Rybelsus (semaglutide) is an oral medication licensed in the UK for treating type 2 diabetes mellitus in adults. As the first tablet-form GLP-1 receptor agonist, it offers an alternative to injectable diabetes treatments. Rybelsus works by mimicking a natural hormone that regulates blood sugar, stimulating insulin release when glucose levels are elevated and slowing digestion to reduce post-meal spikes. It is typically prescribed alongside metformin or other diabetes medications when diet and exercise alone are insufficient to achieve adequate glycaemic control. Regulated by the MHRA and prescribed according to NICE guidance, Rybelsus helps improve HbA1c levels and often leads to modest weight reduction in people with type 2 diabetes.

What Is Rybelsus and How Does It Work?

Rybelsus (semaglutide) is an oral medication licensed in the UK for the treatment of type 2 diabetes mellitus in adults. It belongs to a class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that helps regulate blood sugar levels. Rybelsus is the first GLP-1 receptor agonist available in tablet form, offering an alternative to injectable formulations for patients who prefer oral medication.

The primary purpose of Rybelsus is to improve glycaemic control when diet and exercise alone are insufficient. It is typically prescribed alongside other diabetes medications such as metformin, or as monotherapy when metformin is not tolerated or contraindicated. By activating GLP-1 receptors in the pancreas, Rybelsus stimulates insulin secretion and reduces inappropriate glucagon secretion in a glucose-dependent manner—meaning it only works when blood sugar levels are elevated, which reduces the risk of hypoglycaemia compared to some other diabetes treatments.

Rybelsus also slows gastric emptying, which helps reduce post-meal blood sugar spikes, and acts on appetite centres in the brain to promote satiety. This mechanism often leads to modest weight loss, which can be beneficial for many people with type 2 diabetes who are overweight. The medication has been shown in clinical trials to reduce HbA1c (a measure of long-term blood sugar control) effectively. While cardiovascular safety has been demonstrated, Rybelsus does not have a specific UK licence for cardiovascular risk reduction. It is not licensed for weight management alone in the UK. Rybelsus is regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) and prescribed according to NICE guidance NG28 for type 2 diabetes management.

Who Can Take Rybelsus in the UK?

Rybelsus is licensed for adults aged 18 years and over with type 2 diabetes mellitus. It is not approved for use in children, adolescents, or for the treatment of type 1 diabetes or diabetic ketoacidosis. According to NICE guidelines (NG28), GLP-1 receptor agonists like Rybelsus are generally considered when:

• Metformin is already being taken but blood sugar control remains inadequate (HbA1c typically ≥58 mmol/mol)

• The person has a body mass index (BMI) of 35 kg/m² or higher (or with BMI thresholds reduced by 2.5 kg/m² for people from South Asian or certain other ethnic backgrounds)

• There are specific clinical circumstances where weight loss would benefit other obesity-related conditions

Rybelsus may also be used as monotherapy if metformin is contraindicated or not tolerated, though this is less common. Your GP or diabetes specialist will assess your individual circumstances, including your current HbA1c, weight, other medications, and any complications of diabetes, before deciding if Rybelsus is appropriate.

Contraindications and cautions are important to consider. The formal contraindication for Rybelsus is hypersensitivity to semaglutide or any of the excipients. Additionally, Rybelsus is not recommended in people with:

• Type 1 diabetes or for treating diabetic ketoacidosis

• Severe gastrointestinal disease, including gastroparesis (use with caution)

• Pregnancy or breastfeeding—women should discontinue treatment at least 2 months before a planned pregnancy and use effective contraception

Patients with a history of pancreatitis, pre-existing diabetic retinopathy (particularly if on insulin), gallbladder disease, or severe renal impairment require careful assessment and monitoring. Rybelsus should not be used in combination with DPP-4 inhibitors (another class of diabetes medications). If you take sulfonylureas or insulin, dose reductions of these medications may be needed when starting Rybelsus to reduce hypoglycaemia risk.

Animal studies have shown thyroid C-cell tumours with semaglutide, though the relevance to humans is unknown. You should report any symptoms such as a lump in the neck, hoarseness, or difficulty swallowing to your doctor. If you have any concerns about these conditions, discuss them openly with your healthcare provider before starting treatment.

How to Take Rybelsus Correctly

Taking Rybelsus correctly is essential for the medication to work effectively, as its absorption can be significantly affected by food, drink, and other medications. Rybelsus tablets come in three strengths: 3 mg, 7 mg, and 14 mg. The usual starting dose is 3 mg once daily for 30 days, which helps your body adjust to the medication and minimises side effects. This initial dose is for initiation only and not for glycaemic control. After this initial period, the dose is typically increased to 7 mg once daily. If further blood sugar control is needed after at least 30 days on 7 mg, your doctor may increase the dose to 14 mg once daily.

