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Takeaways

    • Rybelsus is taken once daily as a tablet, while Ozempic is available as a once-daily tablet and a once-weekly injection.
    • Rybelsus and Ozempic tablets are taken in the same way, but the tablet formulations cannot be substituted milligram for milligram.
    • A person taking Rybelsus 7 mg may switch to an Ozempic 4 mg tablet, and a person taking Rybelsus 14 mg may switch to an Ozempic 9 mg tablet.
    • Patients should not switch between the tablets during the first 30 days of treatment.

Novo Nordisk is replacing Rybelsus 3, 7, and 14 mg with a newer oral formulation sold as the Ozempic pill. It is still once-daily oral semaglutide, but has greater bioavailability, so lower milligram doses produce comparable exposure.

The products are not interchangeable milligram for milligram. Patients currently using Rybelsus will require a new prescription in order to get started on Ozempic tablets 1.5 mg, 4 mg, and 9 mg, says Novo Nordisk.

Our Rybelsus-to-Ozempic conversion chart will help you switch safely.

Why is Rybelsus being phased out or discontinued?

Novo Nordisk introduced an updated oral semaglutide formulation under the Ozempic name. According to the manufacturer, the new tablets are smaller and have greater bioavailability, which means the body can absorb more semaglutide from a lower tablet strength.

The updated formulation comes in three strengths:

    • Ozempic 1.5 mg for the 30-day initiation period
    • Ozempic 4 mg as a maintenance dose
    • Ozempic 9 mg as a higher maintenance dose

Novo Nordisk’s professional guidance says current Rybelsus patients require a new prescription to begin Ozempic tablets. The manufacturer also identifies several changes associated with the new product, including new National Drug Code numbers and new packaging.

In an interview with Fierce Pharma Marketing, Ed Cinca, Novo Nordisk’s SVP of Marketing and Patient Solutions, said the goal is to “make things simple” by offering Ozempic as either a pen or a pill.

Rybelsus to Ozempic Conversion Chart

Switching From Rybelsus to Ozempic Tablets

Current Rybelsus dose Corresponding Ozempic tablet dose When to start
3 mg once daily Do not switch during the initiation phase Not applicable
7 mg once daily 4 mg once daily The day after the last Rybelsus dose
14 mg once daily 9 mg once daily The day after the last Rybelsus dose

Rybelsus and Ozempic tablets cannot be substituted on a milligram-for-milligram basis. The difference in tablet strengths reflects the increased bioavailability of the newer formulation. For example, 7 mg of Rybelsus and 4 mg of Ozempic tablets can produce comparable semaglutide exposure. Likewise, 14 mg of Rybelsus corresponds to 9 mg of Ozempic tablets.

Switching From Rybelsus to Ozempic Injection

Current Rybelsus dose Corresponding Ozempic injection dose When to start
Rybelsus 14 mg once daily Ozempic 0.5 mg subcutaneous injection once weekly The day after the last Rybelsus dose
Important This chart comes from an older FDA label. The current Ozempic injection prescribing information does not provide a Rybelsus-to-Ozempic injection conversion. Confirm the dose and timing with a prescriber.

Is Rybelsus the same as Ozempic?

Both Rybelsus and Ozempic contain semaglutide as their active ingredient. Semaglutide activates glucagon-like peptide-1, or GLP-1, receptors. This helps lower blood sugar by increasing insulin release when glucose is elevated, reducing glucagon secretion, and slowing stomach emptying. They’re also both approved and prescribed to treat type 2 diabetes.

But the products differ in their formulations, strengths, and dose schedules.

Feature Rybelsus Ozempic tablets Ozempic injection
Active ingredient Semaglutide Semaglutide Semaglutide
Drug class GLP-1 receptor agonist GLP-1 receptor agonist GLP-1 receptor agonist
Form Tablet Tablet Subcutaneous injection
Frequency Once daily Once daily Once weekly
Starting dose 3 mg 1.5 mg 0.25 mg
Maintenance dose 7 mg or 14 mg 4 mg or 9 mg 0.5 mg, 1 mg, or 2 mg
Food requirements Empty stomach Empty stomach With or without food

Does Ozempic come in pill form now?

Yes. Ozempic tablets are now available in the United States for adults with type 2 diabetes.

The oral version of Ozempic comes in 1.5 mg, 4 mg, and 9 mg strengths. The 1.5 mg dose is used during the first 30 days and is not considered effective for blood sugar control. The usual maintenance dose is 4 mg daily. The dose may be increased to 9 mg daily when additional blood sugar control is needed.

Note that you’ll need a new prescription for this. A pharmacy cannot automatically replace Rybelsus with Ozempic tablets because the products have different brand names, strengths, formulations, and National Drug Code numbers.

