Rybelsus reviews and side effects

Rybelsus in brief: semaglutide as a tablet

Rybelsus is a tablet with semaglutide, a GLP-1 receptor agonist that suppresses appetite, slows gastric emptying and lowers blood sugar. In Europe the medication is registered for type 2 diabetes, not for weight management. Weight loss is listed in the product information as a common side effect. The doctor assesses whether a tablet suits your situation.

You take Rybelsus once a day, on an empty stomach, with no more than half a glass of water. You then wait at least 30 minutes before eating, drinking or taking other medicines. This rule determines how well the substance is absorbed; if you do not follow it, you notice less effect.

According to the Farmacotherapeutisch Kompas (the Dutch national drug formulary), the 1.5 mg, 4 mg and 9 mg tablets are on the market in the Netherlands. You start with 1.5 mg and move to 4 mg after a month; if needed, the doctor then increases to 9 mg. These newer tablets replaced the older strengths of 3, 7 and 14 mg, which you still often come across in experiences: the old 7 mg corresponds to the new 4 mg. You can read more about the tablet as an alternative to the injection in our article on the Ozempic pill.

The most commonly mentioned side effects and how long they last

The most commonly reported side effects of Rybelsus are nausea and diarrhoea, followed by abdominal pain, constipation, a full feeling and reduced appetite. According to Apotheek.nl, the patient information website of the Dutch pharmacists' organisation KNMP, nausea and diarrhoea occur in 10 to 30 in every 100 users. The complaints are usually strongest in the first 2 to 4 weeks and after a dose increase, and decrease afterwards. Read more about stopping Ozempic.

Rare but serious are inflammation of the pancreas and gallstones. As for eye complaints: existing diabetic eye damage can temporarily get worse; read more in our article on Ozempic eye problems.

Tiredness with Rybelsus: side effect or result of eating less?

Tiredness is a registered side effect of Rybelsus: the Farmacotherapeutisch Kompas lists tiredness as common, in 1 to 10 in every 100 users. At the same time, for many users tiredness has a second cause: you eat less, and so you take in less energy, less protein and sometimes less fluid.

What helps is telling the two apart. Tiredness that starts in the first weeks and after a dose increase, and then fades, is usually part of getting used to the medication. Tiredness that persists, together with dizziness, palpitations or trembling, can point to low blood sugar or drinking too little. Discuss that with your doctor.

In practice: spread your food over three small meals with protein, drink enough, and stick to taking the tablet on an empty stomach in the morning so that it is absorbed properly. With type 2 diabetes, tiredness can also be related to blood sugar control itself; that too is a question for the doctor.

Experiences per dose step: 1.5 mg, 4 mg and 9 mg

At each dose step, users see the same pattern: a temporary increase in stomach and bowel complaints, followed by adjustment within 2 to 4 weeks. The starting dose of 1.5 mg (previously 3 mg) is intended to let the body get used to the medication; on this step, most people notice little of the effect on appetite and weight.

On 4 mg (previously 7 mg), users usually report the first clear effect: feeling full sooner, less appetite between meals. This is also the step where most questions about side effects arise, because for some people the nausea is strongest here. On 9 mg (previously 14 mg) the effect is greatest, but so is the chance of complaints; the doctor only increases if it is necessary and the lower step is well tolerated.

The experience of taking the tablet plays a part at every step. If you take the tablet with too much water, or eat or drink something within 30 minutes, you absorb less of the substance and notice less effect. That explains part of the varying experiences.

Wondering whether a tablet or an injection suits you better? In the consultation, the doctor assesses whether medical weight loss suits you and which form goes with it. Eligibility check →

Rybelsus and weight: what users notice and what research says

The weight loss result with Rybelsus varies from person to person and is smaller on average than with the injections at a high dosage. Users mainly report less appetite and smaller portions; the scales respond variably. Important to know: Rybelsus is registered for type 2 diabetes, and the strengths available in the Netherlands are tailored to that.

