Ozempic was approved by the FDA in 2017 for use as a once-weekly injection medication along with healthy lifestyle modifications to treat type 2 diabetes for adults. Ozempic is classified as a semaglutide, one of several glucagon-like peptide-1 (GLP-1) receptor agonists prescribed for type 2 diabetes.
Type 2 diabetes is more common among adults. The condition occurs when there is too much glucose in the blood, or high blood sugar (hyperglycemia). If diet and exercise can’t control the condition, a healthcare provider typically prescribes medication. According to the ADA, [the drug] “metformin remains the preferred first-line therapy for treating type 2 diabetes.” However, adding a GLP-1 agonist is considered in some patients with certain intolerances, counter-indications, or those who don’t reach their target A1C in three months. A semaglutide may also be prescribed for patients with atherosclerosis, heart failure, or chronic kidney disease.
Ozempic is a popular choice due to its cardiovascular benefits, helping lower risks of heart disease, heart attack, stroke, and even death. Semaglutide GLP-1 hormone effectively helps in other ways, by lowering A1C, and it promotes weight loss by
- Releasing GLP-1 hormone after eating, resulting in patients feeling full longer, which can lead to weight loss
- Stimulating the pancreas to release insulin, slowing gastric emptying
By releasing GLP-1 hormone after eating, patients feel full longer, which can lead to weight loss. Weight loss averages 14.9% body weight. It’s good news for patients who want to lose weight, too.
But what about patients who have problems with injections? Some people suffer psychological barriers like injection anxiety or lack of confidence in performing self-injection. Others might rather just take semaglutide in another manner because they dislike shots.
Meet Rybelsus
Rybelsus is a daily tablet form of Semaglutide which is the off-brand medication in Ozempic & Wegovy. It was FDA-approved in 2019. Similar to Ozempic, Rybelsus treats type 2 diabetes in adults, as an adjunct to diet and exercise.
Rybelsus is easier for patients to take. Rather than injecting a semaglutide medication, patients simply swallow a tablet first thing every morning, along with a glass of water. Patients wait 30 minutes before they can eat, drink, or take other medications. The protocol must be followed to ensure the medication works as prescribed.
Are Rybelsus and Ozempic the same?
They are very similar in many ways. Studies suggest Rybelsus is safe for people with heart disease. However, the cardiovascular benefits that Ozempic provides haven’t been validated in Rybelsus.
Also, because Rybelsus works to slow movement in the stomach, slowed absorption rates may occur for other oral medications. This may occur for the thyroid medication named Levothyroxine, as indicated in a possible drug interaction per the boxed warning. Similarly, it’s recommended that prescribers reduce the dose of Rybelsus for new patients who also take sulfonylureas or insulin, “to reduce the risk of hypoglycemia.” NovoNordisk
Can anyone switch from Ozempic to Rybelsus?
A healthcare provider can switch a patient from Ozempic 0.5 mg/week to Rybelsus 7.0 mg or 14.0 mg/day. In fact, the National Institute of Health (NIH) recommends physicians consider basing medication choices on patient preferences and needs. The switch begins up to 7 days after a patient’s last injection. Unfortunately, for people taking 1 mg or more of Ozempic, there is no equivalent dosing for Rybelsus.
It is not uncommon for healthcare providers to take corrective action based on risk, too, changing medications due to adverse drug reactions. Or—supply chain problems.
A patient’s healthcare provider can determine the best semaglutide choice based on health conditions, need and preference. For example, While a GLP-1 receptor agonist can be taken with Metformin, Ozempic’s improved efficacy for heart disease may be a first-choice option for patients who take Metformin and are also at risk for heart disease.
In order to avoid dangerous interactions, it’s important that healthcare providers and pharmacists know all prescriptions their patients take. It’s particularly important for patients with multiple prescriptions and/or various conditions. Both doctors and pharmacists can conduct checks, which should occur yearly.
Do Ozempic and Rybelsus present side effects?
Ozempic and Rybelsus share similar side effects. Some are bothersome and go away over time. Others may be more serious.
Nausea and abdominal pain are most common, especially when starting either medication. A patient’s healthcare provider typically raises the dose slowly over several weeks, minimizing side effects. Fortunately, side effects tend to subside the longer you take the medication.
| Common side effects | Rate of frequency | |
| Side effect | Ozempic | Rybelsus |
| Nausea | 16%-20% | 11%-20% |
| Vomiting | 5%-9% | 6%-8% |
| Diarrhea | 9% | 9%-10% |
| Abdominal pain / Reduced appetite | 6%-7% | 10%-11% |
| Constipation | 3%-5% | 5%-6% |
| Injection-site pain. | Less than 1% | N/A |
Ozempic and Rybelsus also exhibit similar serious side effects. Though rare, watching for them is important.
Both medications carry a boxed warning regarding thyroid C-cell tumors. Although the type of tumor was observed in animal studies, it’s unclear whether it poses a risk in people. Nevertheless, neither Ozempic nor Rybelsus should be taken by those with a personal or family history of thyroid cancer.
Other serious side effects include:
- Pancreatitis (inflamed pancreas)
- Complications of diabetic eye problems (retinopathy)
- Acute kidney injury
- Serious allergic reactions
- Low blood sugar
- *Acute gallbladder disease (reported in Ozempic only)
Comparing efficacy
According to the (NIH), in the two studies, SUSTAIN and PIONEER phase III clinical trial programs, semaglutide (Ozempic and Rybelsus) “provide effective reductions in HbA1c and body weight…and…”is the only GLP-1RA that is available in both an injectable and oral formulation.”
In addition regarding efficacy, results “suggest that Ozempic and Rybelsus significantly reduced both HbA1C and body weight when compared to similar medications…”
What about costs?
The cost of Ozempic is approximately $900.00/month while the cost of Rybelsus is approximately $800.00/month. This can be pricey for those without coverage and are not available in less expensive generic forms. However, with patient assistance programs, uninsured/underinsured patients may get either medication at no charge. Patients with commercial insurance who meet eligibility requirements may pay only $25 for Ozempic or $10 for Rybelsus with a manufacturer’s savings card.