Rybelsus is a GLP-1 drug prescribed to treat type 2 diabetes. It contains the same active ingredient (semaglutide) as the popular, brand-name weight loss drugs Wegovy and Ozempic that are blowing up on social media. But what is Rybelsus? And does it work for weight loss?

This article will detail basic facts about Rybelsus, including how it is used, how to take it, and possible side effects it may cause.

What is Rybelsus?

Rybelsus is a prescription medication used to control blood sugar levels in patients with type 2 diabetes. It was approved by the U.S. Food and Drug Administration (FDA) in 2019, making it the first oral GLP-1 diabetes medication, meaning it's taken in pill form rather than through injections.

Novo Nordisk, the pharmaceutical company behind Rybelsus, also manufactures Ozempic and Wegovy. These drugs share the same active ingredient as Rybelsus, a compound called semaglutide.

Semaglutide belongs to the category of drugs known as glucagon-like peptide-1 receptor agonists. GLP-1 receptor agonists mimic the action of GLP-1, a hormone naturally produced in the intestines in response to food intake. When you eat, your intestines release GLP-1, signaling the pancreas to release insulin. Insulin helps the body absorb glucose (sugar) from the blood into cells for energy or storage. GLP-1 ensures insulin is released when needed, especially after meals when blood glucose levels tend to rise.

Additionally, GLP-1 reduces the secretion of another pancreatic hormone called glucagon, which has the opposite effect of insulin by increasing blood sugar levels. By inhibiting glucagon, GLP-1 helps prevent excessive release of glucose from the liver, which can lead to high blood sugar levels.

GLP-1 agonists like Rybelsus may also slow down the emptying of the stomach (gastric emptying). This helps regulate the rate at which nutrients from your meal enter the bloodstream, preventing sudden spikes in blood sugar levels after eating. Slower stomach emptying can also make you feel full for longer, potentially reducing your overall calorie intake.

Does Rybelsus cause weight loss?

Rybelsus is FDA-approved for the treatment of type 2 diabetes. It is not formally approved as a chronic weight management aid. However, it has been shown to lead to weight loss in patients when coupled with a healthy diet and regular exercise. Because 90% of adults with type 2 diabetes also have obesity or are overweight, the benefits of Rybelsus affect both conditions.

Rybelsus may result in weight loss through two actions.

Semaglutide, the active ingredient in Rybelsus, encourages the pancreas to release insulin, which helps move glucose (sugar) from the blood into cells for energy. This action stabilizes blood sugar levels and reduces the chance of sudden energy swings that can make you crave high-calorie foods.

Also, semaglutide effectively stops the production of glucagon, another hormone that raises blood sugar levels, by telling the liver to release stored glucose into the blood. By controlling glucagon, Rybelsus keeps blood sugar levels steady and prevents excessive hunger caused by low blood sugar.

Rybelsus's impact extends beyond blood sugar control; it also regulates appetite.

GLP-1 receptors in the brain, especially in the hypothalamus, control our hunger and fullness. When GLP-1 binds to these receptors, it tells the brain to reduce appetite and cravings. This means you'll feel less hungry and more satisfied with smaller meals.

Rybelsus also slows down how quickly the stomach empties its contents into the small intestine. Slower stomach emptying means food stays in your stomach longer after you eat, making you feel full for a longer time and reducing the urge to eat more.

Rybelsus is prescribed alongside lifestyle changes like eating fewer calories and exercising more. It's not meant to be the only treatment for obesity.

Is Rybelsus approved for weight loss?

As of December 2023, Rybelsus is only FDA-approved to help patients with type 2 diabetes regulate their blood glucose levels. Novo Nordisk has recently been testing Rybelsus’s efficacy as a weight loss aid.

Novo Nordisk has released key findings from the OASIS 1 phase 3a trial, part of the global OASIS program. The 68-week trial involved 667 adults who were overweight or obese with weight-related health issues. It compared a once-daily 50 mg dose of Rybelsus, alongside lifestyle changes, to a placebo for weight management. The trial successfully met its primary goal, showing that oral semaglutide 50 mg led to significant and superior weight loss compared to the placebo.

Specifically, participants taking the oral medication achieved a substantial 17.4% weight loss after 68 weeks, while those on the placebo experienced only a 1.8% reduction. Furthermore, 89.2% of the oral semaglutide group achieved a weight loss of 5% or more, compared to only 24.5% in the placebo group.

