GLP-1 medications with semaglutide have changed the way people manage diabetes and weight loss. When they think of them, thoughts tend to go to Ozempic® and Wegovy®, the once-weekly injectable forms. Rybelsus® is the oral form of semaglutide—the same active ingredient found in those injectable medications. It is also the only FDA-approved oral GLP-1 medication.
Rybelsus® works just like Ozempic® and Wegovy®. The semaglutide mimics GLP-1 (glucagon-like-peptide-1), a hormone that is released when you eat. Semaglutide extends this action by binding to GLP-1 receptors, lowering appetite, slowing digestion, and regulating blood sugar.
Rybelsus isn’t approved for weight loss, but some healthcare providers prescribe it off-label for that purpose.
While Rybelsus® contains semaglutide, it doesn’t have the same effectiveness as the injectable versions of semaglutide. Let’s explore that, talk about the results people see, and what to expect in terms of safety and cost. We’ll also talk about the potential future of oral GLP-1 medications and what’s being studied.
What is Rybelsus®?
Rybelsus® is the first (and still the only) FDA-approved oral GLP-1 medication.
Rybelsus® contains semaglutide and works the same way as Ozempic and Wegovy to lower appetite, slow digestion, and regulate blood sugar. But semaglutide tends to work better as an injection because the medication avoids the acidic environment of your stomach. When you swallow medications like semaglutide, which are delicate proteins called peptides, your digestive system breaks them down before they can be absorbed.
The maker of Rybelsus®, Novo Nordisk, got around this by using a special absorption helper (an ingredient called SNAC) that helps semaglutide survive the stomach long enough to get into your bloodstream. Still, today’s approved GLP-1 medications work better as injections, though some more powerful oral GLP-1 options are in clinical trials.
Who can be prescribed Rybelsus® for weight loss?
Rybelsus® is FDA-approved for type 2 diabetes but is sometimes prescribed off-label for weight loss. It may be prescribed off-label to people with a BMI of 30+ or a BMI of 27+ with a related condition, such as high blood pressure or high cholesterol. It works best as part of a balanced plan that includes eating fewer calories, regular activity, and other healthy habits.
How much weight can you lose with Rybelsus®?
Weight loss results with Rybelsus® can vary depending on dosage, lifestyle habits, and overall health, but tend to be much more moderate than injectable semaglutide.
In clinical studies, people taking the 14 mg daily dose lost about 4% of their body weight over 6 months. For comparison, the highest dose of Wegovy® (2.4 mg) led to about 15% body weight reduction over 68 weeks.
How long does it take to lose weight on Rybelsus®?
Rybelsus® takes a little time to build up in your system. It usually takes about four to five weeks for the medication to reach steady levels in your body. Because of that gradual buildup, you might not notice major changes right away.
It can take 2 to 3 months before you see meaningful shifts in weight. Let’s take a look at how much weight you can lose over time:
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Wegovy®
Ozempic®
Metformin
Zepbound®
Mounjaro®
Liraglutide
Rybelsus®: Cost and insurance
The list price of Rybelsus® is around $998 per month, though what you actually pay depends on your insurance coverage, where you fill your prescription, and whether you’re using it for type 2 diabetes or off-label weight loss.
Does insurance cover Rybelsus®?
If you are using it for weight loss, insurance coverage is very rare. You might be covered if you are prescribed it for diabetes. For those without insurance, Novo Nordisk’s Patient Assistance Program may provide the medication at no cost for eligible people with type 2 diabetes.
- Private insurance: Some plans cover Rybelsus® for type 2 diabetes but rarely for weight loss. Even with coverage, insurers often require prior authorization and proof that other, lower-cost medications didn’t work first. Copays can range from $50–$150 per month. If you have commercial insurance, you might qualify for the Rybelsus® Savings Card, which can lower your cost to as little as $10 per month for up to 48 months.
- Medicare (Part D or Advantage): Most plans cover Rybelsus® for diabetes but not for weight loss. Nearly all Part D enrollees have access to it, and those with extra assistance due to lower income may pay as little as $10 monthly.
- Medicaid: Most states cover Rybelsus® for diabetes but not for weight management. Because Medicaid policies vary, check with your state’s program for specific details.
- VA and TRICARE: Both typically cover Rybelsus® for type 2 diabetes with prior authorization, but not for weight loss.
