Can a 69-year-old male patient with impaired glucose regulation, currently taking metformin (Metformin Hydrochloride) 1000 milligrams twice daily, discontinue metformin and initiate Ozempic (Semaglutide) for weight loss?

From the Guidelines

Switching from metformin to Ozempic (semaglutide) for weight loss in a 69-year-old male patient should only be done under medical supervision, and the patient should not stop metformin abruptly without consulting his healthcare provider. According to the most recent guidelines, metformin is a commonly used medication that historically has been the first-line treatment for type 2 diabetes, and it is effective and safe, inexpensive, and reduces risks of microvascular complications, cardiovascular events, and death 1. However, for individuals with type 2 diabetes who require initiation or intensification of glucose-lowering therapy to achieve and/or maintain individualized glycemic goals, Ozempic (semaglutide) may be considered as an alternative, especially for those who need to lose weight, as it has been shown to have very high efficacy for weight loss 1.

When considering switching to Ozempic, the patient's overall health status, diabetes control, and treatment goals should be carefully evaluated. If approved by his doctor, the typical starting dose of Ozempic is 0.25 mg injected subcutaneously once weekly for the first 4 weeks, then increased to 0.5 mg weekly, with potential further increases as tolerated. The transition may involve temporarily overlapping medications while Ozempic reaches therapeutic levels. Ozempic works by mimicking GLP-1, a hormone that regulates blood sugar and appetite, making it effective for both diabetes management and weight loss. However, it may cause side effects including nausea, vomiting, and diarrhea, particularly when starting treatment.

Some key points to consider when switching to Ozempic include:

• The patient's kidney function, as metformin is contraindicated in patients with severe kidney disease, but Ozempic may be used with caution in patients with kidney disease 1.
• The patient's risk of cardiovascular disease, as Ozempic has been shown to have cardiovascular benefits 1.
• The patient's weight loss goals, as Ozempic has been shown to be effective for weight loss 1.
• The potential side effects of Ozempic, including nausea, vomiting, and diarrhea, and the need for careful monitoring and dose adjustment as needed.

Overall, the decision to switch from metformin to Ozempic should be made on a case-by-case basis, taking into account the individual patient's needs and health status, and under the guidance of a healthcare provider.

From the FDA Drug Label

The delay of gastric emptying with semaglutide may influence the absorption of concomitantly administered oral medicinal products The potential effect of semaglutide on the absorption of co-administered oral medications was studied in trials at semaglutide 1 mg steady-state exposure. No clinically relevant drug-drug interaction with semaglutide was observed based on the evaluated medications; therefore, no dose adjustment is required when co-administered with semaglutide. Metformin and oral contraceptive drug (ethinylestradiol/levonorgestrel) were assessed at steady state.

The patient can stop metformin and start ozempic, but caution is advised as the drug label does not directly address the safety of stopping metformin and starting ozempic in a 69-year-old male patient. Key points to consider:

• The drug label does not provide direct guidance on stopping metformin and starting ozempic.
• Ozempic may influence the absorption of concomitantly administered oral medications, including metformin.
• No clinically relevant drug-drug interaction with semaglutide was observed with metformin. It is recommended to consult with a healthcare professional before making any changes to the patient's medication regimen 2.

From the Research

Stopping Metformin and Starting Ozempic for Weight Loss

• The decision to stop metformin and start Ozempic (semaglutide) for weight loss in a 69-year-old male patient with type 2 diabetes should be based on individual patient needs and medical history 3, 4.
• Metformin is a well-established first-line treatment for type 2 diabetes, effective in lowering blood glucose levels without increasing the risk of hypoglycemia 5.
• However, newer agents like glucagon-like peptide-1 receptor agonists (e.g., semaglutide) and sodium-glucose cotransporter-2 inhibitors have shown significant positive effects on glycemia and added benefits in patients with obesity, renal disease, heart failure, and cardiovascular disease 3, 4.
• Semaglutide has been shown to be effective in achieving adequate glycemic control in type 2 diabetic patients inadequately controlled with metformin monotherapy, with significant reductions in HbA1c, weight, and fasting blood glucose levels 6.
• The patient's weight loss goals and overall health status should be considered when deciding to switch from metformin to Ozempic, as semaglutide has been shown to be effective in promoting weight loss 7, 6.
• It is essential to consult with a healthcare professional to determine the best course of treatment for the patient, taking into account their individual needs, medical history, and current health status 3, 4, 5, 7, 6.