Key takeaways
- Rybelsus is a brand-name oral tablet that’s taken once per day to manage blood sugar levels in adults with type 2 diabetes. It is a glucagon-like peptide-1 (GLP-1) receptor agonist medication.
- Common side effects of Rybelsus include nausea, abdominal pain, and diarrhea, but serious side effects such as hypoglycemia and pancreatitis can also occur.
- Rybelsus can interact with other medications, such as sulfonylureas and insulin, potentially increasing the risk of hypoglycemia. It can also interact with other oral medications.
Rybelsus is FDA approved to treat type 2 diabetes in adults. It’s used with a balanced diet and exercise to help manage blood sugar levels.
Drug details
Here you’ll find key information about Rybelsus.
- Drug form: oral tablet
- Generic available? no
- Prescription required? yes
- Controlled substance? no
- Year of FDA approval: 2019
Rybelsus is available only as a brand-name medication. It’s not currently available in generic form. A generic drug is an exact copy of the active ingredient in a brand-name medication.
Rybelsus contains one active ingredient: semaglutide. (As the active ingredient, semaglutide is what makes Rybelsus work.) Semaglutide is also the active ingredient in a brand-name medication called Ozempic. (For information about how Rybelsus and Ozempic compare, see the “Rybelsus vs. Ozempic” section.)
Rybelsus can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Rybelsus. These lists don’t include all possible side effects.
For more information on the possible side effects of Rybelsus, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.
Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Rybelsus and want to tell the FDA about it, visit MedWatch.
Mild side effects
The more common mild side effects of Rybelsus can include:
- nausea and vomiting
- abdominal pain
- diarrhea
- decreased appetite
- constipation
- weight loss
This is a partial list of mild side effects from Rybelsus. To learn about other mild side effects, talk with your doctor or pharmacist, or visit the Rybelsus prescribing information.
Most of these side effects may go away within a few days to a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.
Serious side effects
Serious side effects from Rybelsus aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include:
- Hypoglycemia (low blood sugar). This is more likely if you take Rybelsus with insulin. Symptoms can include:
- sweating
- weakness
- confusion
- Pancreatitis (swelling or irritation of the pancreas). Symptoms can include:
- severe abdominal pain
- vomiting
- fever
- Complications of diabetic retinopathy (a form of eye damage due to diabetes). Symptoms can include:
- worsened eyesight, such as blurred vision, floaters (specks in your vision that move), and difficulty seeing colors
- Sudden kidney problems. Symptoms can include:
- urinating less
- changes in levels of electrolytes (minerals such as potassium and sodium)
- nausea
- Gallstones or gallbladder inflammation. Gallstones may not always cause noticeable symptoms, but in general, possible symptoms of either condition include:
- pain in the upper-right side of your abdomen, your right shoulder, or between your shoulder blades
- fever
- clay-colored stool
- jaundice
- nausea or vomiting
- Severe digestive system side effects, including severe nausea, vomiting, or diarrhea. Symptoms vary depending on the side effect.
Other serious side effects, explained in more detail in “Side effect details,” include:
- allergic reaction
- possible risk of thyroid cancer
Rybelsus has a boxed warning for the risk of thyroid cancer. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see the “Rybelsus precautions” section.
Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on several of the side effects this drug may cause.
Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Rybelsus. However, it’s not known how often allergic reactions occur with Rybelsus.
Symptoms of a mild allergic reaction can include:
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- difficulty breathing or speaking
Call your doctor right away if you have a severe allergic reaction to Rybelsus. Call 911 or your local emergency phone number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Weight loss
Weight loss of about 5 to 10 pounds (2 to 3 kilograms) may occur when taking Rybelsus for type 2 diabetes. However, this medication is not approved by the Food and Drug Administration (FDA) for weight loss.
Clinical trials found that people who took Rybelsus lost more weight than people who took the similar drugs liraglutide (Victoza), sitagliptin (Januvia), empagliflozin (Jardiance), or a placebo (treatment with no active drug ingredient). Exact numbers for how many people lost weight with each treatment aren’t known.
The weight loss may be a result of better blood sugar management, in addition to changes in diet and exercise. It could also be a result of digestive side effects caused by Rybelsus (see the next section).
