. doi:10.2337/cd19-0100King A, Miller EM.Glucagon-like peptide 1 receptor agonists have the potential to revolutionize the attainment of target A1C levels in type 2 diabetes-so why is their uptake so low?Clin Diabetes. 2023;41(2):226-238. doi:10.2337/cd22-0027Han Y, Xie H, Liu Y, et al.Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis.Cardiovasc Diabetol. 2019;18(1):96. doi:10.1186/s12933-019-0900-7
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: Rybelsus—oral semaglutide tablet.Smits MM, Tonneijck L, Muskiet MH, Kramer MH, Cahen DL, van Raalte DH.Gastrointestinal actions of glucagon-like peptide-1-based therapies: glycaemic control beyond the pancreas.Diabetes Obes Metab. 2016;18(3):224-35. doi: 10.1111/dom.12593Lv Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne). 2020;11:191. doi:10.3389/fendo.2020.00191Food and Drug Administration.Riomet ER prescribing information.Almandoz JP, Lingvay I, Morales J, Campos C.Switching between glucagon-like peptide-1 receptor agonists: rationale and practical guidance.Clin Diabetes. 2020;38(4):390-402. doi:10.2337/cd19-0100King A, Miller EM.Glucagon-like peptide 1 receptor agonists have the potential to revolutionize the attainment of target A1C levels in type 2 diabetes-so why is their uptake so low?Clin Diabetes. 2023;41(2):226-238. doi:10.2337/cd22-0027Han Y, Xie H, Liu Y, et al.Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis.Cardiovasc Diabetol. 2019;18(1):96. doi:10.1186/s12933-019-0900-7
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
DailyMed.Label: Rybelsus—oral semaglutide tablet.Smits MM, Tonneijck L, Muskiet MH, Kramer MH, Cahen DL, van Raalte DH.Gastrointestinal actions of glucagon-like peptide-1-based therapies: glycaemic control beyond the pancreas.Diabetes Obes Metab. 2016;18(3):224-35. doi: 10.1111/dom.12593Lv Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne). 2020;11:191. doi:10.3389/fendo.2020.00191Food and Drug Administration.Riomet ER prescribing information.Almandoz JP, Lingvay I, Morales J, Campos C.Switching between glucagon-like peptide-1 receptor agonists: rationale and practical guidance.Clin Diabetes. 2020;38(4):390-402. doi:10.2337/cd19-0100King A, Miller EM.Glucagon-like peptide 1 receptor agonists have the potential to revolutionize the attainment of target A1C levels in type 2 diabetes-so why is their uptake so low?Clin Diabetes. 2023;41(2):226-238. doi:10.2337/cd22-0027Han Y, Xie H, Liu Y, et al.Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis.Cardiovasc Diabetol. 2019;18(1):96. doi:10.1186/s12933-019-0900-7
DailyMed.Label: Rybelsus—oral semaglutide tablet.
Smits MM, Tonneijck L, Muskiet MH, Kramer MH, Cahen DL, van Raalte DH.Gastrointestinal actions of glucagon-like peptide-1-based therapies: glycaemic control beyond the pancreas.Diabetes Obes Metab. 2016;18(3):224-35. doi: 10.1111/dom.12593
Lv Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne). 2020;11:191. doi:10.3389/fendo.2020.00191
Food and Drug Administration.Riomet ER prescribing information.
Almandoz JP, Lingvay I, Morales J, Campos C.Switching between glucagon-like peptide-1 receptor agonists: rationale and practical guidance.Clin Diabetes. 2020;38(4):390-402. doi:10.2337/cd19-0100
King A, Miller EM.Glucagon-like peptide 1 receptor agonists have the potential to revolutionize the attainment of target A1C levels in type 2 diabetes-so why is their uptake so low?Clin Diabetes. 2023;41(2):226-238. doi:10.2337/cd22-0027
Han Y, Xie H, Liu Y, et al.Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis.Cardiovasc Diabetol. 2019;18(1):96. doi:10.1186/s12933-019-0900-7
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