What is the right Rybelsus dose for you?

Managing diabetes is a lot — monitoring blood glucose, watching everything you eat, prioritizing as many healthy habits as you can. When it comes to taking a new medication like Rybelsus, understanding the full treatment picture goes a long way towards minimizing your stress. The oral version of the GLP-1 semaglutide, Rybelsus has six different doses available, but that doesn’t mean you’re necessarily going to try each one. Read on for all the details about Rybelsus dosage.

What strengths does Rybelsus come in?

In the United States, Rybelsus currently comes in three different strengths. But there is a newer version not yet approved in the United States known as R2 (the original is referred to as R1). The R2 version of Rybelsus has the same active ingredient as the R1 version — semaglutide — but different inactive ingredients that enable someone to get the same glucose control with lower doses.

Rybelsus formulation R1

With formulation R1, you will typically start your Rybelsus dosage with 3 mg once daily. After 30 days, that dose will increase to 7 mg. If you're responding well in terms of blood sugar control, you may stay at that dose indefinitely. If not, your provider may recommend increasing to 14 mg once daily, as long as you've taken the 7 mg dose for at least 30 days.

Rybelsus formulation R2

With formulation R2, the newer version not yet approved in the United States, a patient will follow a similar pattern. They’ll start with 1.5 mg once daily. After 30 days, that dose will increase to 4 mg. If their blood sugar is under control, they may stay at that dose. If not, they may go up to 9 mg once daily, as long as they’ve taken the 4 mg dose for at least 30 days.

Switching between Rybelsus formulations

Although both formulations contain the same active ingredient of semaglutide, they can't be used interchangeably, says Dr. Sue Decotiis, M.D., a triple board-certified physician in internal medicine, antiaging medicine, and obesity medicine, who leads a weight-loss practice in Scarsdale, NY. For example, you can't take two tablets of R2 1.5 mg to equal a single 3 mg tablet of R1. This is because the two formulations have different ingredients, and R2 maintains more semaglutide through the digestive process even though it has a lower dose.

Typical Rybelsus dosing schedule

Whether you’re on the R1 or R2 formulation, you would start with the lowest Rybelsus dosage — 3 mg on R1 or 1.5 mg on R2. This dose has limited impact on blood sugar. Instead, it’s a starting dose to help your body get used to the medication, says Decotiis. "You'll begin on the lowest dosage for 30 days before moving up. If your blood sugar doesn't seem to be well controlled after 30 days on that second dosage, your health provider may suggest increasing to the highest Rybelsus dosage."

Rybelsus dosage chart

Here's an example of a Rybelsus prescription dosing schedule for someone who is able to tolerate the medication enough to go to the maximum dosage.

Rybelsus dosing schedule for R1 formulation

Days 1-30: 3 mg

Days 31-60: 7 mg

Days 61+: 14 mg

Rybelsus dosing schedule for R2 formulation (not available in the U.S.)

Days 1-30: 1.5 mg

Days 31-60: 4 mg

Days 61+: 9 mg

Rybelsus form

While the two other semaglutide medications — Ozempic and Wegovy — come as an injection, Rybelsus is an oral medication taken as a tablet. That may be appealing for those who don't like the idea of weekly injections, but you do end up taking higher levels of semaglutide than you would with an injection, according to Dr. Paunel Vukasinov, M.D., a double board-certified physician in internal medicine and obesity medicine, who practices at Medical Offices of Manhattan in New York. "This is due to differences in how the body absorbs semaglutide orally," he says. Unlike an injection, the pill has to go through the digestive process before it can enter the bloodstream, which can degrade the active ingredient.

How to take Rybelsus

Rybelsus should be taken with four ounces or less of plain water at least 30 minutes before your first food, beverage, or other oral medications of the day. Then, after 30 minutes, you should eat a normal breakfast.

It sounds super specific, but there are good reasons for it. If you wait less than that amount of time to eat, or you have Rybelsus with food or another type of beverage — such as your first cup of coffee, for example — it may lessen the effect of the medication. If you take Rybelsus and then wait more than 30 minutes before eating or drinking something, it might speed up the absorption rate, which means it could create a higher risk of side effects.

What happens if you miss a dose of Rybelsus?

If you miss a dose of Rybelsus — for example, you realize in the evening that you forgot to take a Rybelsus dose that morning — you should skip that day, says Decotiis. That's because you'll be taking a dose the next morning and having two doses close to each other may increase the likelihood of side effects. "It's better to wait until the next day and get back on track," she says.

What to do if you overdose on Rybelsus?

It’s incredibly unlikely that you’d overdose on Rybelsus given the fact that most people take it once a day, first thing in the morning, says Decotiis. But if you’re running on autopilot, forget that you already had your pill, and end up taking two pills, you should watch for side effects and contact your doctor’s office if you notice any significant changes that might constitute an emergency, including severe nausea, abdominal pain, vomiting, and fainting.

How to save on Rybelsus

Rybelsus’s out-of-pocket price is about $1,080 for a 30-day supply, and how much of that is covered by insurance will depend on your plan. However, many insurance companies cover medications for type 2 diabetes, like Rybelsus.

If you have to cover some or all of the cost, you may be able to use a savings card from the manufacturer. Those who are eligible might pay as little as $10 each month. To qualify, you must be commercially insured with prescription coverage.

The bottom line

Taken as a daily oral pill, Rybelsus can be effective for managing type 2 diabetes. There are two formulations, R1 and R2, and each one comes in three different doses. R1 has higher doses — 3 mg, 7 mg, and 14 mg — while R2, which is not yet approved by the FDA in the U.S., comes in lower doses — 1.5 mg, 4 mg, and 9 mg. R2 has different inactive ingredients which allow you to have the same glucose control with lower levels of semaglutide. Whichever you’re prescribed, you’ll begin on the lowest dose as a way to get your body used to the medication, then move to the middle dose and ultimately, if necessary, up to the highest dose. As with any medication, it's essential to talk with your healthcare provider about your goals for diabetes control to see if Rybelsus might be a good fit and which dose you should take.