Protocol for Switching from Ozempic to Rybelsus
When switching from injectable semaglutide (Ozempic) to oral semaglutide (Rybelsus), patients should discontinue Ozempic and start Rybelsus at 3 mg daily for 30 days, then increase to 7 mg daily for at least 30 days, followed by titration to 14 mg daily as needed for glycemic control.
Dosing and Administration Guidelines
Initial Transition
- Stop injectable semaglutide (Ozempic)
- Begin oral semaglutide (Rybelsus) at 3 mg once daily for 30 days
- Take on an empty stomach first thing in the morning
- Take with no more than 4 ounces of plain water
- Wait at least 30 minutes before consuming any food, beverages, or other oral medications 1
Dose Titration
- After 30 days on 3 mg, increase to 7 mg once daily for at least 30 days
- If additional glycemic control is needed after at least 30 days on 7 mg, increase to 14 mg once daily 1
- Gradual dose titration is critical to minimize gastrointestinal adverse effects, which are the most common side effects of semaglutide 1
Administration Requirements for Rybelsus
Critical Administration Rules
- Take on an empty stomach when first waking up
- Take with no more than 4 ounces (120 mL) of plain water only
- Wait at least 30 minutes before eating, drinking, or taking other oral medications
- Failure to follow these administration requirements will significantly reduce absorption and efficacy 2, 3
Common Pitfalls to Avoid
- Taking with food (reduces absorption)
- Taking with beverages other than plain water
- Not waiting the full 30 minutes before consuming anything else
- Taking other medications within the 30-minute window 2
Monitoring During Transition
Parameters to Monitor
- Glycemic control (blood glucose, HbA1c)
- Gastrointestinal symptoms (nausea, vomiting, diarrhea)
- Body weight
- Blood pressure 1
Managing Side Effects
- If significant gastrointestinal symptoms occur:
- Maintain the current dose for longer than the recommended 30 days
- Consider slower upward titration
- Use a submaximal dose if a good response is achieved 1
- Advise patients to:
- Take smaller meal sizes
- Avoid high-fat foods
- Limit alcohol and carbonated beverages
- Moderate carbohydrate intake 1
Special Considerations
Renal Function
- For patients with eGFR > 30 mL/min/1.73m², no dose adjustment is required
- For patients with eGFR < 30 mL/min/1.73m², use with caution and consider slower titration 1
Perioperative Management
- Hold oral semaglutide for at least three half-lives before procedures 1
Drug Interactions
- Be aware of potential interactions with medications that affect gastric emptying
- Oral semaglutide may impair absorption of other oral medications during dose titration, including oral contraceptives 4
Efficacy and Safety Considerations
- Oral semaglutide has been shown to provide effective glycemic control comparable to injectable formulations 2, 5
- The safety profile is consistent with the GLP-1 receptor agonist class, with gastrointestinal side effects being most common 2
- Cardiovascular safety of oral semaglutide has been demonstrated to be noninferior to placebo in cardiovascular high-risk patients 3
By following this structured protocol for switching from Ozempic to Rybelsus, patients can maintain effective glycemic control while minimizing potential side effects during the transition.