Rybelsus for Weight Loss
Are you thinking about trying Rybelsus to help you lose weight? Scroll down to learn more about Rybelsus and see if it fits your weight loss journey.
What is Rybelsus?
Rybelsus is an FDA-approved weight loss medication used to treat type 2 diabetes in adults and can be used off-label for weight loss. It contains semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist similar to Wegovy and Ozempic. Rybelsus is different from other GLP-1 receptor agonists because it is an oral medication, not an injectable. This is why it may benefit those who are averse to needles.
How Does Rybelsus Work?
As mentioned, the main ingredient in Rybelsus is Semaglutide. It belongs to a class of drugs called GLP-1 receptor agonists, which mimic the effects of the naturally occurring hormone GLP-1. GLP-1 stands for "glucagon-like peptide-1," a hormone naturally produced in the human body. It is secreted by the cells in the intestines in response to food intake and helps to regulate blood sugar levels by stimulating insulin secretion from the pancreas. GLP-1 also slows down the digestion process, reduces appetite, and promotes feelings of fullness, which can help with weight management
Along with regulating insulin secretion and appetite, there are also anti-inflammatory effects. There are GLP-1 receptors in a multitude of organs. When activated, they lead to a decrease in the amount of pro-inflammatory receptors as well as an increase of anti-inflammatory cells in the body. This anti-inflammatory effect may provide benefits in reducing the risk of atherosclerosis (plaque formation in the arteries) and improving cardiovascular conditions (1).
This may also open avenues for the use of Rybelsus and other GLP-1 agonists in other inflammatory conditions such as arthritis, polycystic ovarian syndrome, and psoriasis. However, more studies are needed to say for sure.
Who Qualifies for Rybelsus?
Rybelsus is approved for the management of type 2 diabetes. Therefore, if you are diagnosed with type 2 diabetes, you may be eligible to start either Rybelsus.
Rybelsus can also be used off-label for weight loss in patients struggling with obesity. If you have a BMI greater than 30 or a BMI greater than 27 and have an obesity-related condition (diabetes, hypertension, dyslipidemia), you may be eligible to take Rybelsus.
Due to the weight loss and anti-inflammatory effects, Rybelsus may also be used in patients with Polycystic Ovarian Syndrome (PCOS). A narrative review of evidence published in 2021 reviewed over 800 articles and found that there may exist a promising therapeutic role of GLP-1 agonist medications, like Rybelsus, in managing PCOS (2). However, more extensive clinical trials are needed to establish a possible role.
Can Rybelsus Be Used for Weight Loss?
Rybelsus has been shown to have weight loss benefits when studied in people with type 2 diabetes. These benefits can extend to those who do not have diabetes. It is always important to remember that you should also be dieting and exercising regularly while taking any prescription weight loss medication. This often includes a calorie restriction diet of some type and regular moderate exercise (~150 minutes/ week). Moderate exercise is any exercise where you are actively sweating or your heart rate is increased (running, long walks, weight lifting, resistance training, etc)
One study that showed weight loss benefits for people taking Rybelsus was the PIONEER-1 trial. In the PIONEER-1 trial, the researchers examined how well Rybelsus managed diabetes in type 2 diabetics compared to a placebo (3). The researchers found a significant difference in body weight in the treatment group receiving a 14 mg dosage of Rybelsus. This group experienced a 2.6 kg (~5lb) difference after just 26 weeks. It should also be noted that the treatment group was not on a diet plan, exercising around 150 minutes per week, nor did a dietician follow them.
Rybelsus vs Other GLP-1 Medications
Rybelsus vs Ozempic and Wegovy
Rybelsus, Wegovy, and Ozempic use semaglutide as their active ingredients. Ozempic and Wegovy are both weekly pen injections that are given at different doses. Ozempic is used for type 2 diabetes and can be used off-label for weight loss. Wegovy is only FDA-approved for the treatment of obesity. Since Rybelsus is an oral medication, it has different effectiveness when compared to Ozempic and Wegovy.
