Rybelsus® is gaining traction as a weight-loss aid. It is an oral tablet containing semaglutide, a GLP-1 receptor agonist. This medication mimics natural hormones to regulate blood sugar levels and reduce appetite. While injectable weight loss medications like Ozempic® and Wegovy are also semaglutide-based, Rybelsus® is the only approved oral option.
What is Rybelsus?
Rybelsus is essentially Ozempic in pill form rather than an injection. Both are manufactured by Novo Nordisk and contain the same active ingredient: semaglutide. Semaglutide, under the brand name Ozempic, is intended for people with type 2 diabetes. The same drug is also sold as Wegovy for treating obesity.
Semaglutide is a GLP-1 receptor agonist. It 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. It remains a powerful glucose-lowering therapy, and it also has a profound effect on body weight. Many semaglutide users find themselves losing weight without consciously cutting calories.
Rybelsus vs. Ozempic: Key Differences
Rybelsus is the only approved oral form of semaglutide. The Food and Drug Administration (FDA) states that the maximum 14 mg daily dose of Rybelsus is equivalent to the 0.5 mg weekly starter dose of Ozempic. One can be switched for the other without needing a dose adjustment. Rybelsus uses higher amounts of semaglutide than Ozempic because only a fraction of the semaglutide that enters the stomach is properly absorbed.
Clinical trials show that the two doses have a comparable metabolic effect: Rybelsus 14 mg daily pill versus Ozempic 0.5 mg weekly injection resulted in a 1.3 percentage point drop in A1C and approximately 10 and 9.5 pounds of weight loss, respectively. A study of real-world data found similar results: Oral semaglutide demonstrated “similar effectiveness” to injectable semaglutide.
Read also: Using Rybelsus for Weight Loss: A Guide
While these results suggest that Rybelsus and Ozempic could be similarly effective for people with type 2 diabetes, the two drugs are not equivalent practically speaking because Ozempic is available in more powerful dosages. Ozempic is additionally available in 1 and 2 mg doses. The maximum dose, when tested in people with type 2 diabetes using metformin, led to an A1C drop of 2.2 percentage points and weight loss of 15 pounds. Rybelsus can’t match these results, at least not at the approved doses. Wegovy is available in an even higher dose, 2.4 mg per week.
Rybelsus for Weight Loss in Non-Diabetic Patients
When using Rybelsus for weight loss, especially in non-diabetic patients, understanding its gradual approach is essential. The journey with Rybelsus and weight loss tends to be steady, not rapid. Therefore, it will take a little longer to achieve the Rybelsus weight loss before and after you seek. Weight loss results vary, with most users experiencing a steady reduction over several months, especially when combined with lifestyle adjustments like a balanced diet and regular exercise. When on Rybelsus for weight loss in non-diabetic patients, users commonly experience gradual weight loss over several months. Most individuals feel a reduction in appetite, which can contribute to weight loss. However, those results vary widely depending on dosage, diet, and lifestyle.
Higher Doses 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.
Is Rybelsus Approved for Weight Loss?
Oral semaglutide is not yet approved as a weight loss therapy. In the recent OASIS 1 trial, however, researchers tested the effect of a 50 mg dose of oral semaglutide for people who were overweight or had obesity. After using the drug for over one year, study participants lost an average of 15.1 percent of their total body weight. That amount of weight loss was about equal to that achieved by people using the maximum dose of injectable semaglutide, suggesting that an oral semaglutide weight loss pill could be just as effective as the injectable.
Read also: Rybelsus: A Weight Loss Option?
Novo Nordisk has already applied for regulatory approval for a semaglutide weight loss pill in both the United States and Europe. In the meantime, some doctors are prescribing Rybelsus off-label as a weight loss therapy for people without diabetes, especially those who cannot tolerate Wegovy or who are unable to use needles.
How to Take Rybelsus
Taking Rybelsus requires adherence to specific instructions. According to the FDA label, 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. By contrast, Ozempic is a single weekly injection and can be taken at any time of day, with or without meals.
