Farxiga vs Ozempic: SGLT2 vs GLP-1 Comparison (Weight Loss, A1C, Cost)

Dapagliflozin (Farxiga) and semaglutide (Ozempic) are both medications used to treat type 2 diabetes, yet they work through entirely different pharmacological pathways. 

Farxiga is an SGLT2 inhibitor an oral medication that lowers blood glucose levels by blocking glucose reabsorption in the kidneys, causing sugar to be eliminated through urine. 

Ozempic is a GLP-1 receptor agonist that lowers blood sugar levels by mimicking the effects of GLP-1, a naturally occurring hormone that stimulates insulin secretion and lowers glucagon secretion from the liver.

TL;DR

• Farxiga (dapagliflozin) and Ozempic (semaglutide) are both widely prescribed diabetes medications, but they belong to different drug classes and serve different clinical priorities. 
• Ozempic is the stronger choice for weight loss (up to 15% of body weight) and A1C reduction (-1.8%), while Farxiga excels in heart failure prevention (-30% hospitalizations) and chronic kidney disease protection (-39% progression). 
• Farxiga is an oral tablet costing roughly $599/month; Ozempic is a weekly injection at about $936/month. 
• Both support blood sugar control and benefits heart health, but through fundamentally different mechanisms. 
• Farxiga primarily removes glucose through the kidneys, while Ozempic slows gastric emptying and enhances insulin secretion. 
• For many patients treated with both conditions, combination therapy delivers the best results.

Head-to-Head Weight Loss: Ozempic 15% vs Farxiga 4-6 lb

When it comes to weight reduction, Ozempic generally leads to greater weight loss compared to Farxiga. Clinical trials demonstrate a clear difference in how these two drug classes affect body weight.

In the SUSTAIN clinical trial program, patients on Ozempic 2 mg achieved approximately 15% total body weight loss over 68 weeks. The mechanism is twofold: Ozempic slows down gastric emptying (helping people feel full longer and reducing the urge to eat) and acts on brain appetite centers to suppress hunger. This promotes significant, sustained promoting weight loss that persists at roughly 12% at two years.

Metric	Farxiga	Ozempic	Winner
Weight Loss	4-6 lb (3-5 kg)	Up to 15% body weight	Ozempic
Mechanism	Calorie loss via urine (200-300 kcal/day)	Appetite suppression + gastric slowing	Ozempic
Appetite Control	Mild indirect effect	Strong central suppression	Ozempic
Sustained at 2 Years	~4 lb maintenance	~12% maintained	Ozempic

Farxiga’s weight loss mechanism is different. Farxiga blocks the SGLT2 protein in the kidneys, preventing glucose reabsorption. The kidneys filter sugar and excrete it in urine removing excess sugar that represents roughly 200-300 calories per day in calorie loss. 

The DECLARE-TIMI 58 trial showed Farxiga users typically lose 3-5 kg (roughly 4-6 lb) in year one, with a plateau at maintenance levels thereafter. As osmotically active molecules are removed, Farxiga’s mechanism also includes a diuretic effect, which pulls extra water out of the bloodstream, contributing to initial weight reduction.

Dosing Comparison: Farxiga 10 mg vs Ozempic 2 mg Weekly

Farxiga is an oral tablet taken once daily, typically in the morning. Patients start at 5 mg and can increase to a maximum of 10 mg daily. Adequate hydration is recommended because Farxiga’s diuretic effect through increased urination can directly impact fluid balance (Farxiga prescribing information).

Ozempic is a once-weekly subcutaneous injection administered via a pre-filled pen into the abdomen, thigh, or upper arm. It follows a 16-week titration schedule starting at 0.25 mg for four weeks, increasing to 0.5 mg, then 1 mg, and finally up to 2 mg. This gradual ramp prevents approximately 80% of initial nausea (Ozempic prescribing information).

Drug	Class	Max Dose	Frequency	Administration
Farxiga	SGLT2 Inhibitor	10 mg	Daily oral	Morning, with hydration
Ozempic	GLP-1 Agonist	2 mg	Weekly subQ	Abdomen/thigh pen injection

Cost Breakdown 2026: Farxiga vs Ozempic Monthly Pricing

Affordability is a crucial consideration when comparing these diabetes medications, as both are typically taken for years rather than months. Farxiga is available in both brand-name and generic forms (generic dapagliflozin launched in 2024), whereas semaglutide (Ozempic) is only available as a brand-name medication with no generic option.

The average retail cost of Farxiga is approximately $599-$680 per month (GoodRx), though GoodRx coupons can bring it as low as $288. Ozempic’s average retail price runs $936-$1,200 per month (GoodRx), making it significantly more expensive. Both medications are typically taken for years, and the ongoing expense of diabetes medications can be a significant burden for patients.

Many insurance plans, including Medicare, typically cover Farxiga. AstraZeneca’s savings card can reduce costs to $0 for eligible commercially insured patients. Novo Nordisk’s Ozempic savings card can lower costs to as little as $25 per month for insured patients.

Pricing	Farxiga	Ozempic	Savings Options
List Price (monthly)	~$599-$680	~$936-$1,200	GoodRx coupons available
Copay Card	$0 eligible	$25 w/ insurance	AstraZeneca / Novo Nordisk
Generic Available?	Yes (dapagliflozin)	No	Farxiga advantage
90-Day Mail Order	~$1,500	~$2,500+	HSA-eligible

A1C Reduction: SGLT2 -0.8% vs GLP-1 -1.8%

For additional glycemic control and lowering blood sugar, Ozempic generally results in greater reductions in HbA1c compared to SGLT2 inhibitors like Farxiga. This difference is consistent across multiple clinical trials and BMI subgroups.

