Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Rybelsus is a type-2 diabetes treatment that’s available by prescription only. It’s one of the more commonly-prescribed diabetes medications in the U.S. The branded version of the medication is called Rybelsus, and the generic version is called semaglutide. These terms refer to the same active compound so we’ll use them interchangeably throughout this article.
In this article we’ll review published medical research on Rybelsus to determine if it’s safe and effective for treating type-2 diabetes. We’ll highlight side effects of the medication and discuss whether it can cause weight loss in overweight and obese patients as a secondary benefit.
Does Rybelsus Work?
Rybelsus is prescribed to treat type-2 diabetes, and it does so by improving blood sugar control.
A medical review of Rybelsus and diabetes published in the Drugs in R&D journal analyzed results from 39 individual clinical trials on the topic. In every single analyzed study, the medication reduced A1C levels, which is a marker for blood sugar levels over the past 3 months. Most of the trials showed a moderate reduction in A1C levels of between 1-2%.
A separate clinical trial published in 2018 analyzed whether Rybelsus could reduce the blood sugar spike after a carb-rich meal. The results were impressive: the drug led to 38.5% lower glucose levels, and improved insulin sensitivity.
Another meta-study analyzed results from 9,980 patients using Rybelsus for diabetes. The researchers found that the medication was effective, but the average decrease in A1C levels is not that impressive in our opinion, at only -0.89%.
The study authors note that Rybelsus did reduce A1C levels by 0.35% more than “active comparators,” which refers to other diabetes medications. This suggests that Rybelsus may be a more effective option than many diabetes drugs on the market today.
We can conclude from the available research that Rybelsus is effective at treating and managing elevated blood sugar levels. While the decrease in blood sugar and A1C levels seen in Rybelsus trials is not that impressive, it is consistent.
Does Rybelsus Cause Weight Loss?
Many patients often ask about whether Rybelsus causes weight loss, because there are some indications in the research trials that the medication led to decreased weight in overweight and obese patients.
Since weight loss alone can help normalize blood sugar levels and insulin sensitivity, a secondary benefit from a type-2 diabetes medication of weight loss would be beneficial to patients.
The same active ingredient in Rybelsus is the active ingredient in an FDA-approved weight loss injection called Wegovy. As we detailed in our Wegovy reviews article, semaglutide is proven to be effective for weight loss when injected, but since Rybelsus uses an oral form of the medication we’ll have to analyze whether that drug delivery mechanism is similarly effective.
A well-designed medical trial testing Rybelsus’ effects on weight was recently published in the Diabetes, Obesity & Metabolism journal. All trial participants had type-2 diabetes.
Over a 12 week period, the subjects using Rybelsus lost an average of 2.7 kilograms (kg) which equates to 5.95 pounds (lbs). This is an impressive result, and even more impressive than the reductions in blood sugar in our opinion. The researchers documented that most of the weight loss was body fat, which is the ideal type of mass to lose.
It appears that Rybelsus may be effective for weight loss in patients with type-2 diabetes, but we don’t recommend using the drug for that outcome alone as it’s not approved for weight loss. If patients are interested in semaglutide for weight loss, we recommend that they speak with their doctor about Wegovy, because that medication contains the same active ingredient but is FDA-approved for weight loss.
How Does Rybelsus Work?
Rybelsus is one of a class of prescription medications called glucagon-like peptide-1 receptor agonists (GLP-1RA). These drugs are effective for diabetes because they help normalize glucose levels.
According to medical studies, GLP-1RA medications may block the release of a hormone called glucagon which is commonly elevated in type 2 diabetics. Glucagon causes the body to increase blood sugar levels, so by limiting its effect, blood sugar levels tend to decrease.
In regard to weight loss, Rybelsus may be effective because it reduces hunger and increases the sense of fullness. The medication delays gastric emptying which causes patients to feel full longer.
Rybelsus Side Effects
There are a variety of potential side effects from Rybelsus use, but the one we want to highlight first is the increased potential for a specific type of thyroid tumor.
The FDA label for Rybelsus contains a “black box” warning which is the most severe type of warning published by the FDA for prescription drugs, and indicates potentially severe or life-threatening side effects.
