Rybelsus (semaglutide) is a prescription drug that’s used to manage blood sugar levels in people with diabetes. This drug can interact with other medications, such as levothyroxine (Synthroid), glyburide (Glynase), and propranolol (Inderal XL).

Rybelsus is prescribed along with exercise and a balanced diet to help manage blood sugar levels in adults with type 2 diabetes.

Rybelsus interacts with food, supplements, and other drugs. An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Rybelsus’s interactions. And for more information about Rybelsus, including details about its uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Rybelsus. In such cases, your doctor may not prescribe Rybelsus for you. These are known as contraindications. The list below includes contraindications for Rybelsus.

If you or a family member have had medullary thyroid cancer. Rybelsus has a boxed warning for the increased risk of thyroid cancer, including medullary thyroid cancer. If you or a family member have had medullary thyroid cancer, your doctor will not prescribe Rybelsus for you. To learn more, see the “Boxed warning” section above.

If you have multiple endocrine neoplasia type 2 (MEN 2). MEN 2 is a rare condition that causes thyroid cancer. And because Rybelsus has a boxed warning for the increased risk of thyroid cancer, your doctor will not prescribe Rybelsus to you if you have MEN 2. To learn more, see the “Boxed warning” section above.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Rybelsus or any of its ingredients, your doctor likely won’t prescribe Rybelsus. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start taking Rybelsus, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Rybelsus is safe for you to take.

There are no known interactions between Rybelsus and alcohol. But drinking alcohol while taking Rybelsus may raise your risk of nausea and vomiting. And if you’ve already experienced nausea and vomiting as a side effect of Rybelsus, drinking alcohol may make it worse.

Also, drinking alcohol when you have diabetes can increase your risk of low blood sugar. While your liver is breaking down the alcohol, it stops releasing stored sugar into the blood. This can be a problem if you haven’t eaten for a few hours, such as when you’re sleeping at night. Because Rybelsus can also cause low blood sugar, drinking alcohol while taking Rybelsus may further increase this risk.

Keep in mind that Rybelsus should be taken on an empty stomach and at least 30 minutes before drinking or eating. This applies to drinking alcohol as well. To learn more, see the “Does Rybelsus interact with food?” section below.

Talk with your doctor if you have questions about drinking alcohol while taking Rybelsus. They can tell how much, if any, alcohol is safe to consume during your treatment.

Before you start taking Rybelsus, tell your doctor and pharmacist about any prescription or over-the-counter drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Rybelsus interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Rybelsus?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below shows a list of drugs that may interact with Rybelsus. Keep in mind that this table does not include all drugs that may interact with Rybelsus. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug nameDrug examplesWhat can happen
insulin• insulin glargine (Lantus, Basaglar)
• insulin aspart (Novolog) insulin lispro (Humalog)
increased risk of low blood sugar
salicylatesaspirin (Ecotrin, Excedrin Migraine, others)
• bismuth subsalicylate (Pepto-Bismol)
increased risk of low blood sugar
certain diabetes medications that help your body make and release more insulin• glimepiride (Amaryl)
glyburide (Glynase)
repaglinide
increased risk of low blood sugar
certain drugs with a narrow safety rangelevothyroxine (Synthroid)
digoxin (Lanoxin)
carbamazepine (Tegretol)
phenytoin (Dilantin)
tacrolimus (Prograf)
can make Rybelsus less effective and affect the absorption of the other drug
beta-blockersmetoprolol (Lopressor, Toprol XL)
nebivolol (Bystolic)
propranolol (Inderal XL)
can hide symptoms of low blood sugar
certain diuretics (fluid pills)furosemide (Lasix)
torsemide (Soaanz)
can make Rybelsus less effective
certain blood pressure medicationslisinopril (Zestril)
losartan (Cozaar)
amlodipine (Norvasc, Katerzia)
valsartan (Diovan)
increased risk of low blood sugar

See below to learn more about certain drug interactions that can occur with Rybelsus.

Interaction with drugs with a narrow safety range

Rybelsus may interact with certain drugs that have a narrow safety range, also called a narrow therapeutic index. With a narrow safety range, small changes in blood levels of the drug can have significant effects. For example, a small increase in the dose may result in harmful side effects. Or if less drug is absorbed by the body, the drug may not work at all.