When considering treatment adherence, those on oral semaglutide 50 mg dose still achieved a significant 15.1% weight loss compared to a 2.4% reduction in the placebo group. Additionally, 84.9% of the oral semaglutide group reached a 5% or more weight loss, compared to 25.8% with placebo.

The trial also found that a higher dose of Rybelsus had a safe and well-tolerated profile, with the most common side effects being mild to moderate gastrointestinal issues. Novo Nordisk plans to seek regulatory approval soon.

In sum, Rybelsus is not specifically approved for weight loss. Currently, it is only indicated to treat type 2 diabetes. However, it has been shown to yield significant weight loss in patients who take it along with lifestyle changes. This off-label effect is why it is sometimes prescribed for weight loss or used for weight loss in patients who also have type 2 diabetes.

What are the side effects of Rybelsus?

Rybelsus was approved by the FDA in 2019 as the first oral semaglutide medication. The approval is based on data from 10 clinical trials involving 9,543 participants, including comparisons with other diabetes medications and placebo control groups. Rybelsus® was shown to reduce A1C levels, along with a reduction in body weight.

Overall, Rybelsus was found to be safe and well-tolerated. However, it may cause side effects in some people.

The most common side effects of Rybelsus are gastrointestinal issues that include nausea, vomiting, diarrhea, constipation, heartburn, and abdominal pain.

More serious side effects may occur, but they are uncommon.

Some serious adverse effects of Rybelsus use include:

• Increased heart rate
  
• Low blood sugar (hypoglycemia)
  
• Allergic Reactions: Rash, swelling, breathing difficulties
  
• Pancreatitis (inflammation of the pancreas)
  
• Gallbladder problems, including gallstones
  
• Increased risk of thyroid cancer
  
  

If you experience any side effects while taking Rybelsus, seek medical attention from a licensed healthcare provider.

What precautions should I take before taking Rybelsus?

While Rybelsus is safe and effective for most patients, it can cause side effects in some people. It may also interact with certain medical conditions or substances in the body, causing adverse reactions.

Before starting treatment with any prescription medication, you should tell your doctor about any medical conditions you have, any prescription drugs or supplements you are taking, and any allergies you may have. This information will help reduce the risk of any drug interactions or severe side effects.

• A history of pancreatitis
  
• Gallbladder problems
  
• Kidney problems
  
• Personal or family history of medullary thyroid carcinoma (MTC) (thyroid tumors)
  
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
  
• Diabetic retinopathy (eye problems)
  
• Any digestive disorders
  
  

Rybelsus may not be prescribed to pregnant women, women who are trying to conceive, or women who are breastfeeding.

Who should take Rybelsus for weight loss?

Rybelsus is FDA-approved to regulate blood sugar levels in patients managing type 2 diabetes. It is not approved to treat type 1 diabetes. Its use as a weight loss aid is off-label, meaning that weight loss is not the primary use of this drug.

Some patients may be prescribed Rybelsus for its off-label weight loss effects. It may be used by health care in adults with obesity (with a body mass index— BMI—of 30 kg/m2 or greater) or overweight adults (a BMI of 27 kg/m2 or greater) who also have weight-related health conditions such as hypertension (high blood pressure), high cholesterol, or obstructive sleep apnea.

Note that the use of Rybelsus as a weight loss medication is strictly at the discretion of the prescribing provider.

What is the recommended dosage of Rybelsus?

Rybelsus is not approved by the FDA for weight loss, meaning there is no formal recommended dosage for this use.

For type 2 diabetes, Rybelsus is available in 3 mg, 7 mg, and 14 mg tablets. The recommended dosage of Rybelsus will vary depending on the individual and their specific needs. Your healthcare provider will start you at a lower dosage for 30 days. After 30 days, this dosage may increase depending on your condition and how well you tolerate the medication.

Usually, Rybelsus is taken orally once daily. You should take the tablet 30 minutes before you eat, drink, or take any other medications.

What’s the difference between Rybelsus, Wegovy, and Ozempic?

Rybelsus, Ozempic, and Wegovy are all medications made by the pharmaceutical company Novo Nordisk, and they serve different purposes in managing health.

