Is Ozempic Or Rybelsus Better For Weight Loss

Both Rybelsus and Ozempic are manufactured by the drug company Novo Nordisk, says Dr. Comite. Their main differences are the route of administration, frequency and strength.

Form and Frequency

“Rybelsus is taken orally as a once-daily pill, whereas Ozempic is taken as a once-weekly subcutaneous (under the skin) injection,” says Dr. Igel.

  • Rybelsus: Daily tablet taken orally in the morning 30 minutes before eating with 4 ounces of water or less. Tablets must be swallowed whole (not crushed, split or chewed).
  • Ozempic: Weekly injection supplied as a prefilled, single-dose pen taken any time on the same day each week, with or without meals.

Dosage

Each medication has a starting dosage that may increase over time according to results and tolerance. The Rybelsus dosage is higher than Ozempic, says Dr. Comite. That’s because semaglutide is less readily absorbed through the stomach than when it’s injected subcutaneously (under the skin), she explains.

  • Rybelsus: Available in 3 milligram, 7 milligram and 14 milligram doses; treatment initiation dosage is 3 milligrams daily for 30 days, after which the dosage is increased to 7 milligrams. The maximum dosage is 14 milligrams daily.
  • Ozempic: Available in 0.25 milligram, 1 milligram and 2 milligram doses; starting treatment is 0.25 milligrams for four weeks, after which the dosage is raised to 0.5 milligrams. Future doses can be increased in 30-day intervals in increments of 0.5 milligrams, with a maximum weekly dosage of 2 milligrams.

Cost

Individuals who are prescribed Rybelsus or Ozempic for diabetes may find that their insurance covers a good portion of the cost, although coverage can vary between plans.

When it comes to out-of-pocket cost for each medication:

Rybelsus: The average cost for a package of 3 milligram tablets is $935.77, the average cost for a package of 7 milligram tablets is $935.77 and 14 milligrams are $935.77 per package.

Ozempic: The average cost for 0.25 or 0.5 milligrams (1 x 1.5-mL pen) is $935.77, the average cost for 1 milligram (1 x 3-mL pen) is $935.77 and the average cost for 2 milligram (1 x 3-mL pen) is $935.77

Side Effects and Safety

Since Rybelsus and Ozempic contain the same active ingredient(semaglutide)common side effects are similar, says Dr. Comite. According to Novo Nordisk, some of the common side effects include:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Gas
  • Bloating
  • Decreased appetite

More serious side effects are also possible:

  • Pancreatitis (inflammation of the pancreas) that may cause severe, persistent abdominal pain with or without vomiting.
  • Changes in vision, including blurry vision and worsening of diabetic retinopathy, a condition causing vision loss and blindness.
  • Hypoglycemia (low blood sugar), especially when combined with other insulin-reducing diabetes medications.
  • Gastrointestinal obstruction caused by slowed passage of waste through the stomach and intestines.
  • Kidney problems, including loss of kidney function and kidney failure caused by dehydration due to nausea, vomiting and diarrhea.
  • Anaphylaxis (severe, life-threatening allergic reaction) that results in swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, severe rash/itching, dizziness, fainting or rapid heartbeat.
  • Gallbladder problems that may cause abdominal pain, fever, jaundice (skin or eye yellowing) and clay-colored stool.
  • Medullary Thyroid tumors and cancer; signs include a lump or swelling in the neck, hoarseness, difficulty swallowing and shortness of breath.

Rybelsus and Ozempic are contraindicated in the following groups, according to Novo Nordisk:

  • Individuals with a personal or family history of medullary thyroid carcinoma (MTC), a rare subtype of thyroid cancer)
  • People with multiple endocrine neoplasia syndrome type 2 (MEN 2), a very rare endocrine condition and risk factor of MTC
  • Pregnant and breastfeeding individuals
  • Individuals with type 1 diabetes

Both drugs have a boxed warning for thyroid cancer, the highest safety warning issued by the Food and Drug Administration (FDA). In animal studies, semaglutide (the active ingredient in Rybelsus and Ozempic) caused thyroid cancer cell tumors in rodents.

Which Is More Effective: Rybelsus or Ozempic?

“No head-to-head studies have compared doses of oral semaglutide (7 milligrams and 14 milligrams) versus once-weekly subcutaneous semaglutide (0.5 milligrams and 1 milligram),” says Dr. Comite. However, separate studies show that Rybelsus and Ozempic deliver similar reductions in glucose levels and weight, she says.

According to a 2021 study, individuals with type 2 diabetes controlled by diet and exercise who received the maximum dose of subcutaneous semaglutide (1 milligram) experienced a reduction in HbA1c levels (the average blood glucose levels over the past three months) of 1.6% (after 30 weeks), while those who received the maximum dose of oral semaglutide (14 milligrams) saw a reduction of 1.4% (at 26 weeks). The same groups experienced an average weight reduction of 9.9 pounds and 8.2 pounds, respectively.[1]Meier, J. Efficacy of Semaglutide in a Subcutaneous and an Oral Formulation. Front. Endocrinol. 2021;12.

According to a recent statement from Novo Nordisk in response to the growing demand of semaglutide products for weight reduction, the company does not promote the use of either Ozempic or Rybelsus for any reasons other than their FDA-approved uses, and neither medication is approved for the treatment of chronic weight management, or cosmetic weight loss.