Administration instructions are very specific and must be followed carefully:

• Take Rybelsus first thing in the morning on an empty stomach

• Swallow the tablet whole with a sip of water (up to 120 ml)

• Do not split, crush, or chew the tablet

• Wait at least 30 minutes before eating, drinking (anything other than water), or taking other oral medications

• If you miss a dose, skip it and take your next dose the following day—do not take two doses to make up for a missed one

These timing requirements exist because food, beverages (including tea, coffee, and juice), and other medications can substantially reduce the absorption of semaglutide from the gastrointestinal tract. Taking Rybelsus with food or too soon before eating may mean you receive a lower dose than intended, reducing its effectiveness.

If you take other medications, take them after the 30-minute interval following Rybelsus. If you take levothyroxine, your thyroid function (TSH) may need monitoring as Rybelsus can increase levothyroxine exposure. Similarly, if you take warfarin, your INR may need more frequent monitoring when starting Rybelsus.

Storage: Keep Rybelsus in its original blister pack to protect from moisture, and store below 30°C. Do not remove a tablet from the blister until you are ready to take it. If you have difficulty remembering the specific administration requirements, consider setting a morning alarm or placing the medication somewhere visible as a reminder.

Common Side Effects and What to Expect

Like all medications, Rybelsus can cause side effects, though not everyone experiences them. The most common side effects are gastrointestinal and typically occur when starting treatment or increasing the dose. These usually improve over time as your body adjusts to the medication.

Very common side effects (affecting more than 1 in 10 people) include:

• Nausea—often the most troublesome initially, but usually lessens after a few weeks

• Diarrhoea

Common side effects (affecting up to 1 in 10 people) include:

• Vomiting

• Abdominal pain or discomfort

• Decreased appetite

• Indigestion or acid reflux

• Constipation

• Flatulence

• Fatigue or dizziness

• Hypoglycaemia (low blood sugar)—more likely if taken with insulin or sulfonylureas

To minimise gastrointestinal side effects, eat smaller, more frequent meals, avoid high-fat or spicy foods initially, and stay well hydrated. If nausea is severe or persistent beyond the first few weeks, contact your GP, as dose adjustment or additional anti-nausea medication may help.

If you take insulin or sulfonylureas (such as gliclazide), your doctor may reduce these doses when starting or increasing Rybelsus to reduce the risk of hypoglycaemia.

Serious side effects are uncommon but require immediate medical attention. Contact your GP urgently or call NHS 111 if you experience:

• Severe, persistent abdominal pain (especially radiating to the back)—possible pancreatitis

• Persistent pain in the right upper abdomen, possibly with fever or yellowing of the skin/eyes—possible gallbladder problems

• Signs of dehydration from vomiting or diarrhoea (dizziness, dark urine, reduced urination)

• Symptoms of hypoglycaemia (trembling, sweating, confusion, rapid heartbeat)—especially if you take other diabetes medications

• Vision changes or signs of diabetic retinopathy worsening—particularly if you have pre-existing eye disease or if your blood sugar improves rapidly

Seek emergency care (999) if you develop signs of a severe allergic reaction (difficulty breathing, facial swelling, severe rash).

Report any suspected side effects to the MHRA through the Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app). Regular monitoring by your diabetes team helps identify any concerns early.

Getting Rybelsus on the NHS

Rybelsus is available on NHS prescription in the UK, but access is determined by NICE guidance (NG28) and local formulary decisions made by individual Integrated Care Boards (ICBs), formerly known as Clinical Commissioning Groups. This means availability and prescribing criteria may vary slightly depending on where you live in the UK.

According to NICE guideline NG28, GLP-1 receptor agonists like Rybelsus are recommended as a treatment option for type 2 diabetes, but typically within specific parameters:

• As a second-line treatment (usually added to metformin) when blood sugar control is inadequate

• When BMI criteria are met (generally ≥35 kg/m² or with BMI thresholds reduced by 2.5 kg/m² for people from South Asian or certain other ethnic backgrounds)

• When there is potential for weight loss to benefit other obesity-related conditions

• As part of a triple therapy regimen in some circumstances

Your GP or diabetes specialist will assess whether Rybelsus is appropriate based on your HbA1c levels, weight, other medications, and overall diabetes management plan. If prescribed, you will typically be reviewed after 6 months to assess effectiveness. NICE guidance recommends continuing GLP-1 receptor agonists only if there has been a beneficial metabolic response, typically defined as a reduction in HbA1c of at least 11 mmol/mol (1.0%) and weight loss of at least 3% of initial body weight.

Prescription costs: In England, if you pay for prescriptions, the standard charge applies (currently £9.90 per item), though many people with diabetes qualify for free prescriptions by applying for a medical exemption certificate. In Scotland, Wales, and Northern Ireland, all prescriptions are free. If Rybelsus is not available in your area or you do not meet NHS criteria, private prescription is possible but costs can vary considerably.

If you believe Rybelsus might be suitable for you, discuss this with your diabetes care team at your next review appointment. They can explain local prescribing policies and whether you meet the criteria for NHS-funded treatment.

Frequently Asked Questions