Rybelsus (oral semaglutide) - First Oral GLP-1 Agonist Dosing: 3 mg daily x 30 days, then 7 mg maintenance dose Can increase to 14 mg after 30 days if needed Rybelsus was finally approved, the first (& only) oral GLP1 agonist! It is semaglutide, the same medication in the injection Ozempic. It is formulated to be bioavailable through the oral route by using the SNAC carrier. Otherwise, it works in the same exact mechanism as the injectable GLP1 agonists. It has a similar titration schedule as Ozempic, where we have a smaller starting dose before getting to the maintenance dose. Patients can remain on the maintenance dose of 7 mg daily if it's working, or increase to 14 mg daily if needed. Rybelsus will be dispensed in a blister pack in order for the drug to remain stable, so it's important to counsel patients not to open the blisters until they are ready to take the drug. It will be taken on an empty stomach first thing in the morning, with just a sip of water (<4 oz.). Patients should not drink more water, eat food, or take any other medications for 30 minutes after taking Rybelsus to ensure the drug can be absorbed appropriately. This is an important counseling point to remember because of course it's important for efficacy, but also because this may seem counter-intuitive. GLP1 agonists are known to have GI upset as a side effect, and many clinicians often automatically tell patients to take meds with food to minimize this side effect. Oral semaglutide has been shown non-inferior to daily liraglutide injection, and to have significant A1c lowering and weight loss when compared to SGLT2 empagliflozin and DPP4 sitagliptin. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Rybelsus #oral #semaglutide #Diabetes #Pharmacology #Endocrinology