Your prescriber must issue a prescription for the correct Ozempic tablet strength. The prescription also gives the pharmacy a chance to check insurance coverage and confirm that the old and new prescriptions will not be filled at the same time.

How to take Ozempic tablets correctly

The instructions for Ozempic tablets are the same as the instructions for Rybelsus pills.

    • Take one tablet in the morning on an empty stomach. Use plain water and limit the amount to no more than 4 ounces, or about 120 milliliters.
    • Swallow the tablet whole. Do not crush, split, chew, or dissolve it.
    • Wait at least 30 minutes before:
        • eating food
        • drinking anything other than water
        • taking another oral medicine

These instructions affect how much semaglutide the body absorbs. Taking the tablet with food, coffee, juice, or too much water may reduce absorption and make the response less predictable.

If you miss a dose, skip the missed tablet. Take your next dose the following morning at the regular time. Do not take two tablets on the same day. Do not take an extra dose to replace the one you missed.

What to expect after switching from Rybelsus to Ozempic

Because Rybelsus and Ozempic tablets contain the same active ingredient and have comparable exposure at their corresponding doses, many patients may not notice a large change after switching.

The tablet may look different, and the dose printed on it will be lower. The daily routine remains the same.

The same side effects

The most common side effects of semaglutide tablets include:

    • nausea
    • abdominal pain
    • diarrhea
    • reduced appetite
    • vomiting
    • constipation

These effects are often more noticeable when treatment begins or the dose increases. Eating smaller meals, stopping when full, and drinking enough fluids may help. Contact your clinician if symptoms are severe, persistent, or make it difficult to stay hydrated.

Risk of low blood sugar

Semaglutide alone has a relatively low risk of causing hypoglycemia. The risk increases when it is combined with insulin or a sulfonylurea such as glipizide, glimepiride, or glyburide. A clinician may need to adjust these other medications during the transition.

Your clinician may still recommend monitoring:

    • fasting blood sugar
    • blood sugar after meals
    • A1C
    • appetite or weight changes
    • symptoms of low blood sugar
    • vision changes

Symptoms of low blood sugar can include sweating, shakiness, hunger, dizziness, weakness, confusion, blurred vision, or a fast heartbeat.

When to get medical help

Get medical advice if you develop:

    • Severe or persistent abdominal pain, especially if it spreads to the back
    • Repeated vomiting or signs of dehydration
    • Sudden or worsening vision changes
    • Swelling of the face, lips, tongue, or throat
    • Difficulty breathing or swallowing
    • Severe rash or itching
    • Upper abdominal pain with fever or yellowing of the skin or eyes
    • A neck lump, persistent hoarseness, trouble swallowing, or shortness of breath

Tell your surgical and anesthesia teams that you take semaglutide before any planned procedure. GLP-1 medications delay stomach emptying, which may increase the risk of stomach contents entering the lungs during anesthesia or deep sedation.

Frequently Asked Questions

Is Rybelsus as effective as Ozempic?

Corresponding doses of Rybelsus and Ozempic tablets are designed to provide comparable semaglutide exposure. But Ozempic injections produce more blood sugar control and weight loss because injectable semaglutide is absorbed better by the body.

Ozempic injections generally produce more weight loss than Rybelsus 14 mg, particularly at the 1 mg and 2 mg weekly doses. A recent meta-analysis of trials involving people with type 2 diabetes found average reductions of 2.88 kg (6.3 lb) with oral semaglutide and 5.07 kg (11.2 lb) with injectable semaglutide. That’s an average difference of 2.19 kg or 4.8 lb, favoring Ozempic injections.

Rybelsus and the Wegovy tablet contain semaglutide, but they have different approved uses and dosing schedules. Rybelsus is approved for type 2 diabetes, while Wegovy tablets are approved for long-term weight management. The Wegovy tablet also has a maintenance dose of 25 mg, while Rybelsus only has 14 mg as the highest dose.

The FDA approved Rybelsus on September 20, 2019. It was the first oral GLP-1 receptor agonist approved in the United States for adults with type 2 diabetes.

As of this writing, there is no FDA-approved generic for Rybelsus. However, generic semaglutide is now available in Canada as an injectable format.

Rybelsus and Ozempic have similar list prices. Both drugs have baseline list prices around $1,000 per month.

The bottom line

After the 30-day initiation period, patients taking Rybelsus 7 mg can switch to Ozempic 4 mg tablets, while those taking Rybelsus 14 mg can switch to Ozempic 9 mg tablets. Take the first Ozempic tablet the day after your final Rybelsus dose. You will need a new prescription for Ozempic tablet.

Switching to the weekly Ozempic injection requires an individualized plan because there is no official direct conversion from oral Rybelsus doses to injection doses. Ask your prescriber to confirm the dose, timing, monitoring plan, and any changes needed for your other diabetes medicines.

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