Rybelsus is a brand-name prescription medication. Its active ingredient is semaglutide. It belongs to the glucagon-like peptide-1 (GLP-1) receptor agonist. It comes in an oral tablet. It was approved by the Food and Drug Administration (FDA) in 2017 to manage blood sugar levels in type 2 diabetic adults. It is used with a healthy diet and exercise and is often used as a long-term treatment. Some people also use this drug for weight loss.

Just like other medications, Rybelsus can result in some side effects. These potential side effects can be common, mild, severe, or rare. It is essential to know Rybelsus' side effects when you start using it so you can watch out for the symptoms. It is necessary to work with a healthcare provider when on Rybelsus because some side effects can be life-threatening, and you want to make sure you take care of yourself properly and not take unnecessary risks.

Common Rybelsus Side Effects for Diabetics

Nausea

Nausea and vomiting are the most common side effects of Rybelsus. This can happen because Rybelsus slows down stomach emptying, letting food stay in your stomach longer than usual.

As in the clinical trials , nausea and vomiting may likely happen when you start taking Rybelsus or have an increased dosage. These usually improve within a few weeks as your body tolerates the medication.

Nausea and vomiting can also be a symptom of pancreatitis or gallbladder problems, especially if you have other symptoms like severe stomach pain. If you are experiencing other symptoms or nausea persists, you must see a doctor immediately.

Nausea Management Strategies  

If you are experiencing nausea, it is essential to stay hydrated; you will find it helpful to take sips of ice-cold drinks or cold fruit juice frequently.

Nausea can make you feel like you are not drinking water. Vomiting will cause you to lose a lot of fluids, too, and this can lead to dehydration.

Drinking sports drinks like Gatorade or eating soups or broth can be helpful if you are vomiting. It helps replace the electrolytes you lose while vomiting.

You should also avoid eating spicy, greasy, or overly sweet foods. Do not eat large main meals; eat smaller amounts more often instead. Do not lie down immediately after eating. And get plenty of fresh air.

Weight loss

Rybelsus causes food to stay in the stomach much longer, so you feel fuller, causing you to eat fewer calories. This can, in turn, make you lose weight. Reduced appetite and weight loss are commonly reported in clinical trials . Some people use Rybelus to lose weight while combining it with a healthy diet and exercise. Also, side effects like nausea, vomiting, or diarrhea can influence weight loss.

Weight loss approaches

Losing weight benefits your blood sugar levels and health if you have type 2 diabetes. Rybelsus should not be used only for weight loss as it is primarily used to control blood sugar levels for patients with type 2 diabetes. Talk to your doctor so it is sure you have enough nutrients. It is also not advisable to lose weight through vomiting and diarrhea. These side effects can make you lose body fluids and electrolytes, which can cause dehydration. You should speak to your doctor if you can't keep food or drink down because of gastrointestinal side effects.

Constipation

Constipation while taking Rybelsus is usually mild. Clinical trials listed this as one of the most common side effects. If constipation is not properly managed, it can cause nausea, hemorrhoids, rectal bleeding, and bowel blockage.

Constipation Alleviation Tips  

You can alleviate constipation symptoms by:

  • drinking more water
  • eating foods high in fiber, like whole grains, fruit, and vegetables.
  • regular exercises

If these do not ease your constipation, your doctor can recommend over-the-counter laxatives like:

  • stool softeners like docusate sodium
  • bulk-forming laxatives like methylcellulose
  • stimulant laxatives, such as senna

If your constipation does not ease up, your doctor may want to recommend a different laxative or switch you from Rybelsus to a different medication.

Severity Levels

Mild Side Effects

Side effects of Rybelsus in this category are usually temporary and may last a few days to weeks. If the side effects worsen, bother you, or persist for longer, you should speak to your doctor. Reported mild side effects of Rybelsus include:

  • Nausea and vomiting
  • Constipation
  • Indigestion
  • Acid reflux
  • Abdominal pain
  • Gas, bloating, and burping
  • Diarrhea
  • Reduced appetite
  • Weight loss
  • Mild allergic reaction

For more information, you can check the prescribing information for Rybelsus.

