Many people associate the start of a new year with fitness and weight-loss goals. Semaglutide, the active ingredient in Ozempic, Wegovy, and Rybelsus, is a popular medication used to treat Type 2 diabetes or obesity and can help patients lose weight. When it comes to treatments for managing blood sugar levels, there are now more options than ever. If you're considering Rybelsus or Ozempic for Type 2 diabetes management, understanding their differences is crucial. This article explains the main similarities and differences between Rybelsus and Ozempic.
What are Rybelsus and Ozempic?
Rybelsus and Ozempic are two semaglutide medications that Novo Nordisk manufactures to manage Type 2 diabetes. Both Rybelsus and Ozempic are brand-name medications used to improve blood sugar in people with Type 2 diabetes. Both Rybelsus and Ozempic contain the active ingredient semaglutide and work by mimicking a hormone called GLP-1, which increases insulin production and reduces appetite. Semaglutide is a GLP-1 receptor agonist, a type of drug that mimics the effect of a hormone that stimulates insulin secretion and prompts feelings of fullness. Semaglutide was originally developed and approved to treat type 2 diabetes, and it remains a powerful glucose-lowering therapy, it also has a profound effect on body weight.
Ozempic and Wegovy are both semaglutide injections but have different doses and strengths. Wegovy is FDA-approved for weight loss in some adults and children aged 12 and older. Rybelsus is an oral tablet that helps adults manage their Type 2 diabetes by lowering blood sugar levels.
Key Differences: Rybelsus vs. Ozempic
Despite their similarities, Rybelsus and Ozempic differ in how they’re administered and dosed. Although Rybelsus and Ozempic contain semaglutide and help lower blood sugar levels, they come in different dosage forms. The main difference is that Ozempic is an injection and Rybelsus is an oral tablet.
Administration: Rybelsus comes as a tablet that you swallow, while Ozempic is given as a subcutaneous injection. Rybelsus is a once daily tablet that must be taken with only a sip of water on an empty stomach. Ozempic is a weekly injection and can be taken at any time of day, with or without meals. You can administer Ozempic injections at any time, with or without food. Ozempic should be injected into your abdomen, thigh, or upper arm. You should give yourself doses on the same day each week.
Read also: Transformations with Ozempic
Dosage: Rybelsus is the only approved oral form of semaglutide. Rybelsus contains a higher dose of semaglutide than Ozempic. Oral drugs need a higher dose than injected ones because they’re partly broken down in the liver before reaching the bloodstream. The standard dosage of Rybelsus is 7 milligrams (mg) once daily, taken at least 30 minutes before the first meal, drink, or other medications. Ozempic injections begin at a dose of 0.25 mg and increase progressively over four weeks, potentially up to 2 mg. Ozempic, on the other hand, is administered as a once-weekly injectable medication.
- Rybelsus vs. Ozempic Usual dosing: Starting dose is 3 mg by mouth once a day (1.5 mg if taking R2 formulation) for 30 days. Then, the dose is increased to 7 mg (4 mg for R2 formulation) once a day.
- Rybelsus vs. Ozempic Usual dosing: Starting dose is 0.25 mg injected under the skin once a week for 4 weeks. Then, the dose is increased to 0.5 mg once a week. After 4 weeks, the dose may be increased to 1 mg once a week if you need more blood sugar control.
Additional Approvals: While both drugs lower blood sugar in Type 2 diabetes patients, only Ozempic is also approved to lower the risk of heart attack, stroke, and death. The drug label for Ozempic specifically states it can be used to help reduce the risk of cardiovascular events like heart attacks and stroke in people with Type 2 diabetes and heart disease. Recently, Rybelsus was also FDA approved to lower the risk of major heart events in adults with Type 2 diabetes at high risk.
Cost: Ozempic costs about $935 per month without insurance, or it could be as little as $25 per month with a discount card from Novo Nordisk. Rybelsus costs about $500 to $1,000 per month without insurance. The financial impact often plays a decisive role in treatment decisions. Both medications carry substantial monthly costs that can create barriers to long-term adherence, making it essential to understand your insurance coverage options and available cost-saving strategies before starting treatment.
Uses of Rybelsus and Ozempic
Rybelsus and Ozempic are both FDA approved to help manage blood sugar in adults with type 2 diabetes. Both drugs are typically prescribed in combination with a balanced diet and exercise routine. These drugs haven’t been directly compared in clinical studies. However, both Rybelsus and Ozempic have been found effective in helping improve blood sugar levels in people with type 2 diabetes. Because of this, they’re expected to be similarly effective at managing blood sugar levels.