Rybelsus is used to help control blood sugar levels in people with type 2 diabetes. It comes in a convenient pill form that you take by mouth. Rybelsus helps your body process sugar more effectively and supports weight loss.

Ozempic is also used to manage blood sugar levels in type 2 diabetes but is given as an injection under the skin. It's typically taken once a week and can help lower blood sugar, promote weight loss, and reduce the risk of cardiovascular problems in people with diabetes.

Wegovy is a medication designed for weight management in people who are overweight or obese, whether they have diabetes or not. It's given as a weekly injection and can help you lose weight by making you feel less hungry and more satisfied with smaller meals.

In summary, Rybelsus is for controlling blood sugar and weight in people with type 2 diabetes, Ozempic is primarily for managing blood sugar and promoting weight loss in those with diabetes, and Wegovy is specifically for weight management in people who are overweight or obese. These medications have different forms of administration (pill or injection) and target various aspects of health. Your healthcare provider can help determine which is right for you based on your health needs and goals.

What are the alternatives to Rybelsus?

Rybelsus is not FDA-approved for weight loss. The decision to prescribe Rybelsus is at the discretion of your healthcare provider. If you are curious about alternatives to Rybelsus, discuss these options with your provider:

Tirzepatide (available as Mounjaro or Zepbound): Tirzepatide is a medication used for both type 2 diabetes and obesity management. It aids in regulating blood sugar levels, reducing appetite, and slowing stomach emptying. The brand name Zepbound, containing tirzepatide, is specifically approved for obesity treatment in patients without type 2 diabetes.

Liraglutide (available as Saxenda): Liraglutide, a GLP-1 receptor agonist, holds FDA approval for treating obesity in adults and adolescents aged 12 and above. It accomplishes this by lowering blood sugar levels, suppressing appetite, and delaying stomach emptying.

Metformin: Metformin, a prescription diabetes medication, can lead to weight loss in some individuals. This is achieved by regulating blood sugar levels and enhancing insulin sensitivity, which reduces the amount of sugar circulating in the bloodstream.

Topiramate (available as Topamax): Topiramate, an anticonvulsant drug, has demonstrated weight loss effects in certain patients. Its exact mechanism of action is not entirely understood, but it is believed to reduce calorie intake through appetite suppression, prevent excess fat storage, lower specific fat and cholesterol levels, and potentially impact the brain's reward system to reduce binge eating. It's important to note that while Topiramate is not FDA-approved as a weight loss medication, clinical trials have shown significant weight loss in individuals taking it compared to those on a placebo.

Contrave (bupropion/naltrexone): Contrave is a combination drug composed of two active ingredients, bupropion and naltrexone, each with distinct mechanisms contributing to its weight loss effects. Primarily, Contrave acts on the brain to control appetite and reduce cravings for high-calorie foods. It's essential to be aware that Contrave may have serious side effects, including the potential for suicidal thoughts.

Do I need a prescription for Rybelsus?

Rybelsus is a prescription drug, meaning that you must have a written order from a licensed healthcare provider to get it. It cannot be purchased over the counter.

Rybelsus is available under its brand name. There are no generic versions of Rybelsus currently available.

Weight loss drugs are prescribed to individuals with obesity or individuals who are overweight and managing a weight-related health condition. If you are curious about Rybelsus or any other weight loss drug, talk to your healthcare provider about whether or not these treatment options are right for you. You should also discuss the cost, potential side effects, and any concerns you may have.

Can I get Rybelsus on Sesame?

Sesame offers a comprehensive online weight loss program to help you get started on your weight loss journey.

Sesame’s online weight loss program is a subscription which renews every 3 months and includes a video consultation with a weight loss doctor or specialist, a GLP-1 prescription (if appropriate), insurance coordination for medication coverage, and 90 days of unlimited messaging with your provider.

Note that all prescriptions are at the discretion of your healthcare provider.

Sources:

• Andersen, A., Knop, F. K., & Vilsbøll, T. (2021). A Pharmacological and Clinical Overview of Oral Semaglutide for the Treatment of Type 2 Diabetes.. NIH.com.
  
• Hughes, S., & Neumiller, J. J. (2020). Oral Semaglutide. Clinical diabetes : a publication of the American Diabetes Association American Diabetes Association.
  
• (n.d.). RYBELSUS- oral semaglutide tablet. DailyMed.