Severe Side Effects

Severe side effects often occur when taking Rybelsus. If you experience severe side effects while taking Rybelsus, seek medical attention immediately or call 911 or your local emergency number.

The severe side effects reported and their symptoms are:

  • Inflammation of the pancreas (pancreatitis). Symptoms may include:
    • nausea and vomiting
    • constant stabbing stomach pain that may spread toward your back
  • Hypoglycemia (low blood sugar levels) occurs, especially if taking sulfonylurea drugs such as glipizide(Glucotrol) or insulin. Symptoms may include:
    • sweating
    • irritability
    • shaking
    • dizziness
    • confusion
    • trouble concentrating
  • Kidney problems like kidney disease or kidney failure. Symptoms may include:
    • swollen feet, ankles, or hands
    • dark colored urine
    • less urination or none at all
  • Gallbladder problems like gallstones or gallbladder inflammation. Symptoms may include:
    • nausea and vomiting
    • jaundice
    • fever
    • pale stools
    • severe stomach pain below the ribs on the right side
  • Serious allergic reactions
  • Risk of thyroid tumors.

For more information, you can check the prescribing information for Rybelsus.

Rare and Serious Side Effects in the Context of Diabetes

Allergic Reactions  

It is not common to have an allergic reaction when using Rybelsus. The clinical trials did not report allergic reactions as a side effect. However, cases of serious allergic reactions have been indicated since the approval of the medication.

Signs of Allergic Reactions

  • Clearly outline the signs of allergic reactions that warrant immediate medical attention in people with diabetes using Rybelsus
  • Stress the importance of prompt intervention to prevent severe outcomes

Symptoms of an allergic reaction can include:

  • itchiness
  • hives (raised welts on your skin)
  • skin rash
  • flushing (redness, temporary warmth, or deepening of skin color)
  • swelling of the mouth, tongue, or throat, which can cause difficulty in breathing
  • swelling under your skin, usually in the eyelids, lips, hands or feet

When to Seek Medical Attention

You should immediately speak to your healthcare provider if you are experiencing a severe allergic reaction like anaphylaxis with symptoms of swelling or breathing difficulty. If you think you are having a medical emergency, get to the emergency right away or call your local emergency number. Your doctor will not prescribe Rybelsus if you have had an allergic reaction to it or its ingredients. If your reactions are mild, like a mild rash, you should call your doctor immediately; they may prescribe an over-the-counter antihistamine oral medication like Benadryl or a hydrocortisone cream you can apply to your skin.

If your healthcare provider confirms your mild reactions, they may decide you should continue using it. If your reactions are severe, they may change your treatment plan.

Pancreatitis 

Inflammation of the pancreas (pancreatitis) is a rare side effect of Rybelsus. Your doctor will not prescribe Rybelsus if you have ever had a medical history of pancreatitis. It is unknown whether Rybelsus is safe for people with a medical history of pancreatitis.

Hypoglycemia  

This is one of the rare side effects of hypoglycemia. Some diabetes medications can increase the risk of low blood sugar. Discuss your other diabetes medications, like insulin and sulfonylureas, with your doctor. If your doctor prescribes Rybelsus, you must closely monitor your blood sugar levels.

Diabetic Retinopathy

Rybelsus may worsen your condition if you are dealing with diabetic retinopathy (eye disease caused by diabetes). If you are experiencing vision side effects of Rybelsus while taking Rybelsus, you should tell your doctor immediately.

Risk of Thyroid Disorder

Rybelsus has a boxed warning indicating the risk of thyroid cancer. A boxed warning means a severe warning from the Food and Drug Administration (FDA) to predict harmful side effects for the benefit of doctors and patients. Animal studies indicate thyroid tumors in mice and rats, but animal studies do not show what happens in humans. No cases of thyroid cancer have been reported in people taking Rybelsus. However, medications like liraglutide (Saxenda and Victoza) in the same drug class as Rybelsus have reported cases of thyroid cancer in humans. However, it is not known if this drug class generally raises the risk of thyroid cancer.