Rybelsus and Side Effects
A substantial minority of Ozempic users experience gastrointestinal side effects. For some, the nausea, vomiting, or diarrhea subsides as the body gets acclimated to the drug. But others don’t feel better and end up quitting the drug entirely.
Clinical trials suggest that Rybelsus has similar side effects. A roughly similar proportion of Rybelsus study participants reported experiencing the most common side effects, including nausea, abdominal pain, diarrhea, and vomiting. Rybelsus’ FDA label also warns of some of the same rare, serious side effects as Ozempic, including pancreatitis (inflammation of the pancreas) and acute kidney injury (a sudden decrease in kidney function).
Important Considerations
It’s extremely important to note that weight loss is a journey and will look different for everyone. Real progress often happens over months rather than weeks. Therefore, you need to view the process as a gradual lifestyle shift rather than a quick solution. Consistency with Rybelsus is the key to achieving your weight loss goals! Track progress by keeping a record of your weight loss journey to see your progress in real-time. Over time, these practices can help optimize the impact of Rybelsus and encourage long-term success.
Read also: Rybelsus and Its Effects
As with any medication, there may be side effects. Fortunately, these symptoms tend to lessen over time as the body adjusts to the medication. However, all of these symptoms have the potential to impact your weight loss results, as they all can disrupt your nutrition and exercise routines. If, after a few months of practicing healthy habits and taking Rybelsus, you aren’t seeing the weight loss results you’d hoped for, it may be time to discuss adjustments with your provider. Some patients may benefit from a higher Rybelsus dosage while others may need to explore other options, like transitioning to an injectable form.
Rybelsus Dosage and Administration
Take this medication by mouth with a sip of water (no more than 4 ounces). Take it in the morning right after waking up every day. Take it on an empty stomach, at least 30 minutes before food, drink, or other medications. Do not cut, crush, or chew this medication. Swallow the tablets whole. Keep taking it unless your care team tells you to stop. A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time. Talk to your care team about the use of this medication in children. Special care may be needed.
If you miss a dose, skip it. Take your next dose at the normal time. Do not take extra or 2 doses at the same time to make up for the missed dose.
Storing Rybelsus
Keep out of the reach of children and pets. Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Keep this medication in the original container. Protect from moisture. Keep the container tightly closed. Get rid of any unused medication after the expiration date. To get rid of medications that are no longer needed or have expired: Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location. If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.
Potential Side Effects
Side effects that you should report to your care team as soon as possible: Allergic reactions-skin rash, itching, hives, swelling of the face, lips, tongue, or throat; Change in vision; Dehydration-increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine; Gallbladder problems-severe stomach pain, nausea, vomiting, fever; Kidney injury-decrease in the amount of urine, swelling of the ankles, hands, or feet; Pancreatitis-severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting; Thyroid cancer-new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness.
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome): Constipation; Diarrhea; Loss of appetite; Nausea; Stomach pain; Vomiting.
Precautions
They need to know if you have any of these conditions: Endocrine tumors (MEN 2) or if someone in your family had these tumors; Eye disease; History of pancreatitis; Kidney disease; Stomach or intestine problems; Thyroid cancer or if someone in your family had thyroid cancer; Vision problems; An unusual or allergic reaction to semaglutide, other medications, foods, dyes, or preservatives; Pregnant or trying to get pregnant; Breast-feeding.
Potential Drug Interactions
Digoxin; Levothyroxine; Warfarin. Some medications may affect your blood sugar levels or hide the symptoms of low blood sugar (hypoglycemia). Talk with your care team about all the medications you take. They may suggest changes to your insulin dose or checking your blood sugar levels more often.