Examples of drugs with a narrow safety range include:

What could happen

Rybelsus causes your stomach to empty more slowly. If you take other drugs that you swallow, these drugs may stay in the stomach for longer than usual before reaching the intestines. This can affect the amount of drug your body absorbs.

For many drugs, this isn’t a problem. But for drugs with a narrow safety range, a small change in the amount of drug absorbed does matter. It may make the drug less effective or increase the risk of side effects.

What you can do

Be sure to tell your doctor all the medications you take before starting Rybelsus treatment. If you take a drug with a narrow safety range that could be affected by Rybelsus, they’ll likely monitor the level of that drug in your body more closely. If needed, they’ll adjust its dosage.

It’s recommended that you take Rybelsus on an empty stomach and at least 30 minutes before drinking, eating, or taking oral medications. Following these instructions helps to decrease interactions between Rybelsus and the other drugs you swallow.

Talk with your doctor if you have questions about taking Rybelsus with other medications. They can discuss a medication schedule that works for you.

Interaction with certain other diabetes medications

Rybelsus can interact with certain other diabetes drugs.

Your doctor may prescribe other diabetes drugs with Rybelsus. There are different kinds of diabetes drugs. Some work by helping your body make and release more insulin. Examples of drugs that work this way include:

What could happen

Rybelsus works by helping your body make and release more insulin. Taking other drugs that do the same may cause you to have too much insulin in your body. This can lead to blood sugar levels that are too low.

What you can do

Let your doctor know if you take other diabetes medications before you start taking Rybelsus. If you do, they may recommend that you monitor your blood sugar level more closely.

If your blood sugar becomes too low, your doctor will adjust the dosages of your diabetes medications.

Interaction with beta-blockers

Rybelsus can interact with beta-blockers. These medications are usually prescribed to lower blood pressure and reduce heart rate.

Examples of beta-blockers include:

What could happen

Typically, you may watch for certain symptoms that warn you of low blood sugar. But taking beta-blockers when you have diabetes may prevent you from experiencing some of these symptoms, including:

  • tremors
  • fast heartbeat
  • sense of dread or anxiety

This means that if you have low blood sugar while taking a beta-blocker, you may not notice these symptoms. (Beta-blockers don’t prevent sweating triggered by low blood sugar, so this is an important symptom you can still watch out for.)

What you can do

Tell your doctor if you’re taking a beta-blocker before starting Rybelsus treatment. They’ll likely have you check your blood sugar level more frequently while taking these drugs together. If your blood sugar becomes too low, they’ll adjust your Rybelsus dosage.

Rybelsus may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Rybelsus.

Does Rybelsus interact with supplements?

Before you start taking Rybelsus, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take, especially those meant to help manage blood sugar levels. Sharing this information with your doctor may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Rybelsus and herbs

There are currently no reports of Rybelsus interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Rybelsus.

Rybelsus interactions with vitamins and minerals

Rybelsus may interact with the mineral supplement chromium. Some studies suggest that chromium may improve blood sugar level management in people with type 2 diabetes. Taking Rybelsus with chromium may cause the blood sugar levels to drop too low.

Talk with your doctor or pharmacist before taking any vitamins or minerals. They can tell you whether they’re safe to take with Rybelsus.

Does Rybelsus interact with food?

Rybelsus does interact with food. Rybelsus needs to be taken on an empty stomach when you wake up, and at least 30 minutes before you consume any food, beverages, or other medications. (It can be taken with up to 4 ounces of water.)

If you take Rybelsus with food or beverages, your body may absorb less of the drug. This can cause Rybelsus to be less effective.

Does Rybelsus interact with vaccines?

There are currently no reports of Rybelsus interacting with vaccines. Talk with your doctor if you have concerns about getting vaccines during your Rybelsus treatment.

Does Rybelsus interact with lab tests?

Currently, there are no reports of Rybelsus interacting with lab tests. If you’re concerned about having lab tests during your treatment, talk with your doctor.

Does Rybelsus interact with cannabis or CBD?

There are currently no reports of Rybelsus interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Rybelsus.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Rybelsus. Before taking Rybelsus, talk with your doctor about your health history. They’ll determine whether Rybelsus is right for you.

Health conditions or other factors that might interact with Rybelsus include:

A personal or family history of thyroid cancer. Rybelsus has a boxed warning for the risk of thyroid cancer. (For more information, see the “Boxed warning” section at the beginning of this article.)

