Side Effects of Rybelsus: What to Know

Medically Reviewed By Alex Brewer, PharmD, MBA
Rybelsus has a boxed warning for the risk of thyroid cancer. This is a serious warning from the Food and Drug Administration (FDA). For details, see the “ Rybelsus: Side effects explained” section below.

Rybelsus: Introduction

Rybelsus is a brand-name prescription drug. It’s a type of medication called a glucagon-like peptide-1 (GLP-1) agonist, and it contains the active drug semaglutide. It comes as an oral tablet that you swallow.

Rybelsus is approved by the Food and Drug Administration (FDA) to treat type 2 diabetes in adults. This medication should be used in combination with healthy diet and exercise habits.

If Rybelsus works for you, your doctor will likely recommend that you take the medication long term.

Similar to other drugs, Rybelsus may cause side effects. Read below for information about possible side effects, including common, mild, and serious ones.

For a general overview of Rybelsus, including details about its uses, see this article.

If you’d like to take Rybelsus, search here to find a healthcare professional who might prescribe it.

Rybelsus: More common side effects

Some of Rybelsus’s side effects may be more common than others. These side effects may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about any side effects with Rybelsus.

In clinical studies of Rybelsus, these were some side effects that occurred more often:

* For more information about this side effect, see “Rybelsus: Side effects explained” below.

Rybelsus: Mild side effects

Rybelsus can cause mild side effects, which are listed below. However, this list doesn’t include all possible mild side effects. To learn more about side effects of Rybelsus, view the drug’s prescribing information.

Mild side effects of Rybelsus include:

The side effects listed above may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about side effects with Rybelsus.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Rybelsus and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Rybelsus: Side effects explained” below.

Rybelsus: Serious side effects

It’s possible to have serious side effects with Rybelsus. Serious side effects are listed below, but this list may not include all possibilities. To learn more about Rybelsus’s side effects, view the drug’s prescribing information.

Call your doctor right away if you have serious side effects with Rybelsus. However, if you think you’re having a medical emergency or life threatening side effects, call 911 or your local emergency number.

Serious side effects of Rybelsus and their possible symptoms include:

* For more information about this side effect, see “Rybelsus: Side effects explained” below.
Rybelsus has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Rybelsus: Side effects explained” section below.
‡ An allergic reaction is possible after taking Rybelsus. However, it’s not clear whether this side effect occurred in clinical studies. For more information about this side effect, see “Rybelsus: Side effects explained” below.

Rybelsus: Common questions about side effects

Here are some common questions about the drug’s side effects and answers to them. Talk with your doctor if you have other questions about this drug.

Do side effects of 3-mg Rybelsus doses differ from those of 7-mg and 14-mg doses?

It’s not likely. However, it’s possible that a 3-milligram (mg) dose of Rybelsus may cause side effects to happen less often than higher doses of the drug. This is because lower doses expose you to less medication. So, by having less medication in your body, you may have a lower risk of side effects.

You may have certain side effects of Rybelsus more often if your doctor increases your dose. For example, nausea, vomiting, and diarrhea can happen more often with higher doses of Rybelsus. However, these side effects may improve over time, even with a higher dose of the medication.

Typically, the 3-mg dose of Rybelsus is only meant to be taken daily for the first 30 days of your treatment. After that, your doctor will likely increase your dose of the drug. This lower starting dose is used to allow your body to get used to Rybelsus and reduce your risk of side effects when you’re starting the drug. For more information about Rybelsus dosing, see this article.

Regardless of your dose of Rybelsus, if your side effects are bothersome, talk with your doctor. They may recommend ways to decrease side effects or the best way to treat them.

To learn more about this drug’s side effects, see the “Rybelsus: Mild side effects” and “Rybelsus: Serious side effects” sections above.

Are reviews available about Rybelsus side effects?

The manufacturer of Rybelsus has patient stories available on its website. However, these stories describe how Rybelsus works for certain people and how it has impacted their lives. The people in these stories don’t discuss side effects they experienced from Rybelsus.

