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Semaglutide oral

Updated 2 Feb 2023 | GLP-1 agonists


Oral formulations of semaglutide.

Drugs List

  • RYBELSUS 14mg tablets
  • RYBELSUS 3mg tablets
  • RYBELSUS 7mg tablets
  • semaglutide 14mg tablets
  • semaglutide 3mg tablets
  • semaglutide 7mg tablets
  • Therapeutic Indications


    Type 2 diabetes (NIDDM) not controlled by diet,weight loss & exercise alone

    The treatment of adults with insufficiently controlled type 2 diabetes as an adjunct to diet and exercise.

    As monotherapy
    In patients where metformin is consider inappropriate due to contraindication or intolerance.

    Adjunctive therapy
    In addition to other treatments for diabetes.



    Initial dose: 3mg once daily for one month.

    Maintenance dose: 7mg once daily. The dose can be increased to 14mg once daily after at least one month of 7mg once daily dose.

    It is not recommended to take two 7mg tablets to achieve a dosage of 14mg once daily.

    Additional Dosage Information

    Switching between oral and subcutaneous administration
    The effect of switching between oral and subcutaneous semaglutide cannot easily be predicted because of the high pharmacokinetic variability of oral semaglutide. Exposure after oral semaglutide 14mg once daily is comparable to subcutaneous semaglutide 0.5mg once weekly. An oral dose equivalent to 1mg of subcutaneous semaglutide has not been established.


    Children under 18 years
    End stage renal disease
    New York Heart Association class IV failure

    Precautions and Warnings

    Females of childbearing potential
    Patients over 75 years
    Diabetic retinopathy
    History of pancreatitis
    Severe hepatic impairment
    Severe renal impairment

    Advise patient to avoid other oral medications for 30 mins after dose
    Record name and batch number of administered product
    Consider dose reduction of hypoglycaemic agents
    Insulin dose adjustment: Reduce insulin dose gradually and monitor for DKA
    Monitor patient for hypoglycaemia if adjunct to insulin or sulfonylurea
    Advise patient of potential risk of dehydration
    Advise patients to report symptoms of acute pancreatitis immediately
    Discontinue if pancreatitis is suspected
    Do not restart treatment following confirmation of pancreatitis
    Discontinue treatment at least 2 months before a planned pregnancy
    Female: Ensure adequate contraception during treatment
    Advise patient of importance of full compliance
    Advise patient on fluid replacement if GI side effects occur
    Patient to inform DVLA if fitness to drive impaired or hypoglycaemic risk

    Caution and close monitoring should be used in diabetic retinopathy patients treated with semaglutide and insulin, as an increased risk of developing diabetic retinopathy complications has been observed in such patients.

    Gastrointestinal adverse reactions associated with semaglutide should be considered when treating patients with impaired renal function, due to risk of dehydration and deterioration of renal function.

    Compliance with the dosing regimen is recommended for optimal effect of semaglutide. Absorption of semaglutide is highly variable, 2 to 4% of patient will not have any exposure and absolute bioavailability of semaglutide is low.

    When semaglutide is added to existing sulfonylurea or insulin therapy, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycaemia.

    Pregnancy and Lactation


    Semaglutide is contraindicated during pregnancy.

    The manufacturer recommends that semaglutide should not be used during pregnancy or in women of childbearing potential unless they are using a reliable form of contraception. Semaglutide should be discontinued at least 2 months before a planned pregnancy due to semaglutide's long half life.

    Animal studies have shown reproductive toxicity. Human data is limited and as such a potential risk cannot be ruled out.


    Semaglutide is contraindicated during breastfeeding.

    The manufacturer does not recommend breastfeeding whilst taking semaglutide.

    Animal studies have shown semaglutide to be excreted in breast milk, however presence in human breast milk is unknown. Effects on exposed infants are unknown.


    Advise patient that tablet should be swallowed whole on an empty stomach. The absorption of semaglutide is decreased if taken with food or large volumes of water.

    Advise patient to avoid other oral medication for 30 minutes after dose.

    Advise patient on the importance of full compliance.

    Advise patient on the potential risk of dehydration.

    Advise patient to report symptoms of acute pancreatitis immediately.

    Advise patient on fluid replacement if gastrointestinal side effects occur.

    Advise patient to report to DLVA if there is a risk of hypoglycaemia, or if fitness to drive may be impaired due to diabetes complications. Guidance can be found be accessing website.

    Side Effects

    Abdominal distension
    Abdominal pain
    Acute pancreatitis
    Anaphylactic reaction
    Decreased appetite
    Diabetic retinopathy complications
    Elevated amylase levels
    Elevated serum lipase
    Gastroesophageal reflux disease
    Increased heart rate
    Weight loss


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2020

    Reference Sources

    Summary of Product Characteristics: Rybelsus. Novo Nordisk Limited. Revised May 2020.

    NICE Evidence Services Available at: Last accessed: 11 September 2020

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