This content originally appeared here. It was reissued with permission.
Medical review Shawn Hashmi, MD
People can’t stop talking about semaglutide (Ozenpic, Wegovi), bougie diabetes, and weight loss pills. Ozempic and Wegovy are injectable medicines. Users stab themselves once a week with a preloaded syringe. However, Ozempic’s popularity led to a shortage, but there was much less hype for Rybelsus, the oral form of Semaglutide.
What is Libers?
Rybelsus is essentially ozempic in the form of pills rather than injections. Ozempic and Rybelsus are made by the same manufacturer Novo Nordisk and carry the same active ingredient, Semaglutide.(1) Semaglutide, when sold under the brand name Ozempic, is intended for people with type 2 diabetes. The same drug is also sold as Wegovy to treat obesity.
Semaglutide is a GLP-1 receptor agonist and is a type of drug that mimics the effects of hormones that stimulate insulin secretion and promote bloating. Semaglutide has been originally developed and approved to treat type 2 diabetes and remains a potent glucose-lowering therapy, which has a major impact on weight. Many Semaglutide users are losing weight without consciously reducing calories.(2)
Rybelsus is the only approved oral form of semaglutide. It is a daily pill and has been shown to lead to clinically significant weight loss and improved blood glucose, both alone and in combination with other diabetic drugs.(3)
Is Rybelsus as effective as Ozempic?
Rybelsus appears to be just as powerful as Ozempic, but it has a catch. It is only available in small quantities.
According to the US Food and Drug Administration (FDA), a daily dose of Liberus, up to 14 milligrams (mg) corresponds to a 0.5 mg starter dose of Ozempic.(4) (Rybelsus uses more semaglutide than Ozempic, as only a small portion of the semaglutide that enters the stomach is properly absorbed.)(5)
Clinical trials have shown that it has a metabolic effect comparable to two doses. (6)
| Rybelsus 14 mg Daily Tablets | Ozempic 0.5 mg weekly injection |
|---|---|
| 1.3% Point Drop on A1c | 1.3% Point Drop on A1c |
| Loss of 10 pounds | Loss of 9.5 pounds |
A study of actual data found similar results. Oral semaglutide showed “similar efficacy” against injectable semaglutide.(7)
These results suggest that Rybelsus and Ozempic may be equally effective in patients with type 2 diabetes, but the two drugs are virtually not comparable, as Ozempic is available at a more potent dose.
Ozempic is available in one dose and 2 mg doses. The maximum dose was 2.2 percentage points for A1c and 15 pounds of weight loss when tested in type 2 diabetes patients with metformin.(8) Rybelsus cannot match these results – at least not an approved dose. Wegovy is available at even higher doses at 2.4 mg per week.
High doses of Liberus are approaching
High doses of Liberus may become available over the next few years. In 2023, Novo Nordisk announced that it would seek FDA approval for large quantities of oral semaglutide to treat type 2 diabetes.(9)
The Pioneer Plus trial, which tested two experimental high doses of oral semaglutide in patients with type 2 diabetes, demonstrated that at the highest dose of 50 mg, the results of drug glucose reduction and weight loss were as good as those found at at least Ozenpic 2 mg. Study participants found that A1c reduced 2% points and weight loss was about 20 pounds.(10)(11)
Is Rybelsus approved for weight loss?
Oral semaglutide is not yet approved as a weight loss therapy.
However, in a recent OASIS 1 trial, researchers tested the effect of a 50 mg dose of oral semaglutide on people who are overweight or obese.(12) After using this drug for more than a year, study participants lost an average of 15.1% of their body weight. That amount of weight loss is roughly equal to that achieved by people using the maximum dose of injectable semaglutide, suggesting that oral semaglutide weight loss pills may be as effective as injectables.(13)
Novo Nordisk has already applied for regulatory approval for semaglutide weight loss drugs in both the US and Europe.(14)
In the meantime, some doctors have prescribed Libers’ Olra Bell as a weight loss therapy for people without diabetes, especially those who cannot withstand Wegovy or use needles.
How to take Rybelsus
If there’s another reason Rybelsus doesn’t know at all, it’s definitely going to be a hassle to take drugs.
According to the instructions on the FDA label, you should bring Rybelsus with you on an empty stomach, every morning, 30 minutes before eating, drinking or using other oral medications. Only during this period may there be up to 4 ounces of plain water. If breakfast is too early, the pill will be less effective. However, waiting 30 minutes or more to eat can enhance the absorption of the pill (which can lead to more important side effects).
In contrast, Ozempic is an injection once a week and can be taken at any time, with or without meals.
Rybelsus and side effects
A considerable number of Ozempic users have experienced gastrointestinal side effects.(15) For some, nausea, vomiting, or diarrhea subsides as the body adjusts to the drug. However, others don’t feel good and end up quitting their medication altogether.
Clinical trials suggest that Rybelsus has similar side effects. Almost similar proportions of Rybelsus study participants reported experiencing the most common side effects, including nausea, abdominal pain, diarrhea, and vomiting.
The FDA label on Rybelsus warns of some of the same rare and serious side effects as Ozempic, including pancreatitis (inflammatory pancreas) and acute kidney damage (sudden reduction in renal function).(4)
Combined oral semaglutide
Currently, some online compounding pharmacies advertise “oral semaglutide,” but some of these products are not actually comparable to Rybelsus. These semaglutide pills sublingual (dissolve under the tongue) rather than swallow, so there is a completely different mechanism for absorption.
With no published studies on sublingual semaglutide, buyers should be vigilant about such products, and the safety and efficacy of such substances may be questionable.
Take home
Liberus, an oral form of semaglutide, appears to be just as effective as Ozempic for diabetes management and weight loss, but is only available at such a strong dose. In the coming years, larger doses may become available for the treatment of both diabetes and obesity. In the meantime, Rybelsus is an effective treatment for type 2 diabetes and may be particularly useful for people with needle phobia or those unable to take Ozempic for other reasons.
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(TagStoTRASSLATE)A1C(T)GLP-1(T)Insulin(T)Intensive management(T)Jardiance(T)Metformin(glucophage)(T)Novo Nordisk(T)Ozempic(Semaglutide)(T)Rybelsus(T)Type 2 diabetes(T)US Food & Drug Adminisonal(FDA)(FDA)(FDA)(FDA)(FDA)(FDA)