According to the label, animal studies of Rybelsus noted increased thyroid C-cell tumors. This doesn’t necessarily mean that the same effects will occur in humans, but it’s definitely worth speaking with your doctor about, especially for patients with a family history of thyroid tumors or conditions.
An independent medical review of the side effects of Rybelsus documented those which were most common: nausea (experienced by around 20% of patients), vomiting (4% to 11.5% of patients) and diarrhea (4.5% to 11.3%).
Clearly the more common side effects are milder than the potential side effect noted in the FDA black box warning.
Rybelsus User Reviews
Rybelsus has been reviewed many times on Drugs.com, which is the only resource we’re aware of for patients to publish reviews of prescription drugs they’re taking. We cannot confirm the legitimacy of any of these reviews.
The average user rating of Rybelsus on Drugs.com’s reviews page is 5.8/10, which is a mediocre rating.
The top positive review is from a user named “Jarin” who claims that the medication significantly reduced their A1C:
“This med Rybelsus is awesome. It has helped me bring my A1C down to 5.1 from a high of 9.7. I first started with the 3mg and am now on the 14mg. Been on this med since March”
The top negative review is from a user named “Dori” who claims that the medication caused uncomfortable side effects. Interestingly, this user also reports significant weight loss:
“I've been on the 7mg for 17 days and the nausea, indigestion, stomach pain and now diarrhea have been almost unbearable and are getting worseI've also lost 18 lbs because I can barely eat anything.”
Rybelsus YouTube Review
One of the most popular YouTube videos on Rybelsus is from a doctor whose channel is called “SugarMD.” The endocrinologist breaks down the science behind Rybelsus and answers some user questions:
Rybelsus appears to be quite expensive. GoodRx is reporting a cost of around $900 - $1,000 for a several month supply.
The manufacturer website has a Savings & Support resource containing a coupon. The manufacturer claims that some eligible customers may qualify for prices as low as $10 for a several month supply.
We strongly recommend patients considering this medication to contact their health insurance company to check what their final cost will be, and to use the manufacturer resource. Speaking with your doctor may also be worthwhile to discuss other ways to bring the cost down.
Can I Take A Generic Version?
As we referenced in the intro section of this article, Rybelsus is the branded name for a compound called semaglutide. We typically recommend that patients speak with their doctor about generic versions of prescription drugs, because they tend to be cheaper (significantly so for patients without health insurance), and are just as effective on average as branded drugs based on medical research.
Unfortunately in the case of Rybelsus, generic semaglutide doesn’t yet appear to be on the market, at least in the U.S. Patent law can allow drug manufacturers to reserve exclusive rights to selling a drug for a number of years, so they can recoup costs of research and development.
We recommend that patients ask their doctor to update them when and if generic semaglutide comes onto the market, because for patients on a budget it may be a better option than Rybelsus.
Rybelsus Vs. Ozempic
Another type-2 diabetes prescription medication which uses the exact same active ingredient is called Ozempic. It’s an injectable semaglutide formulation, while Rybelsus is an oral tablet.
Patients are often curious about which medication is more effective.
A medical review compared the efficacy of oral and injectable semaglutide. The researchers found that the injectable version decreased A1C by 1.5% to 1.8%, while the oral version only decreased A1C by 1% to 1.4%.
The injectable version was also more effective for weight loss, decreasing body weight more than all active comparator drugs tested, while the oral version was only more effective for weight loss than two of the drugs tested.
This research suggests that Ozempic may be more effective for both type-2 diabetes and weight loss than Rybelsus, but injectable medications often come with more side effects, so we recommend that patients speak with their doctor if they’re considering switching from Rybelsus to Ozempic.
Rybelsus Vs. Metformin
Metformin is another commonly-prescribed diabetes medication, so patients are often curious about a comparison. Unfortunately there isn’t medical data directly comparing the two drugs.
Both medications are proven to be effective for treating and managing type-2 diabetes, and both have been shown to cause weight loss in overweight patients with type-2 diabetes (but neither medication is FDA-approved for weight loss alone).
A medical study examining the effects of combined Rybelsus and Metformin administration, published in the Clinical Pharmacokinetics journal, found that there was no safety issues combining the two drugs. This suggests that patients with difficult-to-treat diabetes may benefit from speaking to their doctor about taking both drugs in combination.