Rybelsus Administration and Titration Guidelines

Administration and Dosing

Rybelsus must be taken on an empty stomach with no more than 4 ounces (120 mL) of plain water, at least 30 minutes before the first food, beverage, or other oral medications of the day, as recommended by the American Diabetes Association 1, 2

If a dose is missed, skip that dose and resume the next day at the regular time, and for patients who have missed 3 or more consecutive doses, consider restarting the titration schedule, according to the American Gastroenterological Association 3
For patients planning to fast during Ramadan, titrate to at least 7 mg approximately 2-3 weeks before Ramadan to ensure therapeutic efficacy and tolerance, as suggested by the European Association for the Study of Diabetes 1

No dose adjustment is required for patients with renal impairment, including those with severe renal impairment, as stated by the Endocrine Society and the American College of Physicians 4, 2

Gastrointestinal effects are most common, including nausea, vomiting, diarrhea, abdominal pain, and constipation, and most GI side effects are mild to moderate and transient, typically resolving with continued treatment, according to the American Gastroenterological Association and the World Health Organization 3, 5

Evaluate glycemic response after reaching each dose level, and some patients may achieve adequate glycemic control at submaximal doses (7 mg) and can continue at that dose long-term, as recommended by the American Diabetes Association 3
If a patient has not lost at least 4% of body weight after 16 weeks of treatment (when used for weight management), consider discontinuation, according to the Obesity Society 5

Personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) is a contraindication, and history of pancreatitis requires cautious use, as stated by the American Thyroid Association and the European Association for the Study of Diabetes 5
Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors, and monitor for hypoglycemia when used with insulin or insulin secretagogues (sulfonylureas), according to the American College of Clinical Endocrinologists and the International Society of Nephrology 6, 3