The SUSTAIN trials demonstrated that Ozempic 2 mg reduced A1C by approximately 1.8% from baseline meeting superiority endpoints across all tested populations. Ozempic enhances insulin secretion and reduces appetite, working through multiple pathways to improve blood sugar control.

Farxiga typically lowers A1C by about 0.8% through its insulin-independent mechanism. Because Farxiga helps control blood sugar without requiring the body to produce more insulin, it offers a complementary approach. Notably, the combination of Farxiga and Ozempic can produce an estimated total A1C reduction of approximately 2.5% demonstrating why Farxiga and Ozempic can be used together to manage diabetes effectively.

The ADA 2025 Standards of Care recommend GLP-1 receptor agonists as first-line therapy for patients with BMI >30, while SGLT2 inhibitors are preferred when heart failure or chronic kidney disease is established.

A1C Metric	Farxiga	Ozempic
Year 1 A1C Drop	-0.8%	-1.8%
Fasting Glucose Reduction	~-25 mg/dL	~-50 mg/dL
Mechanism	Insulin-independent (renal glucose excretion)	Insulin secretion + glucagon suppression

Side Effects: Farxiga UTI Risk vs Ozempic Nausea

Both medications carry distinct side-effect profiles tied to their mechanisms. Understanding these differences helps patients and providers weigh the most serious complications and make informed choices.

Farxiga side effects

Because Farxiga primarily removes glucose through the urine, it can lead to urinary tract infections (approximately 9% of Farxiga users) and genital yeast infections due to increased sugar in the urinary tract. Farxiga can cause serious urinary tract infections, including urosepsis and body wide infection, which may require prompt medical treatment.

Additionally, Farxiga’s diuretic effect can cause volume depletion and low blood pressure, particularly in elderly patients or during summer months when dehydration risk is elevated. Farxiga may also increase the risk of diabetic ketoacidosis, especially in individuals with Type 1 diabetes or those with risk factors (FDA Safety Communication).

Ozempic side effects

Ozempic may cause gastrointestinal side effects such as nausea (affecting about 20% of patients in week 4), vomiting, diarrhea, and abdominal pain. Severe stomach pain may indicate pancreatitis Ozempic should be used with caution in patients with a history of pancreatitis. 

In animal studies, semaglutide was associated with thyroid tumors; it is unknown whether Ozempic causes these in humans, but it is contraindicated in patients with a medical history of medullary thyroid carcinoma (Ozempic prescribing information).

Both Farxiga and Ozempic can cause low blood sugar when taken with insulin or insulin-releasing medications such as insulin glargine or sulfonylureas. Both medications can have serious side effects, including pancreatitis and allergic reactions, though these are not common.

Side Effect	Farxiga	Ozempic	Management
Most Common	UTI 9%, yeast infections, dehydration	Nausea 20% (week 4), diarrhea	Hydrate vs slow titration
Serious	Fournier gangrene (0.01%), DKA	Pancreatitis (0.1%), thyroid tumors (animal studies)	Monitor genital infections / abdominal pain
Dropout Rate	~5%	~7%	Equal tolerability long-term

Reality check: Farxiga carries volume depletion risk during summer months. Ozempic’s GI side effects resolve in approximately 90% of patients by month two with proper titration.

Cardiovascular & Renal Outcomes: Comparing Farxiga and Ozempic

Both Farxiga and Ozempic provide heart protection, but they work in different ways and have distinct benefits for cardiovascular disease and kidney disease.

Farxiga can help lower the risk of serious complications, hospitalization, and death in certain adults with heart failure or chronic kidney disease. The DAPA-HF trial demonstrated a 30% reduction in heart failure hospitalizations, while the DAPA-CKD trial showed a 39% reduction in chronic kidney disease progression. 

Farxiga is considered a first-line option for heart failure prevention in people with type 2 diabetes, and recent research confirms that SGLT2 inhibitors like Farxiga offer stronger protection against heart failure and kidney outcomes. Why Farxiga stands out: it treats these conditions even in patients without diabetes.

Outcome	Farxiga	Ozempic	Class Edge
HF Hospitalization	-30%	-20%	SGLT2 (Farxiga)
CKD Progression	-39%	-24%	SGLT2 (Farxiga)
MACE (Heart Attack/Stroke)	17% ↓	26% ↓	GLP-1 (Ozempic)
Kidney Function Preservation	Strong evidence	Emerging evidence	SGLT2 (Farxiga)

Ozempic is proven to reduce the risk of major adverse cardiovascular events (MACE). The SUSTAIN-6 trial demonstrated a 26% reduction in heart attack, stroke and heart related deaths in adults with type 2 diabetes and coronary artery disease or multiple heart risk factors.

Which Is Better? Farxiga vs Ozempic Patient Decision Matrix

Neither medication is universally “better” the right choice depends on your clinical priorities, medical history, and budget. Both support blood sugar control, but through different pathways.

Priority	Best Choice	Why
Maximum Weight Loss	Ozempic	15% body weight vs 4-6 lb
HF/CKD Protection	Farxiga	30-39% risk reduction in clinical trials
Budget / Oral Preference	Farxiga	$599/mo oral tablet vs $936/mo injection
A1C Priority	Ozempic	-1.8% vs -0.8% superiority
Combination Therapy	Both Together	Complementary mechanisms for ~-2.5% A1C

Pharmacological research increasingly supports using both medications together. Because Farxiga blocks glucose reabsorption in the kidneys (an insulin-independent mechanism) and Ozempic improves insulin secretion while suppressing appetite, their combination therapy addresses blood sugar control through non-overlapping pathways. 

Ask your healthcare provider whether the same active ingredient strategies or combination approaches may benefit your treatment plan.