Learn more: Rybelsus® costs in 2025: With and without insurance coverage
Rybelsus®: How to take it
Rybelsus® is a once-daily oral tablet. It comes in two forms: R1 and R2. R2 was approved in late 2024. Tablet dose strengths depend on the form:
- Rybelsus® R1: 3 mg, 7 mg, 14 mg
- Rybelsus® R2: 1.5 mg, 4 mg, 9 mg
Both versions work exactly the same in the body. According to current studies, R1 and R2 reach the same semaglutide levels in the bloodstream, meaning there’s no expected difference in safety, effectiveness, or expected weight loss results. R2 was developed mainly to improve the drug’s absorption efficiency.
How to take Rybelsus: The day-to-day
Rybelsus® is a pill you take once per day, but you can’t take it anytime you want; timing matters a lot. You have to take it first thing in the morning on an empty stomach with a little water—no coffee, breakfast, or vitamins. The medication needs an empty stomach so that your body can absorb it properly.
Here’s the usual routine:
- Take it right when you wake up, with a small amount of water (no more than 4 ounces).
- Wait at least 30 minutes before eating, drinking anything else, or taking other meds.
- Take it at the same time every day.
After that 30-minute window, you just go on with your morning.
How will Rybelsus be increased?
Like all semaglutide medications, Rybelsus® follows a step-up titration process—meaning the dose is gradually increased to help your body adjust and reduce side effects. Each level is typically taken for about 30 days before moving to the next level.
| Rybelsus® formulation | Starting dose (weeks 1-4) | Next dose (weeks 5-8) | Maximum dose (week 9 and beyond) |
|---|---|---|---|
| R1 | 3 mg once daily | 7 mg once daily | 14 mg once daily (if needed) |
| R2 | 1.5 mg once daily | 4 mg once daily | 9 mg once daily (if needed) |
Learn more: Rybelsus® dosage: How to find the right dose for weight loss
What will determine when my dose of Rybelsus changes?
Your Rybelsus® dose may change depending on how your body responds and how well you’re meeting your goals. You’ll want to keep an eye on your:
- Progress: If your weight or blood sugar goals need more support, your provider may raise your dose.
- Side effects or health factors: Ongoing nausea or issues like kidney or liver concerns might lead to a slower increase or a lower maintenance dose.
Rybelsus®: Tips for best weight loss results
Getting the most out of Rybelsus® comes down to consistency and timing. Since it’s absorbed differently from most medications, how you take it each day can make a big difference in how well it works. Here are some tips based on the prescribing information:
- Timing matters: Take your tablet first thing in the morning, before eating, drinking, or taking any other medications. It’s best not to take Rybelsus® at night since it needs an empty stomach to absorb properly.
- Stick to water: Swallow the tablet whole with a small sip—no more than 4 ounces—of plain water only. Avoid coffee, juice, or anything carbonated.
- Wait it out: Give it at least 30 minutes before you eat or drink to help your body absorb the medication properly.
- Keep it consistent: Try to take it at the same time every morning, every day, so your body gets used to a steady routine.
- Make it easy: Keep your medication somewhere visible, like your nightstand, or set a reminder to take it as soon as you wake up.
- Storage: Keep Rybelsus® in its original container at room temperature, away from heat, moisture, and sunlight—no need for refrigeration.
Always follow your provider’s guidance on how to take Rybelsus®. A steady routine helps the medication work as intended and keeps your progress on track.
Learn more: Rybelsus® dosage: How to find the right dose for weight loss
Rybelsus®: Side effects and safety
Rybelsus® has a well-established safety profile, but like any medication, it can cause side effects. Most are mild and related to how it regulates digestion and blood sugar, though some may require prompt medical attention. Here’s a look at what to expect.
Common side effects
Most side effects from Rybelsus® are mild and temporary. They usually appear during the first few weeks or after a dose increase, then lessen as your body adjusts.
The most common side effects include:
- Nausea
- Abdominal pain
- Diarrhea
- Vomiting
- Constipation
If these symptoms continue or feel difficult to manage, let your provider know—they might suggest staying on your current dose longer before increasing it.
Serious side effects and warnings
Serious reactions are uncommon but can happen. It’s important to recognize the warning signs and know when to get medical attention:
- Pancreatitis: Look for severe stomach pain that spreads to your back, often with nausea or vomiting. Get immediate medical attention.
