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How long does it take for Rybelsus to start working?

Medically reviewed by Carmen Fookes, BPharm. Last updated on June 29, 2020.

Official Answer

by Drugs.com
  • Rybelsus is started at a lower than effective dose to reduce the risk of side effects which means benefits will not be seen until the dose is increased to 7mg.
  • The dose is increased from 3mg to 7mg after 30 days so you can expect Rybelsus to start showing an effect from day 31 onward.
  • Every time you increase the dose of Rybelsus it takes 4 to 5 weeks for steady levels to be reached so it may take two to three months before the full effects of Rybelsus are seen.
  • Some people may require 14mg of Rybelsus for it to be effective.

Rybelsus (semaglutide) is an oral medicine that is used to improve blood sugar control in adults over the age of 18 with type 2 diabetes. It is usually prescribed after oral medications for diabetes have not worked or have stopped working.

Rybelsus is best taken on an empty stomach when you first wake up, at least 30 minutes before food, and with a small amount of water (no more than 4 oz). This ensures Rybelsus is absorbed properly. Rybelsus works best if food is eaten 30 to 60 minutes after taking it.

Rybelsus needs to be started slowly at 3mg once a day. Starting at a lower dosage helps your body to get used to taking the medicine and reduces the risk of digestive side effects, such as nausea, belly pain, diarrhea, decreased appetite, vomiting, and constipation.

This low dose is taken for 30 days and it is not effective at lowering blood sugar. After 30 days of taking Rybelsus 3mg a day, your doctor will increase the dose to 7mg once a day. This dose is usually effective at lowering blood sugar levels and may be increased to 14mg a day after 30 days if well tolerated and further blood sugar lowering is desired. Taking two 7mg tablets to achieve a 14mg dose is not recommended.

Because Rybelsus is started slowly, at a lower-than-effective dose, it won’t start working properly until the dose is increased to at least 7mg which is done after 30 days of taking 3mg. So it takes at least 31 days before it is effective.

How is Rybelsus able to be given orally?

Rybelsus tablets are formulated with salcaprozoate, which is an absorption promoter.

Salcaprozoate helps poorly soluble large molecules, such as semaglutide (but also others such as insulin or heparin), to be absorbed, offering a more convenient way for medications to be taken that are typically given by injection.

The absorption of Rybelsus primarily occurs in the stomach, but only up to 1% of a dose is absorbed, which is why it is important to take it on an empty stomach. After one dose of Rybelsus, maximum concentrations of semaglutide are reached one hour after administration. After 4 to 5 weeks of regular dosing, blood levels of semaglutide have reached steady state (this means they remain constant in the blood and don’t fluctuate up and down).

Semaglutide lasts a long time in the body – about 4 to 5 weeks after the last dose.

Clinical studies have shown:

  • After 26 weeks, 69% of people taking Rybelsus 7mg achieved an HbA1c of <7% compared to 77% of patients taking Rybelsus 14mg and only 31% of patients taking placebo (a pretend pill)
  • Fasting plasma glucose levels also decreased by 28 in people taking Rybelsus 7mg, by 33 in people taking Rybelsus 14mg and only 3 in people taking placebo.
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