Can you take Ozempic (semaglutide) and Lantus (insulin glargine) together?

Concurrent Use of Ozempic (Semaglutide) and Lantus (Insulin Glargine)

Yes, Ozempic (semaglutide) and Lantus (insulin glargine) can be safely used together and this combination is often beneficial for patients with type 2 diabetes requiring intensification of therapy beyond oral medications. 1

Rationale for Combination Therapy

The American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) support combining GLP-1 receptor agonists like Ozempic with basal insulin like Lantus when:

• A single medication is insufficient for glycemic control
• The patient has established cardiovascular disease
• Weight management is a priority
• Hypoglycemia risk needs to be minimized 1

Benefits of This Combination

1. Complementary mechanisms of action:

   • Lantus (insulin glargine) provides consistent basal insulin levels over 24 hours with no pronounced peak 2
   • Ozempic (semaglutide) stimulates insulin secretion in a glucose-dependent manner, reduces glucagon secretion, improves satiety, and promotes weight loss 1

2. Clinical advantages:

   • Greater HbA1c reduction compared to insulin alone 3
   • Weight loss with semaglutide counteracts the weight gain typically seen with insulin 3
   • Lower risk of hypoglycemia compared to insulin intensification strategies 3

Administration Guidelines

When using Ozempic with Lantus:

• Administer as separate injections - never mix the products 4
• You may inject in the same body region, but injections should not be adjacent to each other 4
• Ozempic is administered once weekly, while Lantus is administered once daily 4, 2
• Maintain a consistent schedule for both medications

Dosing Considerations

For Ozempic:

• Start with 0.25 mg once weekly for 4 weeks (initiation dose)
• Increase to 0.5 mg once weekly after 4 weeks
• May increase to 1 mg once weekly after at least 4 weeks if additional glycemic control is needed 4

For Lantus:

• Typically started at 10 IU daily and titrated based on fasting glucose targets
• Administer at the same time each day 2
• Dose adjustments should be made gradually (typically every 3-7 days) based on fasting glucose readings

Hypoglycemia Risk Management

When combining these medications:

• Monitor blood glucose more frequently during initiation and dose adjustments
• Consider reducing Lantus dose when starting Ozempic, as GLP-1 receptor agonists may increase the hypoglycemic potential of insulin 1
• Educate patients on hypoglycemia recognition and management
• Ensure patients have rapid-acting carbohydrates available for treating hypoglycemia

Potential Side Effects

• Gastrointestinal effects from Ozempic (nausea, vomiting, diarrhea) - typically transient and mild-to-moderate 5
• Hypoglycemia - risk is lower than with insulin alone but still present 3
• Injection site reactions - may occur with either medication

Monitoring Recommendations

• Regular blood glucose monitoring, especially during initiation
• HbA1c every 3-6 months
• Weight monitoring at each visit
• Assessment for side effects, particularly gastrointestinal symptoms and hypoglycemia

Important Precautions

• This combination should be used cautiously in patients with gastroparesis as semaglutide may delay gastric emptying 5
• Avoid in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 5
• Use with caution in patients with a history of pancreatitis

Clinical Pearls

• If a patient misses an Ozempic dose, they should take it as soon as possible if within 5 days of the scheduled dose 4
• Lantus has a lower risk of nocturnal hypoglycemia compared to NPH insulin 6
• The combination of GLP-1 receptor agonists and basal insulin is preferred over basal-bolus insulin regimens when possible 1