Research into oral semaglutide in overweight without diabetes has been done with a much higher dosage. In the OASIS 1 study, published in The Lancet, adults with overweight or obesity lost an average of 15.1% of their body weight in 68 weeks with 50 mg of oral semaglutide per day, compared with 2.4% on placebo, alongside lifestyle support. That 50 mg tablet is not on the market in the Netherlands. The figures show what the substance can do, not what you can expect from the available strengths.

What users and research have in common: the result depends on what you eat and how you move. The tablet takes away the appetite; you fill in your meals yourself, preferably with support.

Rybelsus or Ozempic: what is the difference in practice?

Rybelsus and Ozempic contain the same active substance, but differ in administration, intake, dosage and experience. Ozempic is a weekly injection; Rybelsus a daily tablet with strict intake instructions. For people who do not want injections, that is the main argument for the tablet. For people who find the empty-stomach intake and the daily routine difficult, the injection is often simpler.

In 2023, during the Ozempic shortages, Bijwerkingencentrum Lareb (the Netherlands Pharmacovigilance Centre) received reports from people who switched from the injection to the tablet. Stomach and bowel complaints were reported most; in two cases the dosage turned out to be unintentionally too high after the switch. So you only switch with a doctor who monitors the dosage.

The medications also differ in price; you can read about that in our article on the Rybelsus price. What users of the injection report is in the article on Ozempic reviews.

What our doctors advise about these experiences

Our doctors' advice about these experiences is always the same: start low, only increase if necessary, stick to the intake rules and report complaints early. A supervised programme differs from a stand-alone prescription because someone is watching at every step.

• Take the tablet at the same time every day, on an empty stomach, with little water, and wait 30 minutes. This is the most common cause of a disappointing effect.
• If you feel sick, stay on the current step instead of increasing further; the doctor decides when the next step is responsible.
• Eat three small, protein-rich meals and drink enough, even if you have little appetite.
• Report persistent tiredness, severe abdominal pain or signs of low blood sugar straight away.
• Only buy Rybelsus on prescription from a recognised pharmacy. How that works is in our article on how to get a Rybelsus prescription.

With us, the doctor assesses whether a tablet suits your situation or whether an injection is a better fit. That choice is part of the consultation for medical weight loss with injections.

Would you like to know which form of medication suits you? Our doctor assesses whether medical weight loss suits you and guides you at every step. Medical weight loss with injections →

Frequently asked questions about Rybelsus

What are the most common side effects of Rybelsus?

Nausea and diarrhoea are the most common, in 10 to 30 in every 100 users, followed by abdominal pain, constipation, a full feeling, reduced appetite and tiredness. The complaints are usually strongest in the first weeks and after a dose increase, and decrease afterwards.

Is tiredness a side effect of Rybelsus?

Yes, tiredness is listed as a common side effect in the product information (1 to 10 in 100). In addition, tiredness often arises because you eat and drink less. Discuss persistent tiredness with your doctor, especially with dizziness or palpitations.

How much weight can I lose with Rybelsus?

That varies from person to person and cannot be predicted. Rybelsus is registered for type 2 diabetes; weight loss is a common effect. In research with a much higher dosage (50 mg, not available in the Netherlands), participants lost an average of 15.1% in 68 weeks. The doctor discusses what is realistic in your situation.

What should you not eat with Rybelsus?

There are no forbidden foods, but fatty, sugary and large meals increase the chance of nausea. Eat smaller portions with enough protein and fibre. You can find practical guidance in our article on an Ozempic diet plan. Alcohol increases the chance of low blood sugar; read more about this in Ozempic and alcohol.

How long can you use Rybelsus?

There is no fixed maximum duration of use. With type 2 diabetes, Rybelsus is usually a long-term treatment. When it is used for weight, the doctor decides the duration based on effect and side effects, and discusses how you taper off or continue.

What is the difference between Ozempic and Rybelsus?

Both contain semaglutide. Ozempic is a weekly injection with stable absorption; Rybelsus a daily tablet that you take on an empty stomach with little water, after which you wait 30 minutes before eating. Experiences with side effects are similar; absorption of the tablet is more variable.

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