- Low blood sugar (hypoglycemia): This can happen if you’re also taking insulin or certain diabetes medications. Symptoms include shakiness, sweating, dizziness, fast heartbeat, or confusion. Call your provider if this happens, or seek emergency care if symptoms become severe.
- Kidney issues: Ongoing vomiting or diarrhea can cause dehydration, which may affect your kidneys. Signs include swelling in your legs or ankles, fatigue, or less frequent urination. Get immediate medical attention if you notice these symptoms.
- Gallbladder problems: Pain in the upper right part of your stomach, nausea, fever, or yellowing of your skin or eyes can be signs of gallstones or gallbladder inflammation. Seek emergency care if these appear.
- Allergic reaction: Get emergency help if you experience swelling of your face, lips, tongue, or throat, or have trouble breathing or swallowing.
- Thyroid tumors: Although this has only been seen in animal studies, any neck lumps, hoarseness, or trouble swallowing need to be immediately evaluated.
While most people do well with Rybelsus®, listening to your body and reporting new or persistent symptoms early can help monitor for complications.
Learn more: Rybelsus® side effects: Symptom guide & management tips
Who shouldn’t take Rybelsus®
Rybelsus® isn’t a fit for everyone. Before starting, your healthcare provider will review your medical history, other medications, and any health conditions to make sure it’s safe for you.
You should not take Rybelsus® if you:
- Have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
- Are allergic to semaglutide or any of the ingredients in Rybelsus®.
- Are pregnant, planning to become pregnant, or breastfeeding.
Your provider may use extra caution if you have digestive issues, kidney or liver problems, take insulin or other diabetes medications, or have a history of pancreatitis or gallbladder disease. Always share all medications and supplements you use to help your provider create a safe plan for you.
Overdose risks and symptoms
Taking more than your prescribed Rybelsus® can cause nausea, repeated vomiting, or signs of low blood sugar like dizziness, sweating, or a rapid heartbeat.
If you think you’ve taken too much, contact Poison Control at 1-800-222-1222 or seek emergency help if your symptoms are severe. To stay safe, take only one tablet a day and double-check your schedule before each dose.
Learn more: Rybelsus® side effects: Symptom guide & management tips
Rybelsus® vs. other weight loss medications: Weight loss potential
Here’s how Rybelsus compares with other GLP-1 medications in cost, results, and how they’re taken:
| Medication | Brand names and uses | Cost per month (without insurance) | Effectiveness | How it’s taken |
|---|---|---|---|---|
| Semaglutide – GLP-1 receptor agonist | Rybelsus®: type 2 diabetes, off-label weight loss Wegovy®: weight loss, heart disease, and MASH | Rybelsus®: $998 Learn more Wegovy®: $1,350 NovoCare Pharmacy: $199 per month for the first two months $349 for all other doses thereafter Learn more | Rybelsus®: People lost about 4% of their body weight. Wegovy®: People lost an average of 15% of body weight with injectable semaglutide. | Rybelsus®: Daily pill Wegovy®: Weekly injection |
| Tirzepatide – GLP-1/GIP receptor agonist | Zepbound®: weight loss and obstructive sleep apnea (OSA) | Zepbound®: Pens: $1,086 Vials: $349 (2.5 mg) $499 (5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg) Learn more | People lost an average of 21% of body weight at 72 weeks. | Weekly injection |
| Liraglutide – GLP-1 receptor agonist | Saxenda®: weight loss Generic liraglutide: weight loss, type 2 diabetes, and heart disease | Saxenda®: $1,350Learn more. Generic liraglutide: $470 – $700 | People lost an average of 5-6% of body weight in one year. | Daily injection |
Other medications
Not all weight-loss prescriptions work through GLP-1 pathways. Here’s a quick comparison of other medications that approach weight management in different ways.