Keep in mind that not everyone who uses Rybelsus will have the same experience. The side effects that you may have will depend on your personal situation.

To learn more about side effects, see “Rybelsus: Mild side effects” and “Rybelsus: Serious side effects” above. If you have additional questions about side effects from Rybelsus, talk with your doctor or pharmacist.

Does Rybelsus cause hair loss as a side effect?

It’s not likely. Hair loss was not a side effect reported by people taking Rybelsus in clinical studies.

However, it’s possible for diabetes to increase your risk of hair loss. In fact, diabetes can decrease your hair growth and stop new hair from growing. And Rybelsus is prescribed for people with diabetes.

If you notice hair loss during treatment with Rybelsus, talk with your doctor. They can determine what may be causing your hair loss and advise on the best treatment options. Your doctor may recommend medications such as minoxidil (Rogaine).

Rybelsus: Side effects explained

Here’s detailed information about some side effects of Rybelsus.

Risk of thyroid cancer

Rybelsus has a boxed warning for the risk of thyroid cancer. This is a serious warning from the Food and Drug Administration (FDA).

In animal studies, Rybelsus was shown to cause thyroid tumors and thyroid cancer. However, these side effects were not reported in human studies.

Taking higher doses of Rybelsus or taking it for a long period of time may increase your risk of developing thyroid cancer. Due to this possible risk, you should not take Rybelsus if you have a personal or family history of medullary thyroid cancer (MTC). You should also not take Rybelsus if you have multiple endocrine neoplasia syndrome type 2 (MEN 2).

Symptoms of thyroid cancer may include:

What to do

If you or anyone in your family has a history of thyroid cancer, be sure to tell your doctor before starting Rybelsus. In some cases, your doctor may recommend a different treatment option for you.

Also, if you experience any symptoms of thyroid cancer, talk with your doctor. They will be able to determine what is causing your symptoms. Your doctor will also monitor you for symptoms of thyroid problems throughout your treatment with Rybelsus. For example, they may order blood tests to monitor your thyroid.

Nausea

In clinical studies, nausea was the most common side effect reported by people taking Rybelsus.

Nausea may occur most often when you first start taking Rybelsus or when your dose increases. This side effect may improve as your body adjusts to the medication.

What to do

If you’re experiencing nausea that’s severe or bothersome, talk with your doctor. They may be able to recommend ways to reduce the nausea. For example, your doctor may recommend taking ginger candies. In some cases, they may recommend an over-the-counter (OTC) or prescription medication to treat your nausea. Your doctor will choose the treatment they think will be safest for you.

Vomiting

Vomiting was a common side effect reported in clinical studies of people taking Rybelsus.

However, vomiting occurred most often when people first started taking Rybelsus and when their dose increased. So, this side effect may improve as your body adjusts to the medication.

What to do

If you’re experiencing vomiting while taking Rybelsus, talk with your doctor. This side effect may improve over time. Your doctor may also recommend staying hydrated to help avoid dehydration.

If your vomiting becomes severe, your doctor may recommend a medication, such as ondansetron (Zofran ODT), for short-term use.

Low blood sugar

Rybelsus may increase the risk of hypoglycemia (low blood sugar). This risk is higher if you are also taking certain medications that lower your blood sugar.

Examples of these drugs include sulfonylureas, such as glimepiride (Amaryl), and insulin, such as insulin glargine (Basaglar, Lantus).

Symptoms of low blood sugar may include:

Rarely, low blood sugar can become severe. Symptoms of severe low blood sugar may include:

  • inability to focus or complete simple tasks
  • fainting or loss of consciousness
  • inability to drink or eat
  • seizures
  • coma

What to do

If you’re experiencing mild low blood sugar while taking Rybelsus, talk with your doctor. They may recommend testing your blood sugar more often, especially with dose changes. In some cases, your doctor may recommend a lower dose of your other diabetes medication.

