How does Rybelsus work? Oral semaglutide explained

Key Points

• Rybelsus is the first FDA-approved oral form of semaglutide
• It is approved to treat those with type 2 diabetes
• The medication stimulates insulin release, reduces appetite, and slows down stomach emptying
• The right timing maximizes how well your body absorbs it

As the first oral GLP-1 medication, Rybelsus provides an alternative to injectable semaglutide for type 2 diabetes management.

The medication works through three main approaches to help control blood sugar levels. Understanding these processes can help you know what to expect during treatment.

What is Rybelsus?

Rybelsus is the pill form of semaglutide, made by Novo Nordisk, the same company behind Ozempic and Wegovy.

Rybelsus is FDA-approved to help control blood sugar levels in adults with type 2 diabetes. It is meant to be used along with a nutritious diet and regular exercise.

Note: Rybelsus is not currently FDA-approved for weight loss.

How does Rybelsus work?

"Rybelsus works by mimicking the action of GLP-1, a natural hormone that helps regulate blood sugar levels after eating," says Gia Eapen, MD. "This oral formulation provides similar benefits to injectable semaglutide but in a convenient pill form."

The medication targets blood sugar control through three distinct mechanisms:

• Triggers insulin release only when blood sugar is high, helping manage glucose levels when needed
• Signals the brain's appetite center to create a feeling of fullness
• Slows gastric emptying, which means food moves more slowly from your stomach to your small intestine

How to take Rybelsus?

Rybelsus is meant to be taken on an empty stomach first thing in the morning with no more than 4 ounces of plain water. Guidelines recommend waiting at least 30 minutes before eating, drinking anything else, or taking other medications.

This timing is important because only 0.4%-1% of each Rybelsus dose is absorbed by the body, primarily in the stomach. If you don't take the medicine as per instructions, it may affect the absorption.

Rybelsus dosage

The standard Rybelsus dosing starts with 3mg once daily for 30 days, then increases to 7mg daily. If additional control is needed after at least 30 days on 7mg, the dose may increase to a maximum of 14mg once daily.

"Starting with 3mg for 30 days allows the body to adapt to the medication,” explains Eapen, MD.

How effective is Rybelsus for blood sugar control?

Research shows that Rybelsus is effective for blood sugar control. One study revealed that taking a daily dose of Rybelsus resulted in a 1.2% reduction in A1C levels over a 26-week period.

How long does Rybelsus stay in your system?

Rybelsus remains in your system for 5 weeks after the last dose because it has a half-life of approximately one week. Half-life refers to the time it takes for your body to eliminate half of the medication from your bloodstream.

Rybelsus side effects

Common side effects of Rybelsus include nausea, abdominal pain, diarrhea, decreased appetite, vomiting, and constipation. These gastrointestinal effects are most frequent when starting treatment and typically improve over time.

"Starting any new diabetes medication can come with an adjustment period, and Rybelsus is no exception," says Eapen, MD. “While gastrointestinal symptoms like nausea and diarrhea are common when beginning Rybelsus, these symptoms usually adjust as your body adjusts to the medication. However, if side effects persist or become severe, it's important to reach out to your healthcare provider to discuss adjusting your treatment plan."

Importance of diet when on Rybelsus

Healthy eating remains essential for optimal results with Rybelsus, as it's prescribed alongside diet and exercise modifications.

“The medication can reduce cravings and help you feel full sooner, but it's important to maintain adequate nutrition despite the decreased appetite," notes Rita Faycurry, RD, Registered Dietitian.

Working with a registered dietitian can help optimize Rybelsus's benefits while ensuring proper nutrition despite reduced appetite.

Final thoughts: How does Rybelsus work?

Rybelsus is the first oral GLP-1 medication, providing an alternative to injectable diabetes treatments for people with type 2 diabetes. Studies show that oral semaglutide can help manage blood sugar levels and lower A1c readings.

The medication does require specific timing and may cause side effects.

The once-daily oral format offers some convenience compared to injections, particularly for people who do not like needles. These pills are also easy to transport and do not have stringent storage requirements like the injectables do.

As with any diabetes medication, it's important to discuss with your healthcare provider whether it aligns with your individual treatment needs and medical history.

Get a personalized semaglutide diet plan, covered by insurance.

Frequently asked questions (FAQs)

How does Rybelsus help you lose weight?

Rybelsus is currently not FDA-approved for weight loss. However, people on Rybelsus for type 2 diabetes management may lose weight through appetite reduction and satiety effects. GLP-1 receptor agonists, like Rybelsus, affect brain pathways controlling hunger and fullness and delay gastric emptying.

How is Rybelsus different from Ozempic?

Both Rybelsus and Ozempic contain semaglutide and are used for type 2 diabetes management. They share similar side effects, including nausea, vomiting, and abdominal pain. However, they differ in how they are administered and how often they are taken. Rybelsus is a once-daily oral tablet, while Ozempic is a weekly subcutaneous injection. Oral semaglutide has a much lower bioavailability (how much your body absorbs) than Ozempic. Your healthcare provider can help you learn which type of semaglutide may work better for your health goals.

Is Rybelsus approved in the US?

Yes, the FDA approved Rybelsus for improving blood sugar control in adults with type 2 diabetes, when used together with diet and exercise. However, it's not approved for weight loss.

What should you avoid eating on Rybelsus?

“While Rybelsus doesn't have strict food restrictions, limit high-fat and fried foods, which can worsen nausea and digestive side effects,” says Registered Dietitian, Rita Faycurry, RD. “Avoid sugary foods, refined carbohydrates, and ultraprocessed foods that can spike blood sugar levels and counteract the medication's effects. Spicy foods and large meals may also increase stomach discomfort. Focus on lean proteins, high-fiber foods, and smaller meals instead.”

Find a dietitian to help you manage your Rybelsus diet, covered by insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.