Does Rybelsus cause weight loss?

Obesity in the U.S. affects around 100 million (41.9%) adults and almost 15 million (19.7%) children. Poor diet and low physical activity are significant risk factors for obesity, which is linked to heart disease, high blood pressure, stroke, type 2 diabetes (T2DM), cancer, and osteoarthritis. Losing even a modest amount of weight can improve blood pressure, cholesterol, and blood sugar, reducing the risk of these conditions. When diet and exercise are insufficient, healthcare providers may prescribe medications such as GLP‑1 agonists like Rybelsus.

Rybelsus (semaglutide) is an FDA‑approved, once‑daily oral medication used with diet and exercise to control blood sugar in adults with T2DM. It is the only semaglutide product that is not an injection. Although not FDA‑approved for weight loss, Rybelsus is often used off‑label for this purpose, and studies show that most people taking it lose weight.

Weight Loss Studies

  • PIONEER 2: 14 mg dose added to metformin resulted in average weight loss of 8.4 lb after 26 weeks.
  • PIONEER 3: 7 mg dose lost 4.8 lb, 14 mg dose lost 6.8 lb after 26 weeks.
  • PIONEER 4: 14 mg dose lost almost 10 lb after 26 weeks; placebo lost 1.1 lb.
  • OASIS 1 (oral semaglutide 50 mg for 68 weeks): average weight loss of around 17% of starting body weight, comparable to Wegovy’s 15% in the largest trial.

Based on these findings, Novo Nordisk plans to seek FDA approval for the higher‑dose oral semaglutide indication in 2023 under a new brand name.

Rybelsus FAQs

What Conditions Does Rybelsus Treat?

Rybelsus is approved to improve blood glucose levels in adults with T2DM when used with diet and exercise. It carries a boxed warning against use in those with a personal or family history of certain thyroid cancers and should be avoided in type 1 diabetes. It is also used off‑label for weight loss.

How Does Rybelsus Work?

Rybelsus contains semaglutide, a GLP‑1 receptor agonist. GLP‑1 is a hormone released by the gut after eating. By activating these receptors, Rybelsus stimulates insulin release, suppresses glucagon secretion, and slows gastric emptying—helping to lower blood sugar and reduce appetite.

What Doses Are Available?

  • 3 mg
  • 7 mg
  • 14 mg

How Do You Take Rybelsus?

Take Rybelsus on an empty stomach upon waking with no more than 4 oz of water. Wait at least 30 minutes before eating, drinking anything else, or taking other oral medications. Swallow tablets whole; do not crush or chew. If you miss a dose, skip it and return to your regular schedule.

Drug Interactions

Rybelsus may alter the absorption or effects of other drugs. Inform your provider about all prescription medications, OTC drugs, vitamins, and supplements. Particular attention is needed for insulin, sulfonylureas, metformin, and any oral drugs affected by slowed gastric emptying.

Side Effects

Common side effects include:

  • Nausea
  • Diarrhea
  • Abdominal pain
  • Decreased appetite and weight loss
  • Constipation
  • Vomiting

Other possible side effects:

  • Bloating
  • Indigestion and reflux
  • Gas

Rare serious side effects may include:

  • Anaphylaxis (hives, facial/swelling, breathing trouble)
  • Medullary thyroid carcinoma or MEN 2 risk (lump in neck, hoarseness)
  • Pancreatitis (severe upper abdominal pain radiating to back)
  • Diabetic retinopathy complications (vision changes)
  • Hypoglycemia when combined with other diabetes drugs
  • Dehydration-related kidney problems
  • Gallbladder issues (pain, clay‑colored stools)

Report adverse effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Who Should Not Take Rybelsus?

Avoid Rybelsus if you are allergic to semaglutide or any inactive ingredients, have a personal/family history of medullary thyroid carcinoma, or have MEN 2.

What Should You Tell Your Healthcare Provider?

  • Pancreatic or kidney problems
  • Diabetic vision issues
  • Pregnancy or plans to become pregnant (stop Rybelsus ≥ 2 months before conception)
  • Breastfeeding or plans to breastfeed

Duration for Weight Loss

Some may notice weight loss within weeks, but most studies report outcomes at 26 weeks, showing up to almost 10 lb lost from baseline.

Cardiovascular Effects

While Rybelsus is not approved for cardiovascular risk reduction, it shares its active ingredient with Ozempic (injectable semaglutide), which is approved to lower the risk of major cardiovascular events in T2DM with heart disease. Weight loss and better glycemic control on Rybelsus may similarly reduce cardiovascular risk.

Can You Take Rybelsus and Metformin Together?

Yes. Metformin is typically first-line for T2DM. Rybelsus can be added for additional control. Take Rybelsus ≥ 30 minutes before metformin or other oral medications.

Related Medications

  • Wegovy (semaglutide)
  • Ozempic (semaglutide)
  • Mounjaro (tirzepatide)
  • Saxenda (liraglutide)
  • Victoza (liraglutide)
  • Trulicity (dulaglutide)

Sources