In a meta-analysis published in 2021, researchers compared oral semaglutide (Rybelsus) to injectable semaglutide (specifically Ozempic) and other injectable GLP-1 agonists in patients with type 2 diabetes (4). They reviewed nine different studies and compared the results to each other. One of the things they were comparing was the effects on body weight. The results showed that Ozempic had a larger weight loss effect compared to Rybelsus. However, the results were not significant. The study also does not mention if the studies that were compared for Ozempic and Rybelsus also included diet and exercise.
Comparing the results of the PIONEER-1 trial for Rybelsus to the STEP-1 trial for Wegovy, it appears that Wegovy has a more significant weight loss effect. The STEP 1 Trial was a large randomized control trial with about 1900 participants that examined how effective Wegovy (semaglutide) was at treating obesity in non-diabetic patients (5). Wegovy was given as a once-weekly pen injection starting at a low dose that was gradually increased to a maximum of 2.4mg over 68 weeks. After 68 weeks, they found that participants taking Wegovy along with diet and exercise experienced a significant reduction in body weight (around 15%) compared to the placebo group.
Though Wegovy had better results for weight loss, more people taking Wegovy reported gastrointestinal side effects compared to people taking Rybelsus. Also, Rybelsus may be better for those who do not want to use an injectable medication. It should also be noted that the PIONEER-Trial was done over a short period of time than the STEP-1 trial (28 weeks for Rybeslsu vs 68 weeks for Wegovy). Lastly, the participants in the PIONEER-1 trial were taking Rybelsus without undergoing regular exercise and dieting. Therefore, Rybelsus may have a similar weight loss effect when paired with diet and exercise in the long run.
Rybelsus vs Trulicity
The meta-analysis mentioned before also compared Rybelsus to Trulicity (Dulaglutide). They found that Rybelsus appeared to have better effects on weight loss. However, the difference was not statistically significant. It also does not mention if the studies that were compared included diet and exercise.
Rybelsus vs Victoza
The meta-analysis mentioned before also compared Rybelsus to Victoza (Liraglutide). They found that Rybelsus appeared to have better effects on weight loss. However, the difference was not statistically significant. It also does not mention if the studies that were compared included diet and exercise.
Rybelsus Side Effects
The most common side effects when taking Ozempic are gastrointestinal, but there are other commonly reported side effects. This includes:
- Abdominal pain
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Headache
- Sore throat, or throat pain
The side effects are usually mild to moderate in severity and go away over time. These side effects are less common when compared to the injectable counterparts (Wegovy and Ozempic).
Rybelsus Dosage and Administration
Rybelsus is a once-daily tablet that is started at a dose of 3 mg for 30 days. After 30 days, the dose can be increased to 7 mg or to a max of 14 mg. Rybelsus should be taken 30 minutes before your first meal, beverage, or oral medication. You should take Rybelsus with water. You should not split, crush or chew the tablet. If a dose is missed, the missed dose should be skipped, and the next dose should be taken the following day.
Rybelsus Contraindications and Warnings
Pancreatitis
Pancreatitis occurs when the pancreas becomes inflamed. This is an infrequent but potential side effect of Rybelsus. If you have a history of pancreatitis, please inform your provider before starting Rybelsus.
Hypoglycemia (Low Blood Sugar)
Since Rybelsus increases insulin secretion, there is a risk that your blood sugar can be lowered to dangerous levels. This is known as hypoglycemia. If you have a history of hypoglycemia or are currently using insulin, you must inform your provider before starting Rybelsus.
Serious Allergic Reaction
You may experience a severe allergic reaction to Rybelsus when first taking it. Signs of a severe allergic reaction include swelling of your face, lips, tongue, or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat. Let your provider know immediately if you have experienced this with other GLP-1 medications or are currently experiencing this when taking Rybelsus.
Kidney Disease
Though Rybelsus is safe for people with kidney disease, the stomach problems associated with Rybelsus may lead to fluid loss by vomiting, nausea, or vomiting. If you do have kidney problems, it is essential to stay hydrated while on Rybelsus. If the gastrointestinal side effects of Rybelsus are preventing you from adequately staying hydrated, then let your provider know immediately.
Severe Stomach Problems
The most common side effect of Rybelsus is gastrointestinal upset, which includes stomach ache, nausea, diarrhea, vomiting, and loss of appetite. If these symptoms become so severe that they significantly affect your daily life or ability to eat regularly, then let your provider know.
