Rybelsus (Semaglutide)
What is it?
Rybelsus is a tablet version of the medication Semaglutide. Semaglutide also comes in an injectable form called Ozempic and Wegovy. Rybelsus is the first tablet form of the GLP-1 agonist type of medication. There are other similar tablets in development.
How do GLP-1 agonists work?
GLP-1 agonists work by copying the action of natural hormones in your body called incretins. These hormones are released from your gut after you eat and help to control blood glucose levels.
Incretins work in several ways:
- Help your body produce more insulin but only when your blood glucose levels are rising
- Reduce the amount of glucose being released by your liver when it isn’t needed
- Slow down how quickly food leaves your stomach, helping you feel fuller for longer
- Reduce your appetite
For most people with type 2 diabetes, these effects can:
Improve blood glucose levels
- In the short term, this means fewer symptoms of high blood glucose levels (such as feeling thirsty).
- In the long term, this means lower risk of developing problems with your eyes, kidneys and feet.
Help with weight management
- Many people taking GLP-1 agonists lose weight. This can be particularly helpful in type 2 diabetes, where weight loss often improves blood glucose control.
Rybelsus also has additional benefits in protecting against heart disease, stroke, kidney disease and a liver condition known as Metabolic Dysfunction Associated Liver Disease (MASLD).
How is Rybelsus taken?
Rybelsus must be taken correctly for it to work properly:
- It can be taken at any time in the day, but should be taken on an empty stomach, so most people take it first thing in the morning.
- It should be swallowed whole with a sip of water (up to a maximum of half a glass, which is equivalent to 120 ml).
- Tablets should not be split, crushed or chewed as this may have an effect on the absorption of the tablet and mean that it doesn't work.
- You should wait at least 30 minutes before eating or drinking or taking any other tablets or medicines by mouth. Waiting less than 30 minutes reduces the absorption of the tablet and may mean that it will not work.
- Your doctor will start you on a low dose which is gradually increased over a period of months, depending on how you get on with it and how well it is helping you reach your goals.
Rybelsus with other medications
GLP-1 agonists such as Rybelsus slow down how quickly food leaves the stomach. This helps with blood sugar and appetite, but it can also affect how your body absorbs other medications. There are a few medications that you should discuss with your healthcare team before you start Rybelsus:
-
Warfarin or Levothyroxine
- you may need more monitoring with blood tests when you start on Rybelsus or after a change in dose.
-
Hormone replacement therapy (HRT)
- If you take a tablet form of progesterone or you are unsure what sort of tablet HRT you take, you should speak to your healthcare team. They may suggest a change in dose or moving to an alternative form of HRT.
- If you notice any unusual bleeding, you should inform your healthcare team as soon as possible
Who can have Rybelsus?
Your healthcare team will talk to you about whether a Rybelsus might be right for you. Unlike other GLP-1 agonists, it can only be used for blood glucose control. Rybelsus cannot be used in the UK purely to help with weight management.
Your healthcare team will talk with you about:
- How your diabetes is currently being managed
- What treatment you use now
- Any other health problems you have
- What matters most to you.
They will also only be able to recommend Rybelsus on the NHS if you fit the national guidelines set by NICE (National Institute for Health and Care Excellence), details see below. These guidelines can seem confusing, but your healthcare team will guide you through them. It’s important to remember that Rybelsus doesn’t work for everyone, and some people may experience side effects or feel unwell when taking them. The most recent guidelines are as follows:
starting treatment:
Rybelsus is only advised as a first treatment option for people diagnosed with type 2 diabetes under the age of 40. The guideline suggests “considering” a GLP-1 agonist (eg Rybelsus) or Tirzepatide (Mounjaro) in combination with other medications*
*If you are being started on multiple medicines, your healthcare team will introduce them one by one. This is to make sure each medicine suits you before adding the next.
After starting other treatments:
Some people may be considered for Rybelsus after they have been on their initial diabetes treatment for a while as follows:
- People living with obesity (defined as a BMI 30 kg/m² or above [or 27.5 kg/m² for people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African–Caribbean backgrounds])
- AND you’ve been on your first diabetes treatment for at least 3 months
- AND additional medicines needed to reach your individual blood glucose targets
- People diagnosed with type 2 diabetes under the age of 40
- If you were not already taking a GLP-1 agonist, the guidelines advise “considering” a GLP-1 agonist or Tirzepatide (Mounjaro)
There is a lot of research being done on GLP-1 agonists and it is likely that the guidelines will change. Your healthcare team may wish to discuss your treatment with you between your routine appointments.
Who should not take Rybelsus?
Rybelsus may not be suitable for everyone. You should tell your doctor before starting it if you:
- Have severe problems with your kidneys
- Have had gastrointestinal disease (particularly pancreatitis)
- Are pregnant, planning a pregnancy or breastfeeding
- Have had allergic reactions to any medications
What are the side effects of taking GLP-1 agonists?
Not everybody will experience side effects from taking this type of medication, however, the most common ones include:
- Diarrhoea
- Nausea
- Vomiting
- Headaches
- Dizziness
- Increased sweating
- Indigestion
- Constipation
- Loss of appetite
Most of the side effects usually go away over time. Sometimes reducing the dose or changing your diet can help.