If you have any concerns about weight loss while taking Rybelsus, talk with your doctor. They can review your treatment plan to help make sure you’re at a weight that’s healthy for you.
Digestive side effects
The most common side effects caused by Rybelsus are digestive side effects. These include nausea, abdominal pain, diarrhea, decreased appetite, vomiting, and constipation.
Other less common digestive side effects, such as gas, acid reflux, and burping, were also reported in clinical trials.
Higher doses of Rybelsus are usually more likely to cause digestive effects.
If you have digestive symptoms that bother you, become severe, or don’t go away, tell your doctor. They may be able to recommend ways to help ease your side effects or select a different dose or medication for you.
The Rybelsus dosage your doctor prescribes will depend on several factors. These include:
- the severity of the condition you’re taking Rybelsus to treat
- other medical conditions you may have
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Drug form and strengths
Rybelsus comes as a tablet that you swallow.
Rybelsus is available in two formulations, each with its own strengths. These are listed here in milligrams (mg):
- formulation R1: 3 mg, 7 mg, and 14 mg
- formulation R2: 1.5 mg, 4 mg, 9 mg
Your doctor will prescribe one formulation or the other for you. These formulations are not meant to be used interchangeably.
Dosage for type 2 diabetes
For treatment of type 2 diabetes, you’ll usually start with a low dose of Rybelsus once per day for 30 days. The low starting dose will help your body get used to the drug. This, in turn, can help avoid digestive system side effects.
Then your doctor will likely increase your dose. After another 30 days, your doctor may increase your dose once more if needed to help improve blood sugar management.
The following table lists the dosage increases recommended for each formulation of Rybelsus.
| Rybelsus formulation | Starting dose (days 1 through 30) | Maintenance dose (from day 31 on) | Maximum dose (if increase needed, from day 61 on) |
|---|---|---|---|
| formulation R1 | 3 mg | 7 mg | 14 mg |
| formulation R2 | 1.5 mg | 4 mg | 9 mg |
Your doctor will work with you to determine which Rybelsus formulation is right for managing your blood sugar levels.
Switching Rybelsus formulations or from Ozempic to Rybelsus
Rybelsus formulations are not interchangeable. However, your doctor may suggest switching from one to the other if needed to better manage your condition.
Likewise, if you’re taking Ozempic, your doctor may suggest switching to Rybelsus if they feel Rybelsus will improve your blood sugar levels. (Ozempic and Rybelsus contain the same active ingredient, semaglutide. The active ingredient is what makes a drug work.)
Your doctor will give you instructions on how to safely switch Rybelsus formulations or switch from Ozempic to Rybelsus. You can also see this Rybelsus dosage guide for additional information.
What if I miss a dose?
If you miss a dose of Rybelsus, wait until the next day to take your regularly scheduled dose. Don’t double up on doses to make up for the dose you missed.
To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.
Will I need to use this drug long term?
Rybelsus is meant to be used as a long-term treatment. If you and your doctor determine that Rybelsus is safe and effective for you, you’ll likely take it long term.
Rybelsus is prescribed along with a balanced diet and exercise. Good diet and exercise habits may help manage type 2 diabetes. In some instances, the condition may improve so much that your doctor may decrease your dosage of Rybelsus or have you stop taking the drug.
As with all medications, the cost of Rybelsus can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.
Your insurance plan may require you to get prior authorization before approving coverage for Rybelsus. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know whether your plan will cover Rybelsus.
If you’re not sure whether you’ll need to get prior authorization for Rybelsus, contact your insurance company.
Financial and insurance assistance
If you need financial support to pay for Rybelsus, or if you need help understanding your insurance coverage, help is available.
A Rybelsus savings card is available that you may be eligible for. To learn more, you can visit the drug website or call 833-ASK-A-CDE (833-275-2233).
You can also visit Optum Perks for price estimates of Rybelsus. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.
Discover more about Rybelsus
Optum Perks is owned by RVO Health. By clicking on this link, we may receive a commission. Learn more.
