If you have diabetes, your doctor may suggest that you take Rybelsus. It’s a prescription drug that’s used for type 2 diabetes in adults.
Rybelsus comes as tablets. You’ll take it by mouth once a day, at least 30 minutes before your first meal of the day.
If you’d like to learn more about Rybelsus’ side effects, how it’s taken, and more, read on.
Like most drugs, Rybelsus may cause mild or serious side effects. The lists below describe some of the more common side effects that Rybelsus may cause. These lists don’t include all possible side effects.
Your doctor or pharmacist can tell you more about the potential side effects of Rybelsus. They can also suggest ways to help reduce side effects.
Mild side effects
Here’s a short list of some of the mild side effects that Rybelsus can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Rybelsus’ medication guide.
Mild side effects of Rybelsus can include:
- belly pain
- loss of appetite
- weight loss*
You may have nausea, vomiting, and diarrhea when you first start taking Rybelsus. But mild side effects of many drugs may go away within a few days or a couple of weeks. If they become bothersome, talk with your doctor or pharmacist.
* For information on this side effect, see the “Side effect focus” section below.
Serious side effects
Serious side effects from Rybelsus can occur, but they aren’t common. If you have serious side effects from Rybelsus, call your doctor right away. However, if you think you’re having a medical emergency, you should call 911 or your local emergency number.
Serious side effects can include:
- changes in eyesight*
- low blood sugar*
- kidney problems*
- boxed warning: thyroid cancer (see “Side effect focus” below for details)
- inflammation in your pancreas (see “Side effect focus” below for details)
- allergic reaction (see “Side effect focus” below for details)
* For information on these serious side effects, see the “What should be considered before taking Rybelsus” section below.
Side effect focus
Learn more about some of the side effects Rybelsus may cause.
Thyroid cancer. It’s not known if Rybelsus increases your risk for developing thyroid cancer. But in rat and mouse studies, there was an increase in thyroid cancer in rodents who received semaglutide. (Semaglutide is the active drug in Rybelsus.)
Keep in mind that studies in animals don’t always show what will happen in people. But doctors don’t recommend Rybelsus for people:
- who’ve had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or have a rare genetic condition called multiple endocrine neoplasia syndrome type 2 (MEN 2)
- who have family members with MTC or a history of MTC
What might help
If you have a personal or family history of MTC, talk with your doctor about treatment options other than Rybelsus. Your doctor can help you find a treatment that’s safe for you.
You may lose weight while you’re taking Rybelsus, but the medication isn’t used as a weight loss drug.
In studies, people who weighed on average about 196 pounds (about 89 kilograms) and took the lowest dose of Rybelsus lost about 5 pounds (about 2 kilograms). And this was seen over a period of 6 months.
But while some people in the study lost weight, others gained weight.
Keep in mind that Rybelsus should be used together with healthy eating and exercise habits to manage diabetes. And diet and exercise may help you lose weight. You may lose weight because of other diabetes medications that you’re taking together with Rybelsus.
Additionally, Rybelsus can cause nausea, vomiting, diarrhea, and loss of appetite. And some people may lose weight because of these side effects.
What might help
Weight loss may be a desired side effect of Rybelsus. But weight loss from nausea, vomiting, and diarrhea may not be safe for you. If you have nausea and vomiting with Rybelsus, tell your doctor. And to help ease these side effects, try eating small meals several times a day rather than eating three large meals.
If you have vomiting or diarrhea with Rybelsus, you may become dehydrated. (With dehydration, you have a low level of fluid in your body.) So be sure to tell your doctor about any vomiting or diarrhea.
To help replenish fluids in your body, drink plenty of fluids that contain electrolytes. For example, you could drink diluted fruit juice or sports drinks. Plain water won’t replace electrolyte losses from vomiting and diarrhea.
Certain over-the-counter (OTC) antidiarrheal medications may also help stop diarrhea. But always talk with your doctor before taking any medications with Rybelsus.
In addition, a bland diet that includes low fiber foods may help relieve diarrhea.
- white rice
- soup or broth
Eating plenty of nutritious calories can help you prevent weight loss. If you’re trying to regain weight that you’ve lost, avoid eating empty calories. Instead, try to choose foods that are high in calories and nutrients. And talk with your doctor about your weight loss concerns.
