What each document records
All three documents rest on the same tablet trials in adults with type 2 diabetes. The US label, which also covers the newer Ozempic® tablets, lists dizziness only among reports received after approval [1]. The Canadian monograph is the only one that shows trial percentages with placebo, because its table includes reactions down to 1% [3].
| Document | Entry | Comparison |
|---|---|---|
| Canadian Product Monograph, Table 3 [3] | Dizziness: 7 mg 1.1%, 14 mg 2.8% | Placebo 2.2% |
| Canadian Product Monograph, Table 3 [3] | Vertigo: 7 mg 1.4%, 14 mg 1.4% | Placebo 0% |
| EU summary of product characteristics, sections 4.7 and 4.8 [2] | Dizziness common, mainly during dose escalation | 1 in 100 to 1 in 10 |
| US Prescribing Information, section 6.2 [1] | Postmarketing report | No rate |
A mixed picture from the trials
The numbers do not line up neatly. On 7 mg, fewer people reported dizziness than on placebo; on 14 mg, slightly more did [3]. Vertigo, the feeling that you or the room are spinning, is counted separately and appeared on both strengths but not on placebo [3]. With only 356 people per group, a difference of one or two percentage points rests on a handful of people.
What the documents agree on is timing. The European summary says dizziness can be experienced mainly during dose escalation [2], and the Canadian monograph says it can happen initially as the dose is raised and that stomach side effects may be reported together with it [3]. The Canadian patient leaflet adds that you may feel dizzy especially when your dose is being increased [3].
What reporting studies add
Two 2024 analyses of the US FDA reporting system looked at semaglutide tablets. One found a strong signal for positional vertigo, a spinning sensation brought on by moving the head, although it rested on only three reports, and the authors noted it is not described in the product information [4]. The other compared routes and found positional dizziness among the events more prominent with oral than with injected semaglutide [5]. Reports like these flag possible patterns; they cannot give a rate or show cause.
A 2025 study of health records from more than 400,000 people prescribed semaglutide, whose abstract does not separate tablets from injections, found more new diagnoses of inner-ear balance disorders than in matched people not taking it: 0.41% versus 0.16% after three years [6]. It was observational, so other differences between the groups may explain part of the gap.
Label links that can cause dizziness
- Low blood sugar: with insulin or a sulfonylurea, Rybelsus® raises the risk of hypoglycaemia, and the Medication Guide lists dizziness or light-headedness, shakiness, sweating and confusion among the signs [1]. The European leaflet asks you not to drive if you notice signs of low blood sugar [2].
- Fluid loss: vomiting and diarrhoea can dehydrate you, and section 5.5 links this to kidney injury [1]. MedlinePlus explains that dehydration from vomiting, diarrhoea or fever can make you lightheaded because the brain is not getting enough blood [7].
- Allergic reaction: fainting or feeling dizzy is one of the Medication Guide’s signs of a serious allergic reaction, together with swelling of the face or throat and trouble breathing [1].
Common causes with no link to the tablet
MedlinePlus separates lightheadedness, the feeling you might faint, from vertigo, a spinning sensation, and lists many everyday causes [7]:
- Getting up too quickly after sitting or lying down, more common in older people.
- Medicines that lower blood pressure, a cold, flu or allergies.
- Benign positional vertigo, brought on by moving the head, and inner-ear infections after a cold.
- Less often, heart rhythm problems, stroke or internal bleeding, which usually come with other symptoms such as chest pain or a change in speech or vision.
What general sources suggest
For lightheadedness on standing, MedlinePlus suggests avoiding sudden changes in posture, getting up slowly, sitting for a few moments before standing and having something to hold on to [7]. Cleveland Clinic adds drinking enough, limiting alcohol, avoiding heavy meals and squeezing your hand muscles before you stand [8]. During a vertigo spell, MedlinePlus advises keeping still, avoiding sudden movements, and not driving or climbing until a week after symptoms stop [7].
On driving specifically, Europe says to drive or use machines cautiously if dizziness occurs, while Canada says to avoid driving if you feel dizzy [2][3].
The tablet routine and its dose steps
In the US, Rybelsus® starts at 3 mg for 30 days, a step the label says is meant to reduce stomach side effects rather than lower blood sugar, then moves to 7 mg and possibly 14 mg after day 60 [1]. Because both Europe and Canada link dizziness to these increases, the days after a step up are worth watching more closely.
Each tablet is taken on an empty stomach in the morning with a small sip of water, with a 30-minute wait before eating or drinking [1]. If you also take medicines that can lower blood sugar, ask your prescriber how to handle that morning gap.
Rybelsus® and Ozempic® are registered trademarks of Novo Nordisk A/S. PepLabo is not affiliated with or endorsed by Novo Nordisk.
When to get help
The signs and contact information below come from this article’s sourced guidance.
Emergency
- Dizziness with chest pain, an irregular heartbeat, shortness of breath or weakness
Contact: Emergency services
MedlinePlus [7]
- Dizziness with a change in vision or speech, inability to move an arm or leg, a seizure or fainting
Contact: Emergency services
MedlinePlus [7]
- Dizziness with trouble keeping fluids down
Contact: Emergency services or an emergency room
MedlinePlus [7]
- Feeling faint with swelling of the face, lips or throat, or trouble breathing
Contact: Emergency services; stop the tablets
Rybelsus® Medication Guide [1]