The Food and Drug Administration (FDA) approves prescription drugs such as Rybelsus to treat certain conditions. In the case of Rybelsus, the FDA has approved the drug to treat type 2 diabetes.
Rybelsus may also be prescribed off-label for other conditions. Off-label use is when a drug that the FDA has approved to treat one condition is prescribed to treat a different condition. For example, Rybelsus may be used off-label for weight management in certain adults.
Rybelsus for type 2 diabetes
Rybelsus is an FDA-approved drug for the treatment of type 2 diabetes in adults when taken with a nutritious diet and exercise. Specifically, it helps manage blood sugar levels in people with this condition.
With type 2 diabetes, a person’s blood sugar level becomes too high due to problems with insulin. Insulin is a hormone that the pancreas makes to help manage blood sugar. With type 2 diabetes, the body either doesn’t respond well to insulin or doesn’t produce enough insulin.
If type 2 diabetes goes untreated, it can lead to problems with the heart, eyes, and nerves, among other areas of the body. These complications can include high blood pressure, diabetic retinopathy (damage to blood vessels in a certain area of the eye), and neuropathy (nerve damage). For more information about type 2 diabetes, you can refer to our diabetes hub.
Rybelsus is not prescribed for type 1 diabetes.
Effectiveness for type 2 diabetes
In clinical trials, Rybelsus was found to be safe and effective for helping manage blood sugar levels in people with type 2 diabetes. For details about these trials, see the Rybelsus prescribing information.
Other uses for Rybelsus
In addition to its approved use, Rybelsus may be prescribed off-label. Off-label drug use is when a drug that the FDA approved for one use is prescribed for a different one that’s not approved.
Rybelsus for weight loss (off-label use)
Rybelsus is not FDA approved for weight loss. However, it may be prescribed off-label to help with weight loss or weight management. Weight loss can be a side effect of Rybelsus treatment for type 2 diabetes (see the “Rybelsus side effects” section for details).
If you have questions about Rybelsus and weight management, talk with your doctor.
Rybelsus for type 1 diabetes (under study)
Type 1 diabetes is another form of diabetes, and it’s less common than type 2 diabetes. Type 1 diabetes causes high blood sugar levels because the body doesn’t make enough of a hormone called insulin, which helps manage blood sugar.
The FDA hasn’t approved Rybelsus for the treatment of type 1 diabetes. However, the drug is being
If you have questions about Rybelsus or treatments for type 1 diabetes, talk with your doctor.
Rybelsus and children
Rybelsus isn’t approved for use in children. More studies are needed to show whether the medication is safe and effective for this age group.
Rybelsus is approved to treat type 2 diabetes when used with a balanced diet and exercise. However, if this treatment regimen is not enough to help manage your blood sugar levels, your doctor may prescribe additional medications for you. An example is metformin (Glumetza).
If you have questions about your diet and exercise plan or other medications while taking Rybelsus, talk with your doctor.
Rybelsus can interact with several other medications. It can also interact with certain foods.
Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.
Rybelsus and other medications
The following text gives examples of medications that can interact with Rybelsus. Not all drugs that may interact with Rybelsus are listed here.
Before taking Rybelsus, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Rybelsus and sulfonylurea drugs
You may be more likely to develop hypoglycemia (low blood sugar) if you take Rybelsus and medication in a drug class called sulfonylureas. Sulfonylurea drugs help treat type 2 diabetes.
Examples of medications in the sulfonylurea drug class include:
- glipizide (Glucotrol XL)
- glimepiride
- glyburide (DiaBeta, Glynase)
If you’re taking any of these drugs, tell your doctor before you start taking Rybelsus. They’ll create a plan to monitor you for signs and symptoms of low blood sugar, which can include sweating, dizziness, and confusion. Your doctor may also decrease your dose of the sulfonylurea drug during your Rybelsus treatment.
Rybelsus and insulin
You may be more likely to develop hypoglycemia if you take Rybelsus and any type of insulin.
Examples of insulin include:
If you’re taking insulin, tell your doctor before you start taking Rybelsus. They can create a plan to monitor your blood sugar. Also, your doctor may decrease your dose of insulin during your Rybelsus treatment.
