The first FDA-approved oral GLP-1: A new treatment for type 2 diabetes?

Semaglutide (Rybelsus) has been approved by the US FDA as the first glucagon-like peptide (GLP-1) receptor protein treatment for adults with type 2 diabetes, along with diet and exercise. However, it is not recommended as the first choice of drug for treating diabetes. Also, it is not meant for use in patients with type 1 diabetes and people with diabetic ketoacidosis.

Administration: To be taken at least 30 minutes before the first food, beverage or other oral medication of the day, with no more than 4 ounces of plain water.

Side effects: Nausea, diarrhea, vomiting, decreased appetite, indigestion and constipation.


  • Patients who have ever had medullary thyroid carcinoma (MTC) or who have a family member who has ever had MTC
  • Patients who have ever had an endocrine system condition called multiple endocrine neoplasia syndrome type 2 (MEN 2)

Warnings and precautions

  • Potentially increased risk of thyroid c-cell tumors.
  • Pancreatitis, diabetic retinopathy, hypoglycemia, acute kidney injury and hypersensitivity reactions
  • It slows digestion, so patients should discuss other medications they are taking with their health care provider before starting treatment.
  • Risk of hypoglycemia when used in combination with sulfonylureas or insulin.

(Source: US FDA)

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