Rybelsus is an oral medication containing semaglutide, primarily prescribed for adults with type 2 diabetes to manage blood sugar levels and reduce the risk of major cardiovascular events. Although not explicitly approved as a weight loss drug, many individuals have experienced weight loss while taking Rybelsus. This article examines how Rybelsus is used, its effectiveness for weight loss, and important considerations for its safe and proper use.
What is Rybelsus?
Rybelsus contains the active ingredient semaglutide, a GLP-1 receptor agonist. GLP-1 receptor agonists mimic a naturally-occurring hormone produced in the gut, triggered in response to food intake. This hormone stimulates insulin production, reduces glucagon secretion, and slows gastric emptying, leading to a feeling of fullness. Semaglutide also acts on receptors in the brain to regulate appetite and food intake.
Rybelsus for Type 2 Diabetes
Rybelsus is used to lower blood sugar (glucose) levels by increasing insulin release, slowing gastric emptying, and decreasing glucagon secretion. It is also prescribed to reduce the risk of major cardiovascular events, such as heart attack, stroke, or death, in adults with type 2 diabetes mellitus who are at high risk for these events.
Rybelsus and Weight Loss
Although Rybelsus is not specifically a weight loss drug, studies have shown that many people lose weight while taking it. In a 6-month study of patients taking Rybelsus for diabetes, participants experienced an average weight loss of 8 pounds.
Off-Label Prescribing
Sometimes, Rybelsus is prescribed "off-label" for weight loss, meaning it is used for a purpose different from its approved indication. This occurs when experts recognize benefits of the medication for an alternative purpose, even if the manufacturer has not yet extended the license. Semaglutide, the active ingredient in Rybelsus, is already prescribed for weight loss under the brand name Wegovy.
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How Semaglutide Aids Weight Loss
Clinical trials have demonstrated the effectiveness of semaglutide in promoting weight loss. A study comparing semaglutide to a placebo found that obese patients lost significantly more weight when taking semaglutide. Over the 68-week trial, most participants lost over 10% of their body weight, and more than half lost more than 15%. Another clinical trial comparing weight loss results among patients taking different anti-obesity medications found that participants taking semaglutide lost more weight than those taking other medications, such as phentermine, liraglutide, and naltrexone.
How to Use Rybelsus for Weight Loss
Rybelsus should be used in conjunction with a healthy diet and lifestyle to achieve the best results for weight loss.
Dosage and Administration
Rybelsus comes in tablet form and contains varying doses of semaglutide. The medication should be taken as directed by a healthcare practitioner. Typically, treatment starts with a low dose, gradually increased over time.
Rybelsus is available in two formulations, R1 and R2, each with different strengths:
Rybelsus formulation R1:
- 3 mg
- 7 mg
- 14 mg
Rybelsus formulation R2:
- 1.5 mg
- 4 mg
- 9 mg
The typical dosage depends on the formulation prescribed by the doctor.
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Rybelsus formulation R1:
- Starting dose: 3 mg once daily for 30 days
- Increased dose: 7 mg once daily after 30 days
- Maximum dose: 14 mg once daily, if needed, after at least 30 days on the 7 mg dose
Rybelsus formulation R2:
- Starting dose: 1.5 mg once daily for 30 days
- Increased dose: 4 mg once daily after 30 days
- Maximum dose: 9 mg once daily, if needed, after at least 30 days on the 4 mg dose.
The doctor will monitor the patient's response to the drug and adjust the dosage as needed.
Important Instructions for Use
- Empty Stomach: Take Rybelsus on an empty stomach in the morning with a sip of plain water (4 ounces or less). Avoid other liquids besides water.
- Timing: Take Rybelsus at least 30 minutes before the first food, drink, or oral medication of the day.
- Swallow Whole: Consume the tablets whole without splitting, breaking, or chewing them to ensure proper absorption.
- Consistency: It's best not to take Rybelsus at night since food in the stomach can impair its absorption. The manufacturer specifically recommends taking Rybelsus in the morning.
Dietary and Lifestyle Recommendations
- Healthy Diet: Follow a balanced diet that includes foods high in fiber and protein.
- High in Fiber: Fresh fruits, vegetables, beans, legumes, brown rice, and oats.
- High in Protein: Seafood, eggs, yogurt, nuts, and seeds.
- Avoid Certain Foods: Limit or avoid foods high in trans or saturated fats, processed foods, and added sugars.
