Rybelsus is a GLP-1 receptor agonist containing semaglutide as the active ingredient. It is primarily used for the treatment of type 2 diabetes to help control blood sugar levels in conjunction with diet and exercise. Unlike other GLP-1 receptor agonists that are administered as injections, Rybelsus is the oral formulation of semaglutide, offering the convenience of a daily pill. Rybelsus (semaglutide) is an effective oral treatment option for type 2 diabetes, helping to improve blood sugar control and potentially support weight loss. It works by mimicking the GLP-1 hormone to regulate insulin, appetite, and glucose production. It is typically well-tolerated, but side effects such as gastrointestinal discomfort, pancreatitis, and thyroid concerns require careful monitoring.

Indications:

Type 2 Diabetes Mellitus (T2DM):

• Rybelsus is indicated for the treatment of type 2 diabetes in adults to improve glycemic control. It is used along with diet and exercise to control blood sugar levels in patients who may not have achieved adequate control with diet alone or other oral diabetes medications.
• It is recommended as monotherapy or as an add-on therapy to other antidiabetic medications, including metformin, sulfonylureas, and insulin.

Cardiovascular Risk Reduction (off-label use):

• Rybelsus may help reduce the risk of cardiovascular events (e.g., heart attack, stroke) in people with type 2 diabetes and established cardiovascular disease, although the primary indication is for blood glucose control.

GLP-1 Agonist: Semaglutide, the active ingredient in Rybelsus, mimics the natural GLP-1 hormone, which plays a critical role in regulating blood sugar levels. It works by:

• Stimulating insulin secretion in response to meals, thereby lowering blood glucose levels.
• Inhibiting glucagon secretion, which reduces glucose production by the liver.
• Slowing gastric emptying, leading to feelings of fullness and reduced food intake.
• Reducing appetite, which can contribute to weight loss in some patients.

Patients should take Rybelsus as prescribed, ensuring the proper dosage, adherence to the 30-minute pre-meal requirement, and follow-up care to optimize results. As with all medications, potential risks and benefits should be evaluated by a healthcare provider.

Monitoring:

Blood Glucose Levels:

• Regular monitoring of blood glucose levels is essential, especially in patients using Rybelsus alongside other antidiabetic medications.

Thyroid and Kidney Function:

• Patients should have their thyroid and kidney function monitored, especially if they have pre-existing conditions or risk factors for these issues.

Weight and Vital Signs:

• Regular monitoring of weight and overall health is recommended to track the medication's effectiveness.

Side Effects:

Common Side Effects:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain or discomfort
• Decreased appetite
• Fatigue

Serious Side Effects:

• Pancreatitis (inflammation of the pancreas)
• Thyroid tumors, including medullary thyroid carcinoma (MTC)
• Acute kidney injury
• Severe allergic reactions (e.g., anaphylaxis, angioedema)
• Diabetic retinopathy complications in patients with existing diabetic retinopathy

Precautions:

Pancreatitis Risk: Rybelsus has been associated with an increased risk of pancreatitis. Symptoms include severe abdominal pain, nausea, and vomiting. If pancreatitis occurs, the medication should be discontinued immediately.

Thyroid Tumors: Animal studies have shown an increased risk of thyroid tumors (including medullary thyroid carcinoma). Rybelsus is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or those with Multiple

Endocrine Neoplasia syndrome type 2 (MEN 2).

Kidney Function: Caution should be exercised when using Rybelsus in patients with renal impairment, as it may exacerbate kidney problems, especially in those with pre-existing kidney disease.

Hypoglycemia Risk: When used in combination with other antidiabetic medications such as insulin or sulfonylureas, there is an increased risk of hypoglycemia. Blood glucose levels should be closely monitored, and dosages of other diabetes medications may need to be adjusted.

Gastrointestinal Issues: Rybelsus may cause gastrointestinal side effects, such as nausea, vomiting, and diarrhea, particularly during the initial dose-escalation period. These effects often subside over time.

Dosage and Administration:

Formulation: Rybelsus is available in oral tablet form, specifically in 7 mg, 14 mg, and 3 mg doses.

Starting Dose: The starting dose of Rybelsus is 3 mg once daily for the first 30 days, which helps minimize gastrointestinal side effects.

Maintenance Dose: After 30 days, the dose is increased to 7 mg once daily. If further glycemic control is needed, the dose may be increased to the maintenance dose of 14 mg once daily.

Administration:

• Rybelsus should be taken once a day in the morning on an empty stomach.
• Take it with at least 4 ounces of water, and wait 30 minutes before eating, drinking, or taking any other medications.
• It should not be taken with food, other medications, or beverages to ensure proper absorption.

Onset of Action: The onset of action for Rybelsus typically begins within 1 to 2 weeks after starting the medication. Glycemic control (reduction in blood sugar levels) is observed as early as 1 week, with maximum effects seen after 4 to 6 weeks of treatment.

Duration of Action: Rybelsus has a long half-life of approximately 1 week, allowing for once-daily dosing. The duration of action lasts throughout the 24-hour period, so it requires only a single dose per day.