Inflammation of the pancreas
It’s possible to develop inflammation in your pancreas while you’re taking Rybelsus. This condition is called pancreatitis. Often, pancreatitis caused by medications is
If you develop pancreatitis, you may have severe belly pain, nausea, and vomiting. Depending on how severe your pancreatitis is, you may feel only mild tenderness or you may have severe pain. But the pain will be constant and feel like a stabbing sensation. It may even feel like it’s moving towards your back.
To feel less of this belly pain, you may tend to bend forward or bring your knees to your chest while lying down.
What might help
When you start taking Rybelsus, your doctor will check to see if you have pancreatitis. If you’ve had it in the past, your doctor won’t prescribe Rybelsus for you.
If you have persistent and severe belly pain, with or without vomiting, stop taking Rybelsus. And call your doctor right away. They’ll likely check to see if you have pancreatitis.
If your doctor diagnoses you with pancreatitis, you won’t be able to take Rybelsus again. Instead, your doctor will prescribe another diabetes medication for you to replace Rybelsus. And they’ll treat your pancreatitis as needed.
Some people may have an allergic reaction to Rybelsus. But it’s not known how often allergic reactions occurred with Rybelsus use during studies.
You should be aware of the possible symptoms of an allergic reaction. Symptoms of a mild allergic reaction can include:
- skin rash
- flushing (warmth, swelling, or redness in your skin)
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.
Call your doctor right away if you have an allergic reaction to Rybelsus. But if you think you’re having a medical emergency, call 911 or your local emergency number.
Your doctor will explain how you should take Rybelsus. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions. Below are commonly used dosages but always take the dosage your doctor prescribes.
Rybelsus comes as tablets that you’ll take by mouth.
You’ll take 1 tablet of Rybelsus once a day. It needs to be taken at least 30 minutes before your first meal of the day. And be sure to take Rybelsus with no more than 4 ounces of plain water.
You can’t take Rybelsus with food, beverages (besides water), or other medications that are taken by mouth. If you don’t have an empty stomach when you take this drug, the amount of Rybelsus that your body absorbs will be lower than it should be.
Your doctor will start you on the lowest dose of Rybelsus for the first 30 days of treatment. After 30 days, your doctor will likely raise your dose to help you achieve your blood sugar goals. If after another 30 days, you haven’t reached your goal, your doctor may raise your Rybelsus dose again.
Taking Rybelsus with other drugs
You may need to take other diabetes medications with Rybelsus to help manage your blood sugar levels. Your doctor will recommend if using other drugs with Rybelsus is something you should do.
But keep in mind that you can’t take Rybelsus at the same time as you take other diabetes medications by mouth. Instead, you must wait at least 30 minutes between taking Rybelsus and taking other medications by mouth. You should take Rybelsus before, instead of after, you take other medications by mouth.
The effectiveness and safety of taking Rybelsus alone and with other antidiabetic drugs has been studied. And the studies have shown that taking other diabetes medications together with Rybelsus can help you achieve your blood sugar goals.
Questions about taking Rybelsus
You may have questions about taking Rybelsus. Below we answer some questions related to the dosage of this drug.
- What if I miss a dose of Rybelsus? If you miss a dose of Rybelsus, take your next dose the following day as usual. Then go back to your regular schedule. But don’t take an extra dose to make up for the missed dose.
- Will I need to use Rybelsus long term? Diabetes is a long-lasting condition, so you may need to take Rybelsus long term. Talk with your doctor about how long you’ll need to take this drug.
- Can Rybelsus be chewed, crushed, or split? No, you shouldn’t chew, crush, or split Rybelsus pills. Instead, you must swallow them whole. If you have trouble swallowing whole pills, talk with your doctor or pharmacist. They’ll help you find a solution to take your medication safely.
- Should I take Rybelsus with food? No, you shouldn’t take Rybelsus with food. Instead, you should take Rybelsus 30 minutes before your first meal of the day. And you should take your dose with no more than 4 ounces of plain water. If you take Rybelsus with food or beverages besides water, you may absorb less of the drug than you’re meant to. And waiting less than 30 minutes before eating or taking other medications by mouth can also alter Rybelsus’ effectiveness.
- How long does Rybelsus take to work? Your blood sugar levels may start to be managed with Rybelsus after 30 days of taking the drug. But it may take several months before major improvements occur. In studies, Rybelsus made significant improvements in people’s blood sugar levels after 26 weeks of treatment.
Questions for your doctor
You may have questions about Rybelsus and your treatment plan. It’s important to discuss all of your concerns with your doctor.