- High in Trans or Saturated Fats: Fried foods, processed meats, full-fat dairy products, and butter.
- Highly Processed and High in Added Sugars: Candy, soda, packaged baked goods, and certain fruit juices.
- Limit Alcohol: Reduce or eliminate alcohol consumption, as it can add significant calories without nutritional benefits.
- Regular Exercise: Incorporate regular physical activity into your routine.
- Adequate Sleep: Ensure you get enough sleep to help avoid weight gain.
Safety and Side Effects
Rybelsus has been approved for the treatment of type 2 diabetes since 2019. Before receiving a prescription for Rybelsus, a healthcare practitioner will review your suitability for the medication.
Common Side Effects
The most common side effects of Rybelsus include gastrointestinal disorders such as:
- Nausea
- Stomach pain
- Diarrhea
- Vomiting
- Constipation
These side effects are common with weight loss medications and tend to resolve as the body adjusts to the medication. Diarrhea and vomiting can lead to dehydration, which is dangerous, especially for individuals with kidney problems.
Serious Side Effects
More serious side effects of Rybelsus include:
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- Pancreatitis (swelling of the pancreas)
- Problems with vision in patients with diabetes (diabetic retinopathy)
- Low blood sugar (hypoglycemia), especially when taken with other medications that lower blood sugar, such as insulin or sulfonylureas. Symptoms of low blood sugar include anxiety, blurred vision, confusion, fast heartbeat, headache, nausea, shakiness, and unusual tiredness or weakness.
- Serious allergic reactions, including anaphylaxis and angioedema. Symptoms include rash, itching, hoarseness, swelling of the face, lips, tongue, or throat, trouble breathing or swallowing.
- Kidney problems, including acute kidney injury. Symptoms include bloody urine, decreased urine output, muscle twitching, nausea, rapid weight gain, seizures, swelling of the face, ankles, or hands, or unusual tiredness or weakness.
- Severe stomach or bowel problems. Symptoms include belching, bloated or full feeling, blood in stools, constipation, diarrhea, excess air or gas in the stomach, hiccups, nausea, stomach pain, uncomfortable swelling around the anus, or vomiting.
- Gallbladder problems (e.g., cholelithiasis, cholecystitis). Symptoms include stomach pain, indigestion, recurrent fever, severe nausea or vomiting, bloating, or yellow eyes or skin.
- Increased risk of thyroid tumors. Tell your doctor right away if you have a lump or swelling in your neck or throat, trouble swallowing or breathing, or if your voice gets hoarse.
Boxed Warning
Rybelsus has a boxed warning for the risk of thyroid C-cell tumors, as semaglutide caused thyroid C-cell tumors in rodents in laboratory studies. It is unknown whether these effects would occur in people.
Precautions
- Pregnancy: Stop using Rybelsus at least 2 months before planning to become pregnant. Controlling diabetes is very important during pregnancy, as is gaining the right amount of weight.
- Alcohol: Drinking alcohol may cause severe low blood sugar. Discuss alcohol consumption with your healthcare team.
- Other Medicines: Do not take other medicines during the time you are using semaglutide unless they have been discussed with your doctor. This includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
Rybelsus vs. Ozempic
Rybelsus and Ozempic both contain the same active ingredient, semaglutide. They are both marketed as treatments for type 2 diabetes and may be prescribed off-label for weight loss. The main difference is the method of administration: Rybelsus is an oral tablet, while Ozempic is an injection administered into the fatty tissue of the stomach, leg, or arm. Rybelsus is a suitable alternative for people who have difficulties with injections.
Managing Rybelsus Treatment
Regular Monitoring
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.
Low Blood Sugar Management
This medicine does not usually cause hypoglycemia (low blood sugar) unless used with other medicines that lower blood sugar. Symptoms of low blood sugar include anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, fast heartbeat, headache (continuing), nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness.
If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, non-diet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar.
High Blood Sugar Management
Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.
Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination (frequency and amount), ketones in the urine, loss of appetite, stomach ache, nausea or vomiting, tiredness, trouble breathing (rapid and deep), unconsciousness, or unusual thirst.
If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.
Cost and Savings
The cost of Rybelsus can vary depending on the treatment plan, the pharmacy used, and insurance coverage. The manufacturer of Rybelsus provides a savings offer for people with commercial or private insurance. Other resources are also available to help determine the cost and coverage for Rybelsus on the manufacturerâs site.