However, there are two very rare but more serious side effects that you should report immediately to your healthcare team:
Severe stomach pain
If you have severe and persistent stomach pain, which may go through to your back, with or without vomiting, you must stop taking the Rybelsus and contact your doctor immediately. This may be a sign of pancreatitis (inflammation of the pancreas).
Sudden changes in vision
If your eyesight suddenly worsens or you experience sudden blindness while taking Rybelsus, stop the medication and go straight to the eye casualty department (if available in your area) or A&E.
There are also some much less common side effects to look out for:
Low blood sugar (hypoglycaemia)
On its own, Rybelsus will not cause your blood glucose level to go too low (hypoglycaemia = blood glucose level less than 4 mmol/L), but it may increase the risk of this happening if you also take insulin or drugs called sulphonylureas (e.g. gliclazide).
High blood sugar (hyperglycaemia)
If you take insulin as well as Rybelsus and your insulin is reduced very quickly, then blood sugars can rise (known as hyperglycaemia). Very rarely, the blood sugars rise very high and cause diabetic ketoacidosis (“DKA”).
Problems with anaesthetics
Rybelsus can slow down how quickly your stomach empties. If you are taking Rybelsus and need an operation with a general anaesthetic (being fully asleep) or deep sedation, there is a risk that food or drink may still be in your stomach. This can sometimes travel into the lungs during surgery, which can be dangerous.
If you are taking Rybelsus, tell your healthcare team, especially the anaesthetist, well before your procedure. They can adjust your preparation and anaesthetic plan to keep you safe.
If you experience any side effects, please discuss them with the doctor or nurse. They can help you decide the safest way to continue your treatment.
Getting the most from your medication
Rybelsus works best for achieving your weight and blood glucose goals when it is taken regularly and combined with healthy lifestyle changes.
Making certain dietary changes can also reduce the risk of side effects, for example eating small, regular, healthy meals and drinking plenty of water.
Making sure your medication is working
It’s important that you attend your regular clinic appointments. After you’ve been taking the medication for a while, your healthcare team will invite you back to check how you’re feeling and whether the treatment is helping you reach your weight and blood glucose goals.
This is a chance to talk about what’s going well and any challenges you’ve experienced.
Depending on how things are going, they might suggest adjusting the dose or stopping it and trying a different medicine. These decisions will be based on the reasons the Rybelsus was started and the goals you agreed together.
Frequently asked questions
Rybelsus and Driving
Taking Rybelsus should not affect your ability to drive, cycle or use machinery or tools as long as your blood glucose levels are stable.
You should never drive with a low blood glucose level. On its own, Rybelsus will not cause your blood glucose level to go too low (i.e. cause hypoglycaemia, which is classed as a blood glucose level less than 4 mmol/L), but it may increase the risk of this happening if you also take insulin or drugs called sulphonylureas (e.g. gliclazide).
Check with your diabetes care team if you would like further guidance, or have a look at the national guidelines for driving when you have diabetes.
What if I forget to take my medication?
If you forget to take a dose, skip the missed dose and just take your next one the following day as normal. Do not take a double dose to make up for a missed one.
Can I buy Rybelsus over the counter?
If you do not fit the national guidelines , it is possible to buy Rybelsus privately but you will still need a prescription. You must have a consultation with a healthcare professional before the prescription can be issued, so that the prescriber can carry out proper checks and make sure you are aware of the benefits and risks of taking the medicine.
Buying GLP-1 agonists without a prescription can put your health at serious risk and the seller is breaking the law. You can find more advice about buying GLP-1 agonists privately online at the Gov.uk and Greater Manchester Integrated Care Partnership websites, including information on how to tell if a pharmacy is legitimate
If you do buy Rybelsus privately, make sure to tell your healthcare team so they can make sure your treatment is safe.
What do I do if I am trying for a baby?
We do not yet know if taking Rybelsus is safe when trying to become pregnant, during pregnancy or while breastfeeding.
If you are planning to start a family, you should speak to your healthcare team about when you should stop your Rybelsus and when it may be safe to re-start it.
When will my healthcare team stop Rybelsus?
Your healthcare team will talk to you about stopping Rybelsus if:
- You become underweight (BMI <18.5 kg/m2).
- The medication is not helping reach your blood sugar targets and is not being used to also reduce your risk of heart attacks and strokes.
NOTE: If Rybelsus has been prescribed within the NHS but outside of national guidelines, your clinical team will need to review your treatment and may stop your prescription.
Are people taking GLP-1 agonists, such as Rybelsus, more likely to hurt themselves or commit suicide?
Taking a GLP-1 does not causes people to hurt themselves, consider suicide or take their own lives. There were some concerns about this in the past which led to a full evaluation in the UK and internationally. No evidence was found for an association between GLP-1 receptor agonists and suicide, suicidal thoughts, self-injury or depression.
Can people with type 1 diabetes use Rybelsus?
At present Rybelsus is only licensed for people with type 2 diabetes.
