Rybelsus (Oral Ozempic): Weight Loss & Side Effects

Key Points

• The pill version of semaglutide (Ozempic's active ingredient) is a medication called Rybelsus, sometimes referred to as “oral Ozempic”.
• Rybelsus is FDA-approved to treat type 2 diabetes. While it can cause weight loss, it's not officially approved for that purpose and is sometimes used "off-label."
• While Rybelsus can lead to some weight loss and help with diabetes management, injectables like Ozempic and Wegovy are more potent and lead to more significant results.

With all the buzz around weight-loss medications like Ozempic, you might be wondering: Is there an Ozempic pill? The idea of taking a tablet instead of giving yourself a shot might be appealing.

There is an oral version of semaglutide (the active ingredient in Ozempic), but it’s not called Ozempic. The brand name for the pill is Rybelsus.

While Rybelsus and Ozempic share the same active ingredient, there are crucial differences in how each medication is used, how effective they are for weight loss, and what you can expect. If you’re wondering whether an "oral Ozempic" could be right for you, here’s a clear, evidence-based look at what you need to know.

What is Rybelsus, the "oral Ozempic"?

Rybelsus is a once-daily tablet that contains semaglutide, the same active ingredient found in the weekly injectable medications Ozempic and Wegovy. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists.

These medications work by copying a natural hormone your gut releases after you eat. This hormone tells your brain you're full, slows down how quickly your stomach empties, and helps your pancreas release insulin to manage blood sugar.

The main difference, of course, is that Rybelsus is a pill you take every day, while Ozempic and Wegovy are injections you take once a week.

Currently, Rybelsus is officially FDA-approved to help manage blood sugar levels in adults with type 2 diabetes, alongside diet and exercise. It is not yet approved specifically for weight loss, but because losing weight is a common side effect, some doctors prescribe it "off-label" for that purpose.

How can a pill do what an injection does?

You might be asking yourself how a pill can survive your digestive system to work effectively. Normally, proteins and peptides like semaglutide are destroyed by stomach acid before your body can absorb them.

Rybelsus gets around this with a clever bit of science. The pill includes another ingredient called salcaprozate sodium, or SNAC, which acts as a bodyguard for the semaglutide.

SNAC does two important jobs:

1. It protects the semaglutide: It acts as a buffer, neutralizing stomach acid in the immediate area around the tablet so the medication isn't destroyed.
2. It helps with absorption: SNAC makes it easier for the semaglutide to pass through the lining of your stomach and into your bloodstream.

This technology is what makes an oral version of this powerful medication possible, but it’s also the reason for the very specific and strict rules you have to follow when taking it.

How does weight loss on Rybelsus compare to Ozempic?

While both medications can absolutely help you lose weight, the clinical trial data show a noticeable difference in the results.

Injectable semaglutide (found in Ozempic and Wegovy) generally leads to more significant weight loss. For example, in major clinical trials for Wegovy (a higher-dose version of semaglutide approved for weight loss), participants lost an average of 15% of their body weight.

The weight loss from Rybelsus is more modest:

• In one trial, people taking the 14 mg dose of Rybelsus lost an average of about 8 pounds (3.7 kg) over six months.
• Another review showed a weight loss of about 8 to 10 pounds over roughly 30 weeks on the highest dose of Rybelsus, compared to about 10 to 12 pounds with a standard 1 mg dose of Ozempic.

So, what does this mean in the real world? For someone who weighs 200 pounds, a 15% weight loss with an injection like Wegovy would be around 30 pounds. An 8-10 pound loss with Rybelsus is still helpful, but it's a very different outcome.

It's worth noting that drugmakers are testing higher doses of oral semaglutide (up to 50 mg) for weight loss, and these have shown results much closer to the injections, with about 15% body weight loss. The maximum of Ozempic is now 2.4 mg as well. However, these higher doses of Rybelsus are not yet FDA-approved or on the market.

The rules of Rybelsus

Choosing a pill over a shot might seem like a no-brainer, but Rybelsus isn't a medication you can just take whenever you remember. For it to work, you have to follow a very strict daily routine.

According to the manufacturer’s guidelines, you must take Rybelsus:

• First thing in the morning on a completely empty stomach.
• With no more than 4 ounces (about half a glass) of plain water. No coffee, no juice, no other liquids.
• At least 30 minutes before you eat, drink anything else, or take any other oral medications, vitamins, or supplements.
• Swallowed whole. The tablet can’t be split, crushed, or chewed.

If you don't follow these rules – for example, if you eat too soon or take it with your morning coffee – the Rybelsus won't be absorbed properly, and you won't get its full effect. This rigid daily routine can be a challenge and is a crucial trade-off for avoiding a weekly shot.

What are the common side effects?

Since Rybelsus and Ozempic share the same active ingredient, they also share similar side effects. The most common ones are gastrointestinal issues, which usually pop up when you first start the medication or when your dose is increased.

Common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Stomach pain
• Constipation
• Decreased appetite

These side effects are often mild to moderate and may get better as your body adjusts. If you're struggling with them, a registered weight loss dietitian can help you adjust your diet to minimize discomfort while ensuring you get the right nutrition for your goals.

It's also important to be aware of the more serious but rare risks, such as pancreatitis (inflammation of the pancreas) and a boxed warning about a potential risk of thyroid C-cell tumors.

Final thoughts

Choosing between oral Rybelsus and an injectable semaglutide involves a clear trade-off: the convenience of a daily pill comes with more modest weight loss results (at least at the doses available today) and a very strict set of rules for taking it. The weekly injections, while less convenient for some, have been shown to be more effective for weight loss.

Regardless of which option you and your doctor consider, know that healthy lifestyle changes are always curcial to yield the best results. Working with a registered dietitian can help you create a sustainable eating plan, manage side effects, and build healthy habits that support your long-term health and weight loss goals.

Frequently asked questions

Is Rybelsus as effective as Ozempic for weight loss?

Based on clinical trials of the currently available doses, Rybelsus generally results in less weight loss than injectable Ozempic or Wegovy. Higher doses of oral semaglutide have shown more comparable results in studies, but they are not yet FDA-approved.

Why do you have to take Rybelsus on an empty stomach?

You have to take Rybelsus on an empty stomach because food, drinks, and other medications can prevent it from being absorbed correctly. The special ingredient (SNAC) that helps the semaglutide get into your bloodstream only works under very specific conditions, which is why waiting 30 minutes before consuming anything else is so important.

Can you get Rybelsus for weight loss if you don't have diabetes?

Rybelsus is only FDA-approved for treating type 2 diabetes. A doctor might prescribe it "off-label" for weight management, but this is less common, and insurance companies are often less likely to cover medications for off-label uses.

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.