However, if you’re having symptoms of severe low blood sugar, call 911 or your local emergency number immediately. Or you can have someone take you to a hospital or clinic for urgent medical care. (Do not try to drive if you have symptoms of severe low blood sugar.) Severe hypoglycemia is a life threatening emergency that requires urgent treatment.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Rybelsus. A more severe allergic reaction is rare but possible. Allergic reactions have rarely been reported since Rybelsus was approved for use.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
• itching trouble breathing
rash • swelling in your throat or mouth
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids

If you have an allergic reaction to Rybelsus, call your doctor right away. This is important to do because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Rybelsus: Precautions

Rybelsus has a boxed warning and other precautions that apply to the medication. Be sure to talk with your doctor about any other medical conditions you have so that they can determine if it’s safe for you to take Rybelsus.

Boxed warning: Risk of thyroid cancer

This drug has a boxed warning for the risk of thyroid cancer. This is a serious warning from the Food and Drug Administration (FDA). For details, see the “Rybelsus: Side effects explained” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Rybelsus. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health.

The conditions and factors to consider include those described below.

Eye problems related to your diabetes. Tell your doctor if you have an eye condition related to diabetes, such as diabetic retinopathy. It’s possible for Rybelsus to make this eye condition worse. So, your doctor may monitor your vision more closely while you’re taking Rybelsus.

Allergic reaction. If you’ve had an allergic reaction to Rybelsus or any of its ingredients, your doctor will likely not prescribe Rybelsus. Ask your doctor what other medications may be better options for you.

Kidney problems. If you have kidney problems, such as chronic kidney disease (CKD), tell your doctor before starting treatment with Rybelsus. This medication may cause new kidney problems or worsen current kidney problems. Your doctor may monitor your kidneys more closely than usual while you’re taking Rybelsus.

History of pancreatitis. If you have a history of pancreatitis (inflammation of your pancreas), tell your doctor before taking Rybelsus. It’s not known if this medication is safe for people who have a history of pancreatitis. In this case, your doctor may recommend a different treatment option for you.

Consuming alcohol during Rybelsus treatment

There are no known interactions between Rybelsus and alcohol.

However, it’s important to note that you should take Rybelsus on an empty stomach. (Do not take Rybelsus with anything more than 4 ounces of plain water.) It is recommended to take your dose at least 30 minutes before your first meal or beverage of the day and before any other medications you take daily. So, be sure that you’re not drinking alcohol with your dose of Rybelsus.

In addition, alcohol may affect your blood sugar levels. This can make diabetes harder to manage, and Rybelsus is prescribed for people with diabetes.

If you’re interested in drinking alcohol while taking this drug, talk with your doctor or pharmacist. They can recommend how much alcohol is safe for you to consume while taking Rybelsus.

Pregnancy and breastfeeding during Rybelsus treatment

It’s not known if it may be safe to take Rybelsus during pregnancy. However, in animal studies, the drug was shown to cause congenital anomalies (commonly known as birth defects) when taken during pregnancy. It’s important to note that animal studies do not always indicate what may happen in humans.

Due to this possible risk, it’s recommended that you stop taking Rybelsus at least 2 months before you become pregnant.

Also, it’s not recommended to breastfeed while you’re taking Rybelsus. At this time, it isn’t known what effects the drug may have on a child who is breastfed. In animal studies, Rybelsus was present in the milk. Due to these risks, your doctor will likely recommend that you avoid breastfeeding while you’re taking Rybelsus.

If you’re pregnant, planning to become pregnant, or breastfeeding, talk with your doctor before starting Rybelsus.

Rybelsus: What to discuss with your doctor

Talk with your doctor or pharmacist to find out more information about Rybelsus. If you have questions about the drug’s side effects, your pharmacist or healthcare professional can help answer them for you.

In addition to discussing Rybelsus with your doctor, you may find the following articles helpful in learning more.

  • Overview of Rybelsus. To read an overview of Rybelsus, see this article.
  • Drug comparison. To learn how Rybelsus compares with Ozempic, read this article.
  • Details about type 2 diabetes. To learn more about type 2 diabetes, which Rybelsus is used to treat, see this article.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Alex Brewer, PharmD, MBA
Last Review Date: 2022 May 21
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.