Rybelsus is the oral tablet form of the drug semaglutide. Originally created and approved to treat type II diabetes, semaglutide has recently garnered a lot of attention as a weight loss drug. It is the active ingredient Ozempic, which is also known as “Hollywood’s worst-kept weight loss secret.”
But Ozempic and Wegovy—another semaglutide product specifically approved for weight loss—are both injectable medications, which can be off-putting to those who feel squeamish at the thought of injecting themselves. Many wonder if Rybelsus, the only oral form of semaglutide, could become a viable alternative for patients trying to achieve weight loss.
Semaglutide belongs to a class of medications called GLP-1 receptor agonists, shortened from “Glucagon-like Peptide-1 Receptor Agonists.” Glucagon is a hormone naturally produced in your intestinal tract when you eat. It does two things: first, it tells your pancreas to release insulin to help move glucose from your bloodstream and into your cells. Second, it sends signals to your brain to help you feel full.
That second action is the most important for weight loss. When you take semaglutide, it helps regulate your appetite, so you end up eating less. It also slows down food moving through your digestive system and enables you to stay full longer, once again decreasing your desire to eat.
In the PIONEER 4 trial—a randomized, double-blind study—14mg of daily Rybelsus was compared to 1.8 mg daily subcutaneous liraglutide and a placebo. Researchers found that after 26 weeks of treatment, patients taking semaglutide lost 4.4kg (nearly 10 pounds), while those taking liraglutide lost 3.1kg (just under 7 pounds), and those taking the placebo lost only 0.5kg (around 1 pound). The study concluded that Rybelsus was “superior in decreasing body weight compared with both liraglutide and placebo.”
In addition to clinical evidence, anecdotal reports from patients describe the effects of Rybelsus on their body weight. Here are a few examples from real-life patients:
Technically, Rybelsus is only approved by the FDA to treat diabetes, not to help patients lose weight. However, it is entirely legal and very common for doctors to prescribe their patients a medicine that has been approved to treat a condition other than their condition. This is called using a drug for off-label use and accounts for about 20% of all prescriptions written in the US.
Since there is strong clinical and anecdotal evidence that Rybelsus can help with weight loss, if your doctor thinks losing weight is in your best interest, they might be willing to write you an off-label prescription for Rybelsus to help. However, this varies from doctor to doctor. Some providers may prefer you to lose weight through natural methods such as diet and exercise. Others might feel uncomfortable prescribing you diabetes medication if you don’t have diabetes, especially because there have been shortages and people who need the medication to control their blood sugar have been unable to get them.
Wegovy, an injectable form of semaglutide, is available strictly as a weight loss treatment. However, not everyone feels comfortable administering an injection. Novo-Nordisk, the makers of Rybelsus and all forms of semaglutide, are also currently trying to get a high-dose oral semaglutide for weight loss approved by the FDA.
Higher doses of semaglutide promote more weight loss. Right now, there are currently three available Rybelsus dosages. Patients take 3mg for the first 30 days to help their bodies adjust to the medication and then increase the dosage to 7mg or 14mg for maintenance. The average weight loss for a person taking 7mg daily was 5 pounds after 26 weeks. For those taking 14mg, it was more than 8 pounds over the same period. Patients with a higher body weight when they started treatment were more likely to lose weight after taking Rybelsus.
The makers of Rybelsus are trying to get 25mg and 50mg doses approved for type II diabetes management and weight loss. In the PIONEER PLUS trial, those taking 14mg or Rybelsus lost around 10 pounds. At the 25mg dose, weight loss increased to 15 pounds. Patients taking the 50mg dose lost an average of 20 pounds. The OASIS 1 trial, which tested 50mg of oral semaglutide as a weight loss treatment in patients without diabetes, found that patients lost more than 17% of their body weight 68 weeks after starting treatment.
Like many medications, Rybelsus comes with potential side effects. At higher doses, these side effects can be more pronounced. Side effects will likely improve the longer you take Rybelsus, and more than 90% of patients find the side effects tolerable enough to keep taking it. Common side effects to expect include:
Rybelsus might not be the right medication for everyone. Certain medications may interact with Rybelsus and cause dangerous and potentially fatal effects. You should never take Rybelsus with the skin cancer treatment bexarotene. Other medications to avoid include diuretics, estrogen, corticosteroids, antipsychotics, and beta-2 stimulants. For uncontrolled high blood sugar, your doctor may prescribe you Rybelsus and another diabetes medication. However, this may cause hypoglycemia. If you want to take Rybelsus for weight loss but are already on another medication for high blood sugar, talk to your doctor first. In general, you should always talk to your doctor about your current medications before you start a new one.
Don’t take Rybelsus if you are allergic to semaglutide or any of the other ingredients. Signs of an allergic reaction may include itching, hives, swelling of the face, tongue, or throat, difficulty breathing, and a rapid heart rate. If you start to experience symptoms of an allergic reaction while taking Rybelsus, call 911.
People with certain health conditions should not take Rybelsus. Reybelsus is only approved for the treatment of type II diabetes and is not recommended for patients with type I diabetes, even if you are taking it for weight loss. As it may cause pancreatitis, it is also not recommended in patients with a history of this condition. You shouldn’t take Rybelsus if you or anyone in your family have a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
Consult your doctor if you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed while on this medication. Also, let them know if you’ve ever had problems with your kidneys, pancreas, or eyes before you start taking Rybelsus.
Without insurance, Rybelsus be fairly expensive. It can cost upwards of $1,000. However, with insurance, it can be much more affordable, as low as $10 to $50. Price may also vary by pharmacy. Some patients may be eligible for coupons or other cost savings.