Ozempic in Tablet Form: Everything You Need to Know About Rybelsus

What exactly is "Ozempic in tablet form"?

When talking about modern weight loss medications, Ozempic and Wegovy are two of the best-known names. Both of these medications from Novo Nordisk contain the active substance semaglutide and are administered via a weekly injection under the skin. However, for people who suffer from a fear of needles, or who for other practical reasons prefer to take their medication orally, there is an alternative.

The drug Rybelsus contains the same active substance, semaglutide, but is formulated as a tablet taken daily. This makes Rybelsus an option for certain patients, especially those who want to avoid injections.

Rybelsus is, like Ozempic, primarily approved for the treatment of adults with insufficiently controlled type 2 diabetes in order to improve blood sugar control. In some cases, the medication may be prescribed off-label for the treatment of overweight or obesity, following an individual medical assessment where the treatment is deemed appropriate and potentially beneficial for the patient.

How does semaglutide work in the body?

Regardless of whether semaglutide is taken as an injection or as a tablet, the substance belongs to a class of drugs called GLP-1 receptor agonists. This type of medication mimics the body's own natural intestinal hormone, GLP-1 (Glucagon-like peptide-1), which is normally released when we eat.

When you are treated with a GLP-1 analogue, your body is affected through several interacting biological mechanisms:

• Reduced appetite and increased satiety: The medication interacts with the brain's appetite center. This means that you feel full faster when you eat, and that the feeling of fullness lingers longer, which can lead to reduced calorie intake.
• Delayed gastric emptying: Semaglutide causes the stomach to empty its contents into the intestine at a slower pace. Food remains in the stomach longer, which can contribute to a more stable blood sugar level and reinforce the physical feeling of fullness.
• Suppressed cravings: The medication affects the brain's reward system. This can contribute to reduced cravings for sweet or fat foods and can quiet thoughts about the next meal, a phenomenon often described as "food noise."

By affecting these biological systems, the treatment can make it easier to maintain the calorie deficit required to reduce weight, without you having to struggle against a constant and overwhelming hunger.

Clinical effect: How much weight can you lose?

The active substance semaglutide, which is included in both Ozempic and Rybelsus, has shown good effects on weight loss in several studies. In the clinical study OASIS-1, the effect of semaglutide in tablet form (oral semaglutide) was studied in adults with overweight or obesity, without type 2 diabetes. Participants who received a daily dose of 50 mg oral semaglutide, in combination with diet and exercise advice, achieved an average weight loss of approximately 15 percent after 68 weeks of treatment, compared to 2.4 percent in the placebo group.

Although individual variations in weight loss occur, many patients achieve a good and clinically meaningful weight loss, especially when the treatment is combined with lifestyle changes.

Side effects of Rybelsus (semaglutide)

Semaglutide affects the gastrointestinal tract, partly by delaying the emptying of the stomach, which means that the most common side effects are gastrointestinal.

Common side effects include:

• Nausea
• Diarrhea
• Constipation
• Vomiting
• Gas and bloating

These side effects are usually mild to moderate and typically occur at the beginning of treatment or when the dose is increased. They often subside gradually as the body gets used to the medication.

To minimize side effects, Yazen always works according to the principle of "lowest effective dose." The treatment starts at a very low dose which is then increased slowly, with close medical follow-up. If the patient achieves a good effect and stable weight loss on a lower dose, there is no reason to increase it. This strategy optimizes both safety and the patient's well-being during treatment.

GLP-1: The difference between Rybelsus, Ozempic and Wegovy

It is easy to become confused by the different drug names, especially when they contain the same active substance semaglutide. Here is a brief overview of the differences:

• Rybelsus (semaglutide): An oral medication taken daily and approved for the treatment of insufficiently controlled type 2 diabetes as a supplement to lifestyle changes to improve blood sugar control. The drug can in some cases be used off-label for weight loss for people living with obesity or overweight with at least one complication, after individual medical assessment.
• Ozempic (semaglutide): Weekly injection treatment approved for the treatment of insufficiently controlled type 2 diabetes as a supplement to lifestyle changes.
• Wegovy (semaglutide): Weekly injection treatment approved for the treatment of obesity and overweight with at least one complication as a supplement to diet and exercise. The preparation has a dosage regimen that differs from Ozempic, with higher dose levels in accordance with the approved indication.

Since Wegovy is specifically approved for the indication of obesity, it is usually this medication that is recommended primarily for patients seeking help for weight loss without having a diabetes diagnosis. Tablet treatment can, however, be an alternative after a specific medical assessment.

Who can receive medical weight loss in tablet form?

To be eligible for modern medical treatment for overweight or obesity, whether it concerns tablets or injections, certain clinical criteria must be met. According to medical guidelines, treatment is generally indicated for adults with:

• BMI over 30 classified as obesity.
• BMI over 27 in combination with at least one weight-related complication, such as high blood pressure, type 2 diabetes, sleep apnea or elevated blood lipids.

The treatment is not suitable for women who are pregnant, breastfeeding or planning to become pregnant within the next few months.

In connection with the start of treatment, an individual medical assessment, including relevant testing, shall be carried out, with subsequent medical follow-up during the treatment.

Sources

The Lancet. Oral semaglutide 50 mg taken once per day in adults with overweight or obesity (OASIS 1).
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01185-6/fulltext

European Medicines Agency (EMA). Rybelsus – EPAR Product Information.
https://www.ema.europa.eu/en/medicines/human/EPAR/rybelsus

European Medicines Agency (EMA). Ozempic – EPAR Product Information.
https://www.ema.europa.eu/en/medicines/human/EPAR/ozempic

European Medicines Agency (EMA). Wegovy – EPAR Product Information. https://www.ema.europa.eu/en/medicines/human/EPAR/wegovy