Symptoms of Thyroid cancer

You should see your doctor if you develop the following symptoms:

  • lump in the throat
  • trouble swallowing
  • ongoing hoarseness
  • shortness of breath

When to Seek Medical Attention

Your doctor will likely not prescribe Rybelsus if you have ever had a personal or family history of:

  • medullary thyroid carcinoma (MTC)
  • a rare type of cancer known as multiple endocrine neoplasia syndrome type 2 (MEN 2)

Long-Term Effects and Diabetes Management

Effects on Kidney Function

Rybelsus may cause or worsen kidney problems, especially for long-term use, impacting kidney function in diabetic individuals. Symptoms of kidney disease can include nausea, vomiting, or diarrhea, which can make you dehydrated because of the loss of body fluids. If you have kidney problems, your doctor will often monitor your kidney function while taking Rybelsus.

Diabetes-Specific Patient Considerations

Pregnant or Breastfeeding Diabetics  

Rybelsus has not been studied for pregnant people and breastfeeding moms. Pregnancy and breastfeeding is usually crucial time, so it is essential to talk to your doctor if you're pregnant or breastfeeding or planning to get pregnant or breastfeed. It is not indicated that Rybelsus passes into breast milk, so for safety reasons, if you're taking Rybelsus, breastfeeding is not recommended. Your doctor will know how to control your blood sugar levels during this time and may recommend a different medication. High or low blood sugar can be harmful to the pregnant person or fetus during pregnancy.

Diabetic Individuals with Specific Conditions

People with diabetes can experience low blood sugar levels(hypoglycemia) and diabetic retinopathy when using Rybelsus. Your doctor may need to adjust your dosage and monitor you closely when using Rybelsus. Rybelsus may not cause hypoglycemia when used alone. Still, the risk of low blood sugar levels may increase when it is a drug combination with other diabetes medications like insulin or sulfonylureas.

Interactions with Other Diabetes Medications 

Before you start using Rybelsus, you must list other medications you are taking, whether prescription or over-the-counter and share them with your healthcare provider to indicate potential drug interactions. Do not change your dosage without speaking with your doctor.

People with diabetes who have other conditions like hypertension - high blood pressure or cardiovascular issues can be prescribed beta-blocker medications like propranolol, metoprolol, and glaucoma eye drops like timolol. Beta-blocker medications, especially non-selective ones, can potentially mask the symptoms of low blood sugar (hypoglycemia). Drugs can prevent you from feeling the fast, pounding heartbeat you feel when you have lower blood sugar levels. Beta-blockers may not cause other symptoms like dizziness, hunger, or sweating.

Guidance on Managing Interactions  

Check your blood sugar regularly. Speak with your doctor if there is a need to adjust your diabetes medication. A lot of drugs can affect your blood sugar and make it hard to control blood sugar levels. You have to tell your doctor immediately if you notice symptoms of low or high blood sugar levels. Working with a healthcare professional for personalized guidance based on your medical conditions is essential.

There can be other drug interactions with your diabetes medications, but the list cannot be exhausted in this document; your healthcare professional will be able to talk to you about this based on your medications. Make sure you follow your doctor's instructions carefully when taking Rybelsus.

What Should You Avoid Eating on Rybelsus?

There are no specific dietary restrictions while taking Rybelsus, but it is essential to comply with a healthy eating plan as advised by a registered dietitian or healthcare provider. The following nutritional guidelines can be adapted for the effective use of Rybelsus:

  • Limit the consumption of foods and drinks high in added sugars and processed foods as they are unhealthy and can also increase blood sugar spikes.
  • Cut out the refined carbohydrates.
  • Instead, focus on a balanced diet of nutritious foods like lean proteins, fiber, healthy fats, fruits, and vegetables.Lean protein: poultry, fish, tofu, legumes, and low-fat dairy.Fiber: whole grains, legumes, fruits, and vegetables.Healthy fats: avocados, nuts, seeds, and olive oil.
  • Also, eat regular and balanced meals to avoid overeating and snacking unnecessarily. You can opt for a healthy snack if you need to snack at all.
  • Consider portion control as it helps you be mindful of your portion sizes to help manage calorie intake and maintain a healthy weight. Eating smaller, balanced, and regular meals is very helpful.