Due to this risk, your doctor won’t prescribe Rybelsus if you or a family member have had medullary thyroid cancer or multiple endocrine neoplasia syndrome 2.

Pancreatitis. Rybelsus can cause pancreatitis. If you already have this condition, taking this drug may make it worse. Let your doctor know if you have problems with your pancreas before starting Rybelsus treatment. They’ll determine whether this medication is safe for you.

Kidney problems. Rybelsus may cause new or worsening kidney problems. In studies, most people who had kidney problems while taking Rybelsus were dehydrated (had a low fluid level in the body). You can become dehydrated if you don’t drink enough fluids, are vomiting, or have diarrhea.

It’s important to maintain proper hydration (fluid levels) while taking Rybelsus. Let your doctor know if you have severe vomiting or diarrhea during your Rybelsus treatment. Also let them know if you have kidney problems before starting Rybelsus treatment. They’ll likely monitor your kidney function closely.

Gallbladder problems. Rybelsus may cause gallbladder problems, such as gallstones. If you already have problems with your gallbladder, Rybelsus may worsen them. Talk with your doctor about any gallbladder issues you have. They’ll let you know if this treatment is safe for you.

Diabetic retinopathy. If you have an eye condition called diabetic retinopathy, tell your doctor before you start taking Rybelsus. In studies, Rybelsus caused complications of diabetic retinopathy.

Also, diabetic retinopathy can become temporarily worse if your blood sugar level improves suddenly. If you already have diabetic retinopathy, your doctor may recommend that you have your eyes examined more frequently.

Pregnancy. It’s not known whether it’s safe to take Rybelsus during pregnancy. There aren’t enough studies on people taking Rybelsus during pregnancy. Talk with your doctor if you’re pregnant or planning to become pregnant before taking Rybelsus. They can discuss the potential risks and benefits of taking this drug during pregnancy.

Breastfeeding. It’s not known whether Rybelsus passes into breast milk or the effect it would have on a breastfed child. But due to the potential risk of serious side effects in a breastfed child, breastfeeding is not recommended during Rybelsus treatment. If you’re breastfeeding or planning to do so, talk with your doctor about your options.

Allergic reaction. If you’ve had an allergic reaction to Rybelsus or any of its ingredients, your doctor will likely not prescribe Rybelsus. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Find answers to some frequently asked questions about Rybelsus and possible interactions.

Can you take metformin and Rybelsus together?

Yes, your doctor may prescribe Rybelsus together with metformin to help manage your blood sugar level.

Keep in mind that each drug can cause low blood sugar levels, and taking both drugs together can increase this risk. Because of this, your doctor will likely have you closely monitor your blood sugar level when taking both drugs. If needed, they’ll adjust your dosages.

Talk with your doctor if you have questions about taking other diabetes medications with Rybelsus.

Can you take Jardiance and Rybelsus together?

Yes. Although it’s not common, your doctor could prescribe both Jardiance and Rybelsus for you. Both drugs work in different ways to lower blood sugar levels.

To learn more about how these drugs compare, see this article.

If you have questions about possibly taking Jardiance with Rybelsus, talk with your doctor or pharmacist.

Are there any foods to avoid while taking Rybelsus?

No, there aren’t any specific foods known to interact with Rybelsus.

But taking Rybelsus with food reduces the amount of medication that your body absorbs. This can make Rybelsus less effective. Because of this, you should take Rybelsus on an empty stomach and at least 30 minutes before you eat, drink, or take other medications. (You can take Rybelsus with up to 4 ounces of water.)

Talk with your doctor or pharmacist if you have questions about how to take Rybelsus.

Taking certain steps can help you avoid interactions with Rybelsus. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

It’s also important to understand Rybelsus’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you didn’t get paperwork with Rybelsus, ask your pharmacist to print a copy for you.)

If you have difficulty reading or understanding this information, your doctor or pharmacist can help.

Taking Rybelsus exactly as prescribed can also help prevent interactions.

If you still have questions about Rybelsus and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

  • Would you prescribe Rybelsus with the medications I take for depression?
  • Do I need to tell you if I start taking another medication or supplement during my Rybelsus treatment?
  • Do I need to space taking my medications throughout the day to avoid interactions?

To learn more about Rybelsus, see these articles:

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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 another 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.