Rybelsus, Semaglutide

Rybelsus is used for the treatment of type 2 diabetes where it helps to lower blood sugar levels, Rybelsus also assists in weight loss when combined with exercise and a diet, and Rybelsus also is proven to not increase the risk of heart attacks, strokes or death. Rybelsus is FDA approved for the use of treatment in type 2 diabetes. 

Rybelsus is known as a GLP-1 receptor agonist. GLP-1 is a naturally occurring incretin hormone in the body that is released in the body after a meal, Rybelsus works by doing what GLP-1 does as per clinical trials, it increases the secretion of insulin following a meal and thus reduces the amount of glucose that is produced by the liver, which helps keep blood sugar levels under control and works to make you feel full after having a meal as well thus directly helping in weight loss.

Rybelsus may cause the side effects below Inflammation of the pancreas Changes in vision Low blood sugar or hypoglycemia Diarrhoea Nausea Dehydration Swelling of face, lips tongue or throat breathing problems Rash Dizziness Decreased appetite The most common side effects when you first start taking Rybelsus is abdominal pains, stomach pain, diarrhoea, decreased appetite, vomiting and nausea. 

Each tablet of Rybelsus contains 3 mg, 7 mg or 14 mg of Semaglutide and the following inactive ingredients: magnesium stearate, microcrystalline cellulose, povidone and salcaprozate sodium (SNAC).

To start off semaglutide should be taken 3 mg once daily for one month. After one month, the dose can be increased to a maintenance dose of 7 mg once daily. After at least one month of usage with a dose of 7 mg once daily, the dose can be increased to a dose of 14 mg once daily to further improve blood sugar control.

The maximum recommended single daily dose of semaglutide is 14 mg. Taking two 7 mg tablets to achieve the effect of a 14 mg dose has not been studied and is therefore not recommended.

When semaglutide is used in combination with metformin and/or a sodium-glucose co-transporter-2 inhibitor (SGLT2i) or thiazolidinedione, the current dose of metformin and/or SGLT2i or thiazolidinedione can be continued.

When semaglutide is used in combination with a sulfonylurea or with insulin, a reduction in the dose of sulfonylurea or insulin may be considered to reduce the risk of hypoglycaemia 

Self-monitoring of blood glucose is not needed in order to adjust the dose of semaglutide. Blood glucose self-monitoring is necessary to adjust the dose of sulfonylurea and insulin, particularly when semaglutide is started and insulin is reduced. A stepwise approach to insulin reduction is recommended.

Missed dose

If a dose is missed, the missed dose should be skipped and the next dose should be taken the following day.

Rybelsus should be taken as advised by your doctor, it should be consumed by mouth on an empty stomach first thing when you wake up with plain water. Rybelsus should not be split, crushed or chewed on. Food should be consumed 30 minutes after taking Rybelsus.

Rybelsus could cause serious side effects such as thyroid tumors, if you get a lump or swelling in the neck, trouble swallowing or shortness of breath you should immediately proceed to your doctor for further advise. Rybelsus should not be taken if a person has a family history of  an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) or MTC.

Rybelsus should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Diabetic ketoacidosis has been reported in insulin-dependent patients who had rapid discontinuation or dose reduction of insulin when treatment with a GLP-1 receptor agonist is started.

There is no  experience in patients with congestive heart failure and Rybelsus is therefore not recommended in these patients. There is no therapeutic experience with Rybelsus in patients with bariatric surgery.

Use of GLP-1 receptor agonists may be associated with gastrointestinal adverse allergic reactions that can cause dehydration, which in rare cases can lead to a deterioration of renal function.

Patients treated with Rybelsus should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Acute pancreatitis has been observed with the use of GLP-1 receptor agonists like Rybelsus . Patients should be informed of the characteristic symptoms of acute pancreatitis.

If pancreatitis is suspected, Rybelsus should be discontinued; if confirmed, Rybelsus should not be restarted. Caution should be exercised in patients with a history of pancreatitis. In patients with diabetic retinopathy treated with insulin and Rybelsus , an increased risk of developing diabetic retinopathy complications can occur.

Caution should be exercised when using Rybelsus in patients with diabetic retinopathy. These patients should be monitored closely and treated accordingly. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy, but other mechanisms cannot be excluded. Long-term glycaemic control decreases the risk of diabetic retinopathy.

Following the dosing regimen strictly is recommended for optimal effect of Rybelsus . If the treatment response with Rybelsus is lower than expected, the physician should be aware that the absorption of Rybelsus is highly variable and may be minimal (2-4% of patients will not have any exposure), and that the absolute bioavailability of Rybelsus is low.

Before using Rybelsus please inform your doctor for medical advice if you have had problems with your pancreas, kidneys, Or thyroid cancer before this or if you have had vision related problems due to diabetes. Inform your doctor as well if you are pregnant or plan to become pregnant. Also inform your doctor of body weight and, all the prescription medications you take.

Effects of Rybelsus on other products

Thyroxine, Monitoring of thyroid parameters should be considered when treating patients with Rybelsus at the same time as levothyroxine. Warfarin, Rybelsus did not change the affects of warfarin when taken together, however caution is still recommended. Omeprazole, no changes were seen when taken with Rybelsus however caution is advised. 

In a trial investigating the pharmacokinetics of Rybelsus  co-administered with five other tablets,the presence of multiple tablets in the stomach influences the absorption of Rybelsus if co-administered at the same time. After administering semaglutide, the patients should wait 30 minutes before taking other oral medicinal products.

Women of who can have children are recommended to use contraception when treated with Rybelsus.Rybelsus can be toxic in pregnancy therefore it should not be used during pregnancy. Rybelsus should be stopped if a pregnancy occurs. If pregnancy is planned Rybelsus should be stopped 2 months before. Rybelsus metabolites can excrete in breast milk therefore it is risky for the child, therefore Rybelsus should also not be used during breast feeding. 

Rybelsus should be stored at room temperature, away from direct heat or sunlight.