Healthy meals can help stabilize blood sugar levels, manage weight loss, and promote digestive health.

Frequently Asked Questions

Is Rybelsus bad for the pancreas?

Rybelsus can be bad for the pancreas. Inflammation of the pancreas and gallbladder problems can happen when taking Rybelsus. It is a rare side effect. These conditions can result in severe abdominal pain, nausea, and vomiting. If you are experiencing any of these symptoms, speaking to a healthcare professional is best. If you have an inflamed pancreas or gallbladder, you must stop using Rybelsus.

Is Rybelsus better than Metformin?

Rybelsus and Metformin are good for lowering hemoglobin A1C (3-month average blood sugar levels) by 1% in diabetes patients. They are both oral medications. Most people consider Metformin a choice for treatment, primarily because of the additional cardiovascular benefits. However, other options are sometimes considered because not everyone can tolerate Metformin. Rybelsus is the only oral medication if you need to add a GLP-1 agonist to your drugs. Still, it is not usually recommended first but can be added to other medicines like Metformin to control high blood sugar. Ozempic and Rybelsus contain the same active ingredient, semaglutide. Ozempic may be a preferred form of treatment if you also have heart disease because it can reduce the risk of heart attack and stroke. This benefit has not yet been proven in Rybelsus. Ozempic is an injectable medication. Your healthcare provider's choice of Rybelsus, Metformin, or any other form of treatment depends on several factors.

Conclusion

Rybelsus treatment is used to control high blood sugar. It is a white oval tablet. It should used on an empty stomach 30 minutes before eating. When using Rybelsus, be mindful of drug combinations with other medications and how they interact. Drug interactions may increase the risk of severe side effects. Do well to share your prescription and over-the-counter medications with your doctor. If you miss a dose, skip the missed dose and continue your regular dosing schedule at the usual time. Do not double your next dose to catch up. Monitor your blood sugar level and call your doctor if you are experiencing low blood sugar levels.

There are mild, common, severe, and rare side effects of Rybelsus, like low blood sugar levels, gastrointestinal disorders, pancreatitis, risk of thyroid cancer, and diabetic retinopathy when taking Rybelsus. Gastrointestinal side effects may increase if you drink alcohol while taking Rybelsus.

It is essential to consult healthcare professionals for personalized advice, to monitor if you have diabetes, and to use Rybelsus for controlling blood sugar levels or weight loss. An extensive effort has been made to ensure we give you correct and up-to-date information, but it should not replace your doctor's advice. Side effects of Rybelsus are not something to take lightly, so consult your doctor for uses, precautions, warnings, drug interactions, allergic reactions, or adverse effects of this medication.

Sources

To ensure that we give you correct, accurate, and relevant information, all articles on Diabetic & Me are backed by verified information from academic research papers, well-known organizations, research institutions, and medical associations.

  1. Access Data HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use RYBELSUS® safely and effectively. See full prescribing information for RYBELSUS.
  2. Access Data HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use RYBELSUS® safely and effectively. See full prescribing information for RYBELSUS.
  3. WebMD Rybelsus - Uses, Side Effects, and More
  4. Medical News Today Rybelsus side effects: What you should know

About the Author

Ely Fornoville

Hi, I'm Ely Fornoville, and I am the founder of Diabetic Me. Being a type 1 diabetic since 1996, I developed a passion to help people learn more about diabetes. I write about diabetes and share stories from other diabetics around the world. I currently use a Medtronic Guardian 4 CGM and a MiniMed 780G insulin pump with Humalog insulin.

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