Rybelsus and all other oral medications
You should take Rybelsus at least 30 minutes before taking any other oral medications. Otherwise, Rybelsus won’t work as well to treat your condition.
Rybelsus slows down how quickly your stomach empties, and this can change the way your body absorbs other medications. Because of this, your doctor may test you more often than usual to make sure your medication is working well.
Before you start taking Rybelsus, tell your doctor about any medications you take. They can help advise you on when to take them and Rybelsus.
Rybelsus and herbs and supplements
There aren’t any herbs or supplements that have been specifically reported to interact with Rybelsus. However, you should still check with your doctor or pharmacist before using any of these products while taking Rybelsus.
Rybelsus and foods
You should take Rybelsus at least 30 minutes before you eat or drink anything, except for water. And you shouldn’t drink more than 4 ounces of water within those 30 minutes. Taking Rybelsus with food or liquids other than water can decrease the amount of the drug that your body absorbs. So Rybelsus may not work as well to treat your condition.
If you have any questions about the timing of your Rybelsus doses and meals, talk with your doctor.
Rybelsus and alcohol
There’s no known interaction between Rybelsus and alcohol.
Keep in mind that you should take Rybelsus at least 30 minutes before eating or drinking anything other than 4 ounces of water. If you don’t wait 30 minutes, the medication may be less effective. So it’s best to avoid drinking alcohol at least 30 minutes before taking Rybelsus.
If you have questions about alcohol use during your Rybelsus treatment, talk with your doctor.
Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Rybelsus, talk with your doctor. They can tell you about other medications that may work well for you.
Alternatives for type 2 diabetes
Examples of other drugs that may be used to treat type 2 diabetes include:
The Food and Drug Administration (FDA) has approved Rybelsus and Ozempic to treat type 2 diabetes. The drugs help manage blood sugar in adults when used with a balanced diet and exercise.
Unlike Rybelsus, Ozempic also has other FDA-approved uses. For details, see this Ozempic overview.
Rybelsus and Ozempic both contain the active ingredient semaglutide. As a result, their side effects are similar. Examples of side effects Rybelsus and Ozempic share include nausea and vomiting, abdominal pain, and diarrhea or constipation.
Rybelsus comes as an oral tablet that you take once per day. Ozempic comes as a single-use pen that you use to administer a subcutaneous injection once per week.
To find out whether Rybelsus or Ozempic may be a better treatment option for you, talk with your doctor.
The Food and Drug Administration (FDA) has approved Rybelsus and metformin to treat type 2 diabetes in adults. The drugs help manage blood sugar in adults when taken with a nutritious diet and exercise. Metformin is also approved for this use in children ages 10 years and older.
Rybelsus contains the active ingredient semaglutide. Metformin contains the active ingredient metformin. It’s a generic drug, and it’s also the active ingredient in some brand-name drugs, such as Glumetza.
The side effects of Rybelsus and metformin vary, though some are the same. Examples of side effects these drugs share include nausea and vomiting, diarrhea, and abdominal pain.
Rybelsus comes as an oral tablet that you take once per day. Metformin comes in three forms: an oral tablet, an extended-release oral tablet (which releases the drug into your body slowly over time), and an oral solution. You take metformin each day, but how often you take it per day depends on the form and strength your doctor prescribes.
Depending on your condition, you may take Rybelsus in combination with metformin. Your doctor can discuss whether taking one of these drugs or both might be the right treatment option for you.
You should take Rybelsus oral tablets according to your doctor’s or healthcare professional’s instructions.
When to take
You’ll usually take Rybelsus once per day. You should take the drug at least 30 minutes before you eat or drink anything, except for water. And you shouldn’t drink more than 4 ounces of water within those 30 minutes.
Also, you should take Rybelsus at least 30 minutes before taking any other medication that you swallow.
To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.
If you have any questions about the timing of your Rybelsus doses and meals or medications, talk with your doctor or pharmacist.
Taking Rybelsus with food
It’s important to take Rybelsus at least 30 minutes before having any food or drink (aside from up to 4 ounces of water).
Taking Rybelsus with food or liquids other than water can decrease the drug’s ability to help manage your blood sugar.
You can eat and drink as usual 30 minutes after taking your Rybelsus dose.