| Medication | Brand names | Cost per month (without insurance) | Effectiveness | How it’s taken |
|---|---|---|---|---|
| Naltrexone and bupropion | Contrave® | $600–$800 CurAccess™: $99Learn more. | People lost an average of 7 to 8% of their body weight in a year. | Pill taken up to twice daily |
| Metformin (off-label weight loss) | Glucophage®, Fortamet®, Glumetza® | Generic: $4–$15Brand name: $100–$500+ Learn more. | People lost an average of about 6% of their body weight over six months while taking metformin. | Pill taken up to two times daily |
| Phentermine and topiramate ER | Qsymia® | $180–$260 Learn more. | People lost an average of 10% of their body weight in 56 weeks. | Daily capsule |
| Phentermine | Lomaira®, Adipex-P® | $27–$100Learn more. | About 80% of people with a BMI of 30 or more lost at least 5% of their body weight in 6 months. | Daily pill |
| Diethylpropion | Tenuate®, Tenuate Dospan® | $40–$85 | People lost an average of 10% of their body weight in 6 months. | Pill taken one to three times daily |
| Orlistat | Xenical®, Alli® | $50–$800 | People in a study lost about 10% of body weight after taking Orlistat for 1 year. | Pill taken three times daily with meals |
Learn more about how Rybelsus® compares to other medications:
Frequently asked questions about Rybelsus® for weight loss
Thinking about starting Rybelsus® or already taking it? Here are some of the most common topics people ask about, from timing and food to what kind of results to expect.
Will oral GLP-1s ever be as effective as injectable GLP-1s?
For now, Rybelsus® is the only GLP-1 pill on the market, and it isn’t as effective as injectable GLP-1s for weight loss. But research is currently looking at whether higher doses of oral semaglutide, such as 50 mg, could lead to weight loss results similar to injectable GLP-1 medications, and the results are promising. One study showed that people who took 50 mg of oral semaglutide daily for 68 weeks were able to lose an average of 15% of their body weight, which is comparable to the weight loss from injectables like Ozempic® or Wegovy®.
Also, Eli Lilly, known for Zepbound® and Mounjaro®, is testing orforglipron, a once-daily pill that’s shown about 12% average weight loss over 72 weeks in early clinical trials. If approved, it could offer another convenient, injection-free GLP-1 option for weight management.
What happens if you take Rybelsus® with food?
Taking Rybelsus® with food limits how your body absorbs the medication. This means the medication won’t work as well for managing blood sugar or supporting weight loss. Always take it on an empty stomach with plain water only and wait 30 minutes before eating or drinking anything else.
Can you drink alcohol while taking Rybelsus®?
Having an occasional drink while taking Rybelsus® is usually fine, but alcohol can lower or raise your blood sugar and sometimes make side effects like nausea feel worse. It’s best to check in with your healthcare provider about your drinking habits so they can help you find what’s safe for you.
What happens if I miss a dose of Rybelsus®?
Skip the missed dose and take your next dose at the regular time the following morning. Don’t take two doses to make up for the missed one. Taking extra Rybelsus® can increase your risk of side effects like severe nausea and vomiting.
How long can you safely take Rybelsus®?
Rybelsus® is designed for long-term use when prescribed for type 2 diabetes. Your doctor will monitor you regularly with blood tests and check-ups. There is no set time limit, but your prescribing physician will assess whether it remains right for you.
Can you stop taking Rybelsus® abruptly?
You can stop Rybelsus® without gradually reducing the dose, but don’t stop without first consulting your healthcare provider. Stopping suddenly won’t cause withdrawal symptoms, but your glucose levels and appetite may return to where they were before starting the medication.
The bottom line: Rybelsus® isn’t as effective for weight loss as injectable GLP-1s
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Rybelsus® is a needle-free semaglutide, but its weight-loss results are still much more modest than the injectable versions. But the landscape is changing. Novo Nordisk is now studying higher-dose oral semaglutide, which showed weight-loss results similar to injectable semaglutide in clinical trials. And Lilly’s investigational once-daily pill, orforglipron, is showing real promise as another future oral GLP-1 option.
All of these point to a future where people may have more flexible, easy-to-take GLP-1 pills to choose from. But no matter how the medication options expand, the basics stay the same: these drugs work best when they’re paired with habits that support your long-term health, like mindful eating and regular movement. Medications can help, but your everyday habits are what carry you through it.
If you’re thinking about whether Rybelsus® (or any GLP-1) is right for you, see if you qualify for Noom Med. If you do, you’ll be paired with a clinician who can find the right medication for you, prescribe it if needed, and help you design a plan that will work for you. You’ll learn daily routines and mindset shifts that add up to long-term success.
Note: Rybelsus®, Ozempic®, Mounjaro®, and metformin are not FDA-approved for treating obesity or weight loss.
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At Noom, we’re committed to providing health information that’s grounded in reliable science and expert review. Our content is created with the support of qualified professionals and based on well-established research from trusted medical and scientific organizations. Learn more about the experts behind our content on our Health Expert Team page.
Shoshana Fishbein
Noom Team
