GLP1 weight loss without a needle: Rybelsus

GLP1 weight loss without a needle: Rybelsus
Photo by Markus Spiske / Unsplash

There are lots of popular GLP1 Receptor Agonist (GLP1 RA) drugs and most of them are injections under the skin ("subcutaneous injections"). Here's a short list of the most popular ones that do require injections:

But we're not here to talk about those – we're here to talk about Rybelsus (also created by Novo Nordisk, the firm behind Ozempic), which doesn't require an injection.

Rybelsus main website (source:

Rybelsus is a "semaglutide tablet" which is taken orally and performs the similar functions (particularly with respect to type 2 diabetes) as the other medications above. As is clear, the main focus of Rybelsus is getting A1C blood sugar down.

How does it work in pill form?

Rybelsus is effectively the same treatment as Ozempic, but in a pill, rather than an injection, with the same active ingredient – Semaglutide.

The big difference is that the dosage of Semaglutide in Rybelsus is much lower than that of Ozempic. Thanks to's analysis:

To assess the potency of each drug, we can compare their results in studies that tested similar populations. According to the FDA (PDF), the maximum 14mg daily dose of Rybelsus is equivalent to the 0.5mg weekly dose of Ozempic — one can be switched for the other without the need for titration or adjustment.

Rybelsus has a higher Semaglutide dosage on paper, but only a small amount of it actually absorbed into the body.

Is Rybelsus as effective as Ozempic, Mounjaro, Wegovy and other injected GLP1 RA drugs?

We can compare the results of two studies:

In these studies, Rybelsus performs similarly to Ozempic at the 0.5mg dose – patients lost around 1.3% of their A1C (blood sugar), and lost close to 10 pounds over a year.

The big difference here is that Ozempic is available at even higher doses (and these are delivered directly, given that an injection is required). Higher doses of Semaglutide translates to higher A1C reduction and higher weight loss over time.

So why doesn't Rybelsus have a higher dose? Well NovoNordisk has announced that it's attempting to get approval for 25mg and 50mg doses of Rybelsus.

Are there any new side effects?

The Rybelsus website only shows some of the very serious side effects that can occur with Rybelsus (and are also common to other GLP1 RA drugs):

  • Inflammation of your pancreas (pancreatitis)
  • Changes in vision
  • Low blood sugar (hypoglycemia)
  • Kidney problems (kidney failure)
  • Serious allergic reactions
  • Gallbladder problems

They also list the more common side effects that are slightly less serious:

  • Nausea (more common at the start)
  • Stomach (abdominal) pain
  • Diarrhea (more common at the start)
  • Increased Appetite
  • Vomiting (more common at the start)
  • Constipation

While these symptoms aren't new to the GLP1 RA class of drugs, they're certainly worth carefully considering – and considering stopping immediately if you encounter them.

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