Rybelsus and Ozempic are not approved to treat type 1 diabetes or a complication of diabetes called diabetic ketoacidosis. The drugs also haven’t been studied in people with a history of pancreatitis (inflammation of the pancreas). If you’ve had this condition in the past, your doctor will likely recommend a different diabetes medication. If diet and exercise alone aren’t helping your type 2 diabetes, Rybelsus or Ozempic are add-on options that could be considered.
Read also: Ozempic Meal Plan
Ozempic is also FDA approved to decrease the risk of:
- major heart problems in people with type 2 diabetes and heart disease
- worsening kidney problems and heart-related death in adults with type 2 diabetes and chronic kidney disease (CKD)
Rybelsus isn’t approved for these uses.
Rybelsus and Ozempic for Weight Loss
The active ingredient in Rybelsus and Ozempic, semaglutide, has shown effectiveness for weight loss in some people. However, neither Ozempic nor Rybelsus are FDA approved for this use. Another brand-name semaglutide drug, Wegovy, is approved for weight management in adults and certain children. Because of this, doctors are unlikely to prescribe Rybelsus or Ozempic for weight loss. Many semaglutide users find themselves losing weight without having to consciously cut calories.
Rybelsus and Ozempic may help promote weight loss as a secondary benefit. Although they’re not FDA-approved for weight management, healthcare providers may prescribe them off-label.
Effectiveness of Rybelsus vs. Ozempic
Although no direct studies have compared their effectiveness, both drugs have proven results. Studies have shown that taking Rybelsus and Ozempic each caused weight reductions over 30 weeks. Ozempic 1.0 mg led to a 4.5 kg weight loss, whereas Rybelsus 14 mg led to a 3.7 mg weight loss.
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Some studies suggest Ozempic tends to reduce blood sugar more than Rybelsus. Based on clinical trials, Ozempic can lower blood sugar levels by about 1.5% to 1.8%, while Rybelsus reduces them by roughly 1.0% to 1.4%. In addition, Ozempic may be more effective than Rybelsus in promoting weight loss.
In one study, adults with type 2 diabetes who were identified as overweight or obese took 50 mg of semaglutide once a day. Researchers found that after 68 weeks more patients taking semaglutide lost at least 5% of their body weight compared to those taking a placebo (no active medication). An observational study of patients taking Rybelsus or Ozempic found that both groups experienced similar weight loss (around 6 kg, or 13 lbs) 6 months after starting treatment. The absorption rate may explain this effectiveness gap.
Side Effects and Warnings
Rybelsus and Ozempic can cause some of the same side effects, as well as some different ones. Rybelsus and Ozempic share similar side effects since both contain semaglutide.
Mild Side Effects
The following lists contain some of the more common mild side effects of Rybelsus or Ozempic, and some that both drugs share.
- Can occur with Rybelsus: decreased appetite
- Can occur with Ozempic: injection site reactions, such as skin discoloration or discomfort
- Can occur with both Rybelsus and Ozempic: nausea and vomiting, diarrhea, abdominal pain, constipation, upset stomach, gas, weight loss
These side effects may be temporary, lasting a few days or weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Serious Side Effects
This list contains examples of serious side effects that can occur with Rybelsus and Ozempic when taken individually:
- hypoglycemia (low blood sugar) when used with insulin or other diabetes drugs called sulphonylureas
- allergic reaction
- pancreatitis (swelling or irritation of the pancreas)
- complications of diabetic retinopathy (a form of eye damage due to diabetes), such as worsened eyesight
- sudden kidney problems
- thyroid C-cell tumors
If you have serious side effects while using Rybelsus or Ozempic, call your doctor immediately. If the side effects feel life threatening, or if you believe you’re having a medical emergency, call 911 or your local emergency number right away.
Warnings
Rybelsus and Ozempic may not be right for you if you have certain medical conditions or other factors that affect your health. The two drugs share some of the same warnings, but they also have different ones. Before you start using Rybelsus or Ozempic, be sure to talk with your doctor to see if these warnings apply to you.
Both Rybelsus and Ozempic carry a boxed warning due to an increased risk of thyroid C-cell tumors. Rybelsus and Ozempic carry FDA box warnings due to potential thyroid tumor risks, including cancer. The use of Rybelsus or Ozempic may carry a risk of pancreatitis, diabetic retinopathy, and hypoglycemia. Another potentially serious side effect is acute kidney injury. Rybelsus and Ozempic may cause harm to an unborn baby. Therefore, they should not be used during pregnancy.
