Rybelsus is a type of medication you might need to take if you have type 2 diabetes.
- What is Rybelsus?
- Supply issues of Rybelsus
- How does Rybelsus work?
- Who can take Rybelsus?
- How to take Rybelsus
- Your prescription
- Side effects of Rybelsus
- More information and support
What is Rybelsus?
Rybelsus, a brand name for semaglutide, belongs to a group of drugs called GLP-1 agonists. They are also known as GLP-1 analogues, GLP-1 RAs and incretin mimetics.
There are several different GLP-1 agonists available in the UK.
Supply issues of Rybelsus
The NHS is currently facing supply issues with GLP-1 agonists. Read our response to the serious supply issues of drugs for people with type 2 diabetes.
In January 2024 the NHS England and the Department for Health and Social Care announced that there is sufficient stock of Rybelsus to be prescribed to people with type 2 diabetes.
You might be prescribed this medication if you previously took the diabetes medications Byetta and Victoza This is because Byetta was discontinued in March 2024 and Victoza continues to be out of stock, with further stock not expected until end of 2024.
How does Rybelsus work?
Rybelsus increases the levels of incretins – hormones – which are naturally produced by the stomach when you eat.
It works by helping your body to produce more insulin when needed. It also reduces the amount of glucose, or sugar, produced by the liver, and slows down how quickly food is digested. This all helps to lower blood sugar levels and HbA1c.
Who can take Rybelsus?
Adults over the age of 18 years with type 2 diabetes can take Rybelsus.
Guidelines from The National Institute of Health and Care Excellence, or NICE for short, recommend that adults with type 2 diabetes can be prescribed Rybelsus if they:
- Have previously used three diabetes medications and this has not helped to manage their type 2 diabetes;
- Have not been able to take medications – this might be because of side effects or because of other medical conditions.
Rybelsus is only prescribed to people who have a Body Mass Index, known as BMI, of 35kg/m2 or more and have additional psychological or other medical conditions that are related to obesity.
However, someone with type 2 diabetes can be prescribed Rybelsus if they have a BMI below 35kg/m2 and:
- Using insulin would affect their job due to the risk of low blood sugar, also known as hypoglycemia, or hypos;
- Weight loss would lead to improvements in other obesity-related health issues.
NICE recommends – due to their risk from obesity-related health problems at a lower BMI – that people from Black African, African-Caribbean, Asian, South Asian, Chinese, and Middle Eastern backgrounds receive treatment with Rybelsus at a lower BMI.
Who can’t take Rybelsus?
Some medications might not be suitable for some people, which might be because of medical conditions or other reasons:
- Your doctor will tell you to stop taking Rybelsus if you develop diabetic ketoacidosis, also called DKA;
- If you have liver disease or kidney disease you might not be able to take Rybelsus;
- You might need to temporarily stop Rybelsus if you’re going to have an operation;
- You should not take Rybelsus if you are pregnant of breastfeeding. If you’re planning a pregnancy speak with a healthcare professional if you are using this medication.
When you start a new medication always check with your healthcare team that it’s suitable for you to take.
How to take Rybelsus
Rybelsus is a tablet you swallow. Take it on an empty stomach, before your first meal or snack, this is usually when you first wake up. After you have taken it, you should wait at least 30 minutes before having your first meal or drink of the day or any other medications that you take by mouth. It should be taken with a small sip of water and swallowed whole.
Always take Rybelsus exactly as your healthcare professional has told you. The Patient Information Leaflet inside the box will tell you how to take it but always check with a healthcare professional if you are not sure.
Your prescription
You should only be given a prescription for Rybelsus following an assessment by your healthcare team to make sure that you meet the criteria and that you’ll benefit from its use.
This should be an individual assessment that includes how Rybelsus will fit into your current treatment plan and considers any diet or activity programme that you are following, as well as the risk of side effects, the dose you’ll need, and your personal choices.
Your healthcare team should explain your prescription to you but it's important to make sure you ask if you don't feel you know enough.
And make sure you talk to your GP or your diabetes team if you struggle to take your GLP-1 agonist. They might be able to help by giving you a different dose.
In England, if you need to take any medication to manage your diabetes, your prescriptions will be free. Ask your healthcare team about a prescription exemption certificate if you don't have one, to make sure you don't get charged for your medication. Prescriptions are already free for everybody in the rest of the UK, so you shouldn't pay for your medication.
Side effects of Rybelsus
Like all medications, Rybelsus can cause side effects. But when side effects are listed as common in the Patient Information Leaflet, it doesn’t mean that everyone who takes the medication will get them.
The information about side effects is based on the likelihood of people having them. For example, if a side effect is very common then it can affect more than one in ten people, and if a side effect is very rare then it affects fewer than one in 10,000 people.
Because medicines can affect people differently, your healthcare team will speak to you about what’s best for you and discuss any side effects.
Some of the most common side effects are:
- feeling sick
- diarrhoea
- vomiting.
Risk of low blood sugar
When taken on its own, Rybelsus does not usually cause blood sugar levels to become too low. However, hypos are more likely to happen when you take this medication with other diabetes medications such as insulin or a sulphonylurea.
Your healthcare team may advise reducing the dose of your sulphonylurea or insulin medicine when you start taking Rybelsus to reduce the risk of hypos.
Risk of worsening retinopathy
If you have diabetic eye disease, known as diabetic retinopathy, you’re using insulin, then your retinopathy could get worse when you start Rybelsus, and this might need treatment.
Tell your doctor if you have diabetic eye disease or if you experience eye problems during treatment with Rybelsus.
Risk of high blood sugar
If you take insulin and it is reduced too quickly it can cause high blood sugar levels, this is also called hyperglycaemia, and there is an increased risk of diabetic ketoacidosis, also called DKA. Your healthcare team should discuss with you the signs and symptoms of DKA.
These are not all the side effects. You will find a full list of known side effects in the Patient Information Leaflet. This comes in the medication box.
It’s also important that you take individual advice from your healthcare team before starting treatment and report any side effects to your healthcare professionals, if you experience any.
You can also report these side effects to the Yellow Card Scheme, which is the government system used for recording side effects with medicines in the UK.
Rybelsus and weight loss
Some people lose weight when they take Rybelsus as part of their type 2 diabetes treatment. This is because this medication slows down how quickly food is digested and can reduce your appetite, so you eat less.
More information and support
Still have more questions? Or is there anything you're not sure about Rybelsus after reading this page? Contact our helpline on 0345 123 2399.
You can visit the NHS website for more information.