Here are a few tips that might help guide your discussion:
- Before your appointment, write down questions like:
- How will Rybelsus affect my body, mood, or lifestyle?
- Bring someone with you to your appointment if doing so will help you feel more comfortable.
- If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.
Remember, your doctor and other healthcare providers are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.
If you have diabetes, your doctor may prescribe Rybelsus for you.
Rybelsus is a glucagon-like peptide-1 (GLP-1) agonist. GLP-1 is a protein that’s found naturally in your body. It has a role in helping to control your blood sugar levels.
Rybelsus works to lower your blood sugar levels by:
- Increasing your body’s release of insulin. When you take Rybelsus, your pancreas releases more insulin. And insulin helps move sugar out of your blood and into your cells, lowering your blood sugar level.
- Blocking your body’s release of glucagon. When you take Rybelsus, your pancreas releases less glucagon. Glucagon activates your liver to make sugar, raising your blood sugar level.
Note: Rybelsus isn’t meant to be used as the first type 2 diabetes treatment in people whose blood sugar levels aren’t managed with diet and exercise. In addition, people with type 1 diabetes cannot take Rybelsus because it wouldn’t be effective for this condition. And Rybelsus shouldn’t be used to treat diabetic ketoacidosis (DKA). (DKA is a serious complication of diabetes in which you have a high level of acid in your blood.)
Additionally, it’s not known if Rybelsus is safe to use in people who have had pancreatitis (inflammation in your pancreas). Rarely, Rybelsus can cause pancreatitis as a serious side effect. So your doctor may decide to prescribe a different medication for you if you’ve had pancreatitis in the past.
Some important things to discuss with your doctor when considering Rybelsus treatment include:
- your overall health
- any medical conditions you may have
Tell your doctor if you’re taking any prescription or over-the-counter drugs. This is important to do because some medications may interfere with how Rybelsus works.
These and other considerations to discuss with your doctor are described below.
Taking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.
Before taking Rybelsus, be sure to tell your doctor about all medications you take (including prescription and over-the-counter types). Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Rybelsus.
Note: The lists below don’t contain all types of drugs that may interact with Rybelsus. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Rybelsus.
Interactions with drugs or supplements
Rybelsus slows down digestion in your body. So it can affect how other drugs are absorbed if you take them at the same time as you take Rybelsus.
To ensure proper absorption of other drugs, you must follow the recommendations given for when to take Rybelsus. For more information, see the “How is Rybelsus taken?” section above.
Your doctor may need to monitor how much of other certain drugs you have in your blood stream if you’re taking them with Rybelsus. Some of these
- the anticoagulant warfarin (Coumadin)
- the thyroid medication levothyroxine (Synthroid)
- the antiseizure medications carbamazepine and phenytoin (Dilantin)
- the antipsychotic medication lithium
- the heart medication digoxin
- the immune system blocker tacrolimus
Interactions with other diabetes medications
For example, using Rybelsus with insulin or insulin secretagogues may make your blood sugar level too low. (Insulin secretagogues are drugs that help your body release insulin.)
Examples of insulin secretagogues include:
If your blood sugar level drops too low while insulin or insulin secretagogues with Rybelsus, your doctor may lower your dosage of insulin or insulin secretagogues.
It’s unknown whether any herbs or natural products interact with Rybelsus. Talk with your doctor or pharmacist if you have questions about taking anything with Rybelsus.
There aren’t any foods known to interact with Rybelsus. However, if you take Rybelsus with food, the amount of the drug your body absorbs will be lowered. So you should always take Rybelsus on an empty stomach, at least 30 minutes before your first meal of the day.
In mice and rats, semaglutide (the active drug in Rybelsus) can cause thyroid cancer. But animal studies don’t always show what can happen in people.
It’s not known if Rybelsus causes thyroid cancer in people. But doctors don’t recommend Rybelsus for people:
- who’ve had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or who have a rare genetic condition called multiple endocrine neoplasia syndrome type 2 (MEN 2)
- who have family members with MTC or a history of MTC
For more information, see the “What are Rybelsus’ side effects?” section above.
Rybelsus may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Rybelsus. Factors to consider include those in the list below.
- Changes in eyesight related to diabetes. Some people have had complications of diabetic retinopathy while taking glucagon-like peptide-1 (GLP-1) agonists. (And Rybelsus belongs to the group of drugs called GLP-1 agonists.) With diabetic retinopathy, you have damage to your eyes that’s caused by diabetes. If you already have problems with your vision due to diabetes, your doctor will closely monitor your eyesight while you’re taking Rybelsus.
