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For those interested in taking a GLP-1 receptor agonist (RA) but the fear of injections has put you off, manufacturer Novo Nordisk makes a non-injectable GLP-1 pill alternative called Rybelsus®.
Until 2019, all GLP-1s were prescribed as subcutaneous (under-the-skin) injections. So this oral form of the drug semaglutide is a welcome addition to the team that lineup includes Wegovy® and Ozempic®. The pill is handy for those who also may find it more convenient to take an oral medication instead of a weekly injection, especially if you’re already taking other prescription drugs or supplements.
But with all this talk about injectables, you may have questions about Rybelsus for weight loss and how it works. We’re here to help answer all of your pressing questions. Let’s jump in.
Rybelsus is the brand name for oral semaglutide. It is a part of the glucagon-like peptide-1 receptor agonist (GLP-1 agonist) medication class. It works in your body by mimicking the GLP-1 incretin hormone your body already makes that controls critical functions like regulating blood sugar levels, appetite, and feeling full.
The U.S. Food and Drug Administration (FDA) approved it in 2019 for the treatment of type 2 diabetes in adults. Although not for those with type 1 diabetes, it’s shown fantastic results in regulating hemoglobin A1C (HbA1c)—that’s your average blood sugar or blood glucose levels over the past two or three months—in those with type 2 diabetes.
According to the 2019 FDA press release regarding the placebo-controlled trials Rybelsus underwent, results found that after “26 weeks, 69% of those taking 7 mg once daily and 77% of those taking 14 mg once daily of Rybelsus decreased their HbA1c to lower than 7%, compared with 31% of patients on placebo.”
Although Rybelsus (semaglutide) is a diabetes medication, it has shown meaningful weight-loss results in many patients. Health care providers often prescribe Rybelsus off-label as a weight-loss drug because it causes delayed gastric emptying, meaning it slows the digestion of food helping to promote the feeling of fullness.
In a 26-week clinical trial published in 2017 in the JAMA, 632 patients with type 2 diabetes and an average body mass index (BMI) of 31 were given either once-daily oral semaglutide, a placebo, or once-weekly injectable semaglutide. Those on the oral semaglutide were given doses of 2.5 mg, 5 mg, 10 mg, or 20 mg. Then the doses increased to 40 mg at either a 2-week, 4-week, or 8-week dose escalation schedule.
The body weight loss results were significant with those on the oral semaglutide, ranging from about 4 to 15 pounds. In comparison, the placebo group lost about 2 pounds. Overall, this demonstrated that oral semaglutide is useful for weight loss.
Rybelsus is FDA-approved only for treating type 2 diabetes, but the U.S. National Library reports that oral semaglutide is currently in a phase four trial for the treatment of overweight and obesity.
Medications typically undergo three clinical trials to assess risks and efficacy, and a fourth clinical trial looks at side effects and efficacy after a drug has received FDA approval. This means that Rybelsus is in an additional phase of study to look at its efficacy in treating overweight and obesity and may be close to being FDA-approved as an obesity drug.
The estimated completion date for this study is June 2023. If all goes as planned, Rybelsus may be FDA-approved for weight loss in patients with a BMI of 30 or greater or a BMI of 27 and at least one weight-related health issue.
So, you can speak with your doctor or health care provider about taking Rybelsus for weight loss to see if it is the right choice for your weight-management journey. As we mentioned above, your doctor can prescribe Rybelsus off-label if they think it would be a great fit for you.
Most trials recorded Rybelsus weight loss after the 6-month mark, but you can start losing weight on Rybelsus before then. As an important note, clinical trials also had patients go through health counseling and use Rybelsus in addition to a reduced-calorie diet and increased physical activity for the best results.
Similarly, your blood sugar levels may lower during your first 30 days of Rybelsus. Then your health care provider may adjust or increase your dosage to support lower blood sugar levels.
Like any lifestyle change, getting results may take time, so don’t be discouraged if you don’t see weight loss immediately. Instead, continue building healthy habits to help aid in weight loss, and remember, slow and steady wins the race.
Rybelsus can cause loss of appetite as one of its most common side effects. What’s more, you may not feel as hungry while taking the oral semaglutide because it slows down your digestion of food. Keep reading to get the 411 on other common side effects.
If you’re familiar with the GLP-1 receptor agonist medication family, you know there are some common side effects to be aware of. With Rybelsus the initial side effects typically wear off as your body gets used to the med. Here’s a list of the common Rybelsus side effects:
nausea
diarrhea
vomiting
constipation
decreased appetite
stomach (abdominal) pain
If these side effects become worse or unbearable, contact your health care professional as soon as possible.
Although extremely rare, we want to inform you of more serious side effects you could have while taking Rybelsus. Here are the possible side effects:
inflammation of your pancreas (pancreatitis)
changes in vision
low blood sugar (hypoglycemia)
kidney problems (kidney failure)
serious allergic reactions
gallbladder problems
possible thyroid tumors, including cancer
Novo Nordisk also carries a black box warning advising against taking Rybelsus if “you or any of your family have ever had medullary thyroid carcinoma (MTC), or if you have an endocrine system condition called multiple endocrine neoplasia syndrome type 2 (MEN 2).”
Finally, you shouldn't take Rybelsus if you’re pregnant, planning on becoming pregnant, or currently breastfeeding.
Your healthcare provider will initially prescribe Rybelsus in a daily 3-mg dose. You’ll stay on that dose for 30 days while your body adjusts to the new med. Typically, your health care provider will then up your dose of Rybelsus to 7 mg for 30 days.
If you need additional glycemic control, your heath care provider will then increase your dose to 14 mg and maintain it at that level. Sometimes, your health care provider will increase the dose if you tolerate the medication well.
It’s important to follow all recommended prescribing guidelines your doctor gives you when taking Rybelsus to ensure efficacy.
Yes. You should take Rybelsus first thing in the morning when you wake up with no more than four ounces of water. After that, you must wait 30 minutes before you eat or drink anything else.
As a tip, Novo Nordisk recommends waiting longer to increase absorption. If you don’t wait 30 minutes, you could decrease absorption in your system, and the drug may not work as well.
It may make it easier to build the habit of taking Rybelsus first thing in the morning by putting it on your nightstand with a small glass of water or in your bathroom next to your toothbrush so you can remember. You can also use your phone to set a 30-minute timer to ensure you give ample time for Rybelsus to do its job in your body before eating or drinking.
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GLP-1*
GLP-1 prescriptions, filled through your local pharmacy, are now available as part of Found's weight-loss toolkit. While GLP-1s are effective for weight loss, they are not clinically appropriate for everyone. Eligibility for a GLP-1 is based on a thorough evaluation of your medical history, eating behavior, lab work, and insurance coverage. If a GLP-1 is not appropriate for you, our providers will work with you to determine an effective medication for your health profile.
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