Drug Facts: Oral GLP-1 Receptor Agonists
GLP-1 receptor agonists are diabetes drugs that have been on the market since 2005. They’re a great drug option for people with type 2 diabetes as they do an awesome job lowering blood sugars, they generally don’t cause hypoglycemia, and they can cause weight loss. However, one drawback of them for patients is that they’re injectable medications. Some people may have previously chosen to avoid GLP-1 receptor agonists due to “needle-phobia” or other apprehensions. Luckily, this drug class is now available in pill form!
Rybelsus was FDA approved in September 2019 and is the pill version of the injectable drug Ozempic. Ozempic is a once weekly injection, but Rybelsus needs to be taken daily. Other than that, they work the same. However, at the time of writing this blog post, Rybelsus has not been FDA approved to say that in addition to lowering blood sugars, it also decreases the risk of major cardiovascular events. My guess is that they are in the process of doing these studies and the drug could potentially get this FDA approval in the future.
To be honest, despite this drug having been out for 2 years, I have never seen any patients on it, so I don’t have any clinical experience with it. It seems that many providers aren’t really offering it as a potential option for patients. I’m not totally clear as to why this is, but I’m thinking that maybe physicians have gotten comfortable encouraging patients to try the injectable versions that they just don’t think about the oral option. My personal initial questions about the drug were, is it as effective as the injectables (yes) and will insurance companies pay for it (yes). The drug is priced similar to the injectable version and they seem to be in same tier on insurance companies’ formularies. This means whatever your copay is for the injectable version will also be the same for the pill.
There are some specific instructions on how to take Rybelsus. It needs to be taken on an empty stomach when you first wake up, and it must be taken with plain water and no more than 4 ounces. You then have to wait 30 minutes before you can eat and drink and/or take other medications. This does complicate things if you take medication for hypothyroidism as this is generally prescribed to be taken first thing in the morning on an empty stomach as well. In this situation, I would recommend talking to your providing prescriber and/or pharmacist on the best time to take both medications.
Rybelsus has similar side effects of the injectable GLP-1 RAs which include gastrointestinal issues including nausea and vomiting. To help minimize these side effects, your provider will prescribe a lower dose of 3mg for 30 days before started the 7mg dose. If further blood sugar lowering is needed, the dose can be increased to 14mg.