- Allergic reaction. If you’ve had an allergic reaction to Rybelsus or any of its ingredients, you shouldn’t take Rybelsus. Ask your doctor what other medications are better options for you.
- Low blood sugar. You may need to take Rybelsus together with other diabetes medications. A type of diabetes medication called insulin secretagogue, as well as insulin, may cause low blood sugar. (Insulin secretagogues are drugs that help your body release insulin.) Combining these medications with Rybelsus may lower your blood sugar too much. To help prevent this, your doctor may lower your dosage of insulin or insulin secretagogue.
- Kidney problems. Some people have had new or worsening kidney problems while taking GLP-1 agonists. If you have kidney failure or have severe vomiting or diarrhea with Rybelsus, your doctor will monitor your kidney function. It’s important to drink electrolyte fluids if you have severe vomiting or diarrhea. This reduces your risk for developing kidney problems from dehydration (low fluid level in your body).
- Pancreas problems. Rybelsus hasn’t been studied in people who’ve had pancreatitis (inflammation in your pancreas). Pancreatitis is a rare, but possibly serious, side effect of Rybelsus. So be sure to tell your doctor about any history of pancreas problems, including pancreatitis. They’ll work to determine if Rybelsus is safe for you to take or if you should try a different medication for your condition.
Use with alcohol
Some medications interact with alcohol. But Rybelsus isn’t one of them. However, before starting Rybelsus, ask your doctor or pharmacist if it’s safe for you to drink alcohol.
And remember that Rybelsus should be taken at least 30 minutes before you drink anything other than 4 ounces of plain water. You should avoid drinking alcohol before you take your Rybelsus dose.
Pregnancy and breastfeeding
It’s not known whether Rybelsus is harmful if it’s taken during pregnancy. But having diabetes that’s not well managed during pregnancy is harmful.
So if you have diabetes and you’re pregnant or considering pregnancy, talk with your doctor. They’ll help you weigh the risk and benefits of Rybelsus treatment. Be sure to talk with your doctor before taking Rybelsus while pregnant.
It’s also unknown whether Rybelsus passes into breast milk. It’s recommended that you don’t breastfeed while taking Rybelsus.
Below we answer a commonly asked question about Rybelsus.
How does Rybelsus differ from Ozempic?
Rybelsus and Ozempic are both brand-name medications that contain the active drug semaglutide. And they’re both used in people with type 2 diabetes.
But unlike Rybelsus which is taken by mouth, Ozempic is taken by injection. Ozempic needs to be injected once a week, while Rybelsus needs to be taken by mouth once a day.
Because Ozempic is an injection, you may have some skin reactions, like redness and pain, while using it. But other side effects of Ozempic are similar to those of Rybelsus.
In addition to treating diabetes, Ozempic can be used to lower the risk of major heart or blood vessel events in people with type 2 diabetes and heart disease. (These major events include heart attack and stroke.)
Rybelsus doesn’t increase the risk of heart problems. But unlike Ozempic, it’s not prescribed to reduce the risks of these problems.
Your doctor may switch your treatment between Rybelsus and Ozempic if you prefer one drug over the other. If you’d like to know more about this, or you have more questions about these two drugs, talk with your doctor.
Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for Rybelsus in your area, visit GoodRx.com.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Rybelsus manufacturer’s website to see if they have support options.
Don’t take more Rybelsus than your doctor prescribes. Using more than this can lead to serious side effects.
If you take more Rybelsus than what your doctor prescribed, you’ll need monitoring for possible signs and symptoms of overdose.
What to do in case you take too much Rybelsus
Call your doctor if you think you’ve taken too much Rybelsus. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use their online resource. However, if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.
If you have questions about Rybelsus, talk with your doctor or pharmacist before starting this drug.
Also, ask your doctor about other treatment options for diabetes. Here’s a list of articles that you might find useful:
Some questions you may want to ask your doctor about Rybelsus include:
- How should I store Rybelsus?
- Why do I have to take Rybelsus with other diabetes medications?
- How can I switch from Ozempic to Rybelsus?
- If I have heart disease, should I take Ozempic or Rybelsus?
- Can I drink alcohol while taking Rybelsus?
You can learn more about diabetes and its treatment options by subscribing to the Healthline diabetes newsletter.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.