Can Rybelsus be crushed, split, or chewed?
No, you shouldn’t split, crush, or chew Rybelsus tablets. Swallow them whole with less than 4 ounces of water.
Rybelsus contains the active ingredient semaglutide, which belongs to the glucagon-like peptide-1 (GLP-1) receptor agonist drug class.
Rybelsus is approved to treat type 2 diabetes in adults. It’s used with a balanced diet and exercise to help manage blood sugar levels. To learn how Rybelsus works to treat this condition, as well as how long it takes, see this article on how Rybelsus works.
If you can become pregnant, are breastfeeding, or are using birth control, it’s important to consider whether Rybelsus is a safe choice for you.
It may not be safe to take Rybelsus during pregnancy, and it’s not recommended to breastfeed while taking Rybelsus.
You can refer to this Rybelsus and reproductive health article for information. If you have additional questions, talk with your doctor.
Here are answers to some frequently asked questions about Rybelsus.
Is Rybelsus a type of insulin?
No, Rybelsus isn’t a type of insulin. Insulin is a hormone that manages blood sugar. Rybelsus is a type of drug called a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1s such as Rybelsus help manage blood sugar by increasing insulin levels and decreasing levels of a hormone called glucagon.
In some cases, your doctor may have you take Rybelsus with insulin for even better blood sugar management.
If you have questions about Rybelsus or insulin, talk with your doctor.
What’s wrong with storing Rybelsus tablets in my pill box?
If you store Rybelsus tablets in a pill box or pill organizer, the drug may be exposed to moisture. This can make Rybelsus less effective in managing your blood sugar. So it’s best to keep the medication in its original packaging until you’re ready to take it.
For more about storing Rybelsus, see the “Rybelsus expiration, storage, and disposal” section.
Can I take Rybelsus for type 1 diabetes?
The Food and Drug Administration (FDA) hasn’t approved Rybelsus for the treatment of type 1 diabetes. However, the drug is being studied for use with other medications to treat type 1 diabetes. For more information, see the “Rybelsus uses” section.
If you have questions about Rybelsus or treatments for type 1 diabetes, talk with your doctor.
This drug comes with several precautions.
FDA warning: Thyroid cancer
This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
Semaglutide, the active ingredient in Rybelsus, has been shown to cause thyroid C-cell tumors in animal studies. Tumors are masses of cancerous tissue, and in this instance, they occur in the thyroid gland. The tumors actually start in a type of cell called a C cell.
However, it’s not known whether Rybelsus causes these tumors in humans. The tumors include medullary thyroid carcinoma (MTC).
Your doctor won’t prescribe Rybelsus if you or someone in your family has had MTC. Your doctor also won’t prescribe the drug if you have a rare type of cancer known as multiple endocrine neoplasia syndrome type 2 (MEN 2).
Your doctor will talk with you about the risk of MTC and other thyroid tumors, as well as possible symptoms. These symptoms can include difficulty swallowing, hoarseness that lasts, a mass in your neck, and shortness of breath.
If you have questions or concerns about this boxed warning, talk with your doctor or pharmacist.
Other precautions
Before taking Rybelsus, discuss your health history with your doctor. Rybelsus may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:
- diabetic retinopathy
- chronic kidney failure
- pancreatitis
- upcoming surgery
- gastroparesis
- allergic reaction to Rybelsus or any of its ingredients
- pregnancy
- breastfeeding
Note: For more information about the potential negative effects of Rybelsus, see the “Rybelsus side effects” section.
Do not take more Rybelsus than your doctor recommends.
What to do in case of overdose
If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or visit the website. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
When you get Rybelsus from the pharmacy, the pharmacist will add an expiration date to the label on the packaging. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The
Storage
How long a medication remains good can depend on many factors, including how and where you store the medication.
You should store Rybelsus tablets at a room temperature of 68°F to 77°F (20°C to 25°C) in the original container. If needed, you can keep the drug between 59°F and 86°F (15°C and 30°C) for a short time.
Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.
Disposal
If you no longer need to take Rybelsus and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment. Your doctor or pharmacist can instruct you on how to safely dispose of this drug.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.