You should not take Rybelsus or Ozempic if you or a family member have ever had a type of thyroid cancer called medullary thyroid carcinoma. You also should not take these drugs if you have a rare form of cancer called multiple endocrine neoplasia syndrome type 2. If you develop symptoms of thyroid cancer while taking Rybelsus or Ozempic, see your doctor right away. Symptoms may include trouble swallowing, hoarseness that doesn’t get better, shortness of breath, and a lump in your neck.
Before using Rybelsus or Ozempic, talk with your doctor if any of the following conditions or health factors apply to you:
- if you’ve had an allergic reaction to either drug or any of its ingredients
- if you’re pregnant or breastfeeding
- if you have a history of pancreatitis
- if you have kidney problems, such as kidney failure
- if you have ever been diagnosed with diabetic retinopathy (an eye condition caused by diabetes)
- if you’re taking another medication that may affect your blood sugar, including insulin or an insulin secretagogue
- if you have a history of severe gastroparesis (slow stomach emptying), which may be a complication of diabetes
- if you have an upcoming medical procedure that requires general anesthesia or sedation
Switching Between Rybelsus and Ozempic
Your doctor may switch you to Rybelsus from Ozempic if you’d prefer a medication that you swallow instead of injecting. Or they may switch you to Ozempic from Rybelsus if you prefer taking a drug once a week instead of once per day. Yes, it is possible to switch from Ozempic to Rybelsus and the other way around. The maker of Rybelsus recommends starting Rybelsus one week after stopping 0.5 mg of Ozempic.
The process for switching between the drugs may vary depending on which Rybelsus formulation you’re taking. The manufacturer for Rybelsus provides the following instructions for switching from 0.5-mg weekly Ozempic injections to daily doses of Rybelsus. For more specific instructions, talk with your doctor or pharmacist.
- Switching between Ozempic and Rybelsus formulation R1: If you’re switching to Rybelsus formulation R1 from Ozempic, your doctor will likely prescribe the 7- or 14-mg tablet. You’ll take this tablet once per day, starting 1 week after your last Ozempic dose. If you’re switching to Ozempic from Rybelsus formulation R1, your doctor will likely prescribe the 0.5-mg weekly Ozempic dose. You’ll give yourself this dose once per week, starting the day after your last dose of Rybelsus.
- Switching between Ozempic and Rybelsus formulation R2: If you’re switching to Rybelsus formulation R2 from Ozempic, your doctor will likely prescribe the 4- or 9-mg tablet. You’ll take this tablet once per day, starting 1 week after your last Ozempic dose. If you’re switching to Ozempic from Rybelsus formulation R2, your doctor will likely prescribe the 0.5-mg weekly Ozempic dose. You’ll give yourself this dose once per week, starting the day after your last dose of Rybelsus.
Always seek your doctor’s approval and guidance before switching medications. These recommendations may not apply to you if you’re currently prescribed a different dosage of Rybelsus or Ozempic than outlined above. Your doctor or pharmacist can provide more information.
How to Take Rybelsus
If there’s another reason that Rybelsus hasn’t quite caught on, it’s that taking the drug is arguably something of a hassle. According to the instructions on the FDA label, you need to take Rybelsus on an empty stomach, every morning, 30 minutes before eating, drinking, or using any other oral medications. You may have up to 4 ounces of plain water only during this time. If you have your breakfast too early, the pill will be less effective. But if you wait longer than 30 minutes to eat, the pill’s absorption may be enhanced (which could also lead to more significant side effects). Rybelsus tablets should be stored at room temperature in a dry place away from moisture until the expiration date on the bottle.
The Future of Rybelsus
In the coming years, higher doses of Rybelsus may become available. In 2023, Novo Nordisk announced that it would seek FDA approval for larger doses of oral semaglutide for the treatment of type 2 diabetes.
The PIONEER PLUS trial, which tested two experimental larger doses of oral semaglutide in people with type 2 diabetes, demonstrated that at the highest dose of 50 mg, the drug’s glucose-lowering and weight loss results were at least as good as those found in Ozempic 2 mg. Study participants had an A1C reduction of 2 percentage points, and weight loss of about 20 pounds.
Novo Nordisk has already applied for regulatory approval for a semaglutide weight loss pill in both the United States and Europe.