Medications that may affect your blood sugar levels include: Alcohol; Certain antibiotics, such as ciprofloxacin, levofloxacin, sulfamethoxazole; trimethoprim; Certain medications for blood pressure or heart disease, such as benazepril, enalapril, lisinopril, losartan, valsartan; Certain medications for mental health conditions, such as fluoxetine or olanzapine; Diuretics, such as hydrochlorothiazide (HCTZ); Estrogen and progestin hormones; Other medications for diabetes; Steroid medications, such as prednisone or cortisone; Testosterone; Thyroid hormones.
Medications that may mask symptoms of low blood sugar include: Beta blockers, such as atenolol, metoprolol, propranolol; Clonidine; Guanethidine; Reserpine.
Monitoring and Follow-Up
Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse. You may need blood work done while you are taking this medication. Your care team will monitor your HbA1C (A1C). This test shows what your average blood sugar (glucose) level was over the past 2 to 3 months. Know the symptoms of low blood sugar and know how to treat it. Always carry a source of quick sugar with you. Examples include hard sugar candy or glucose tablets. Make sure others know that you can choke if you eat or drink if your blood sugar is too low and you are unable to care for yourself. Get medical help at once. Tell your care team if you have high blood sugar. Your medication dose may change if your body is under stress. Some types of stress that may affect your blood sugar include fever, infection, and surgery. Wear a medical ID bracelet or chain. Carry a card that describes your condition. List the medications and doses you take on the card.
Talk to your care team about your risk of cancer. You may be more at risk for certain types of cancer if you take this medication. Talk to your care team right away if you have a lump or swelling in your neck, hoarseness that does not go away, trouble swallowing, shortness of breath, or trouble breathing. Make sure you stay hydrated while taking this medication. Drink water often. Eat fruits and veggies that have a high water content. Drink more water when it is hot or you are active. Talk to your care team right away if you have fever, infection, vomiting, diarrhea, or if you sweat a lot while taking this medication. The loss of too much body fluid may make it dangerous for you to take this medication.
If you are going to need surgery or a procedure, tell your care team that you are taking this medication. Do not take this medication without first talking to your care team if you may be or could become pregnant. Your care team can help you find the option that works for you. Weight loss is not recommended during pregnancy. Maintaining healthy blood sugar levels can help reduce the risk of pregnancy complications. Talk to your care team if you are breastfeeding. When recommended, this medication may be taken. Its use during breastfeeding has not been well studied. Lactation may help lower your blood sugar levels. Your care team may recommend changes to your treatment plan.
Risks
This medication may increase the risk of thyroid tumors or cancer. Do not take this medication if you or a family member has or have had multiple endocrine neoplasia (MEN) 2 or a type of thyroid cancer called medullary thyroid carcinoma (MTC).
Compounded Oral Semaglutide
Some online compounding pharmacies are now advertising “oral semaglutide,” but some of these products are not, in fact, equivalent to Rybelsus. These semaglutide pills are taken sublingually (dissolved under the tongue) rather than swallowed, and therefore have an entirely different mechanism for absorption. Buyers should be wary of such products, as there has never been any published study of sublingual semaglutide, and the safety and efficacy of such substances may be questionable.
Real-World Experiences
Adults across the country with type 2 diabetes are getting their A1C DOWN with RYBELSUS®. Beto is a family man and a mechanic who was down to adjust his type 2 diabetes treatment plan when metformin wasn’t enough. Sunny made it a point to maintain an active lifestyle, knowing her family history with diabetes. Troy is a loving husband and pet owner who enjoys finding artifacts with the help of his dog, Jasmine. Living with type 2 diabetes, he decided it was time to make a change when his A1C had reached its highest. To help get his A1C DOWN, Troy's healthcare provider added RYBELSUS®, along with diet and exercise, to his treatment plan. Carolyn shows her true colors as a painter and someone living with type 2 diabetes who wants to lead a healthier life. After not getting the A1C results he needed, his healthcare provider prescribed him RYBELSUS®.
Cost and Support
RYBELSUS® Connect offers support when and where you need it. Eligible, commercially insured patients with product coverage only. Maximum savings of $300 per 1‑month supply, $600 per 2‑month supply, or $900 per 3‑month supply.