Changes in Vision
For patients with a history of diabetic retinopathy, there is a chance that your vision can worsen when taking Rybelsus. If you do have a history of diabetic retinopathy, then let your provider know before starting Rybelsus.
Gallbladder Disease
Rybelsus can also cause some gallbladder issues along with other gastrointestinal side effects. Since Rybelsus can decrease the movement of food through the gastrointestinal system, it can also reduce the function of the gallbladder. This can lead to gallstone formation, which can block the release of bile, leading to the inflammation of the gallbladder.
If you have a history of gallstones or cholecystitis (inflammation of the gallbladder), then let your provider know before starting Rybelsus. If you have had your gallbladder removed in the past, then you can still take Rybelsus.
Thyroid Cancer or Family History of MEN-2
Though very rare, there is a risk of developing a specific type of thyroid cancer when taking Rybelsus, called Medullary Thyroid Cancer. If you have a history of medullary thyroid cancer or a family history of Multiple Endocrine Neoplasia Cancer Syndrome Type 2 (MEN-2), let your provider know before starting Rybelsus. MEN-2 is a genetic cancer syndrome that puts a patient at risk for developing Medullary Thyroid Cancer, which is why patients with this syndrome should avoid taking Rybelsus.
Pregnancy
The use of Rybelsus is not well studied. Studies in pregnant rats do show an increased risk for miscarriage and structural abnormalities when rats were given semaglutide (the active ingredient in Rybelsus). The current recommendations are not to take Ozempic during pregnancy. Let your doctor know if you are pregnant or plan on becoming pregnant before starting Rybelsus.
Rybelsus Coverage and Cost
The cost of Rybelsus can be very expensive. The average cost for Rybelsus can range from $900-950 for a month’s supply. Therefore, you should discuss which medication your plan covers with your insurance provider or if you qualify for any benefit plans.
If you are interested in Rybelsus, there is a Rybelsus savings Card that you can apply for, where you can pay as low as $10 for a 30 - 90 day supply of medication. For Rybelsus, around 99% of commercial insurance plans can help cover the costs. You may also be eligible for the Patient Assistance Program offered by NovoCare, where you may receive Rybelsus for free!
Where Can I Get Rybelsus?
If you would like to learn more about GLP-1 medications or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Mochi Health is a virtual obesity medicine practice that connects you with medical providers, like licensed physicians and nurse practitioners, to help you optimize your weight loss journey. We provide monthly video chats with actual medical providers to provide guidance about weight management and to get you started on prescription weight loss medications to supplement your weight loss plan.
Frequently Asked Questions
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References
- Jensen JK, Binderup T, Grandjean CE, Bentsen S, Ripa RS, Kjaer A. Semaglutide reduces vascular inflammation investigated by PET in a rabbit model of advanced atherosclerosis. Atherosclerosis. 2022 Jul;352:88-95. doi: 10.1016/j.atherosclerosis.2022.03.032. Epub 2022 Apr 4. PMID: 35400496; PMCID: PMC9241989.
- Abdalla MA, Deshmukh H, Atkin S, Sathyapalan T. The potential role of incretin-based therapies for polycystic ovary syndrome: a narrative review of the current evidence. Ther Adv Endocrinol Metab. 2021 Jan 27;12:2042018821989238. doi: 10.1177/2042018821989238. PMID: 33552465; PMCID: PMC7844452.
- Vanita R. Aroda, Julio Rosenstock, Yasuo Terauchi, Yuksel Altuntas, Nebojsa M. Lalic, Enrique C. Morales Villegas, Ole K. Jeppesen, Erik Christiansen, Christin L. Hertz, Martin Haluzík, PIONEER 1 Investigators; PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care 1 September 2019; 42 (9): 1724–1732. https://doi.org/10.2337/dc19-0749
- Chubb, B., Gupta, P., Gupta, J. et al. Once-Daily Oral Semaglutide Versus Injectable GLP-1 RAs in People with Type 2 Diabetes Inadequately Controlled on Basal Insulin: Systematic Review and Network Meta-analysis. Diabetes Ther 12, 1325–1339 (2021). https://doi.org/10.1007/s13300-021-01034-w
- Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: 10.1056/NEJMoa2032183. Epub 2021 Feb 10. PMID: 33567185.
