Three products, two labels
- Ozempic® injection: weekly, under the skin. Its own label [2].
- Rybelsus® tablets: daily, by mouth [1].
- Ozempic® tablets: daily, by mouth, a newer formulation with different strengths, on the same label as Rybelsus® [1].
What the tablet label says about switching
The tablet label says Rybelsus® and Ozempic® tablets are not substitutable milligram for milligram and should not be switched between during the first 30 days (section 2.3). Section 2.4 covers moving from Ozempic® injection to tablets, starting one week after the last injection [1]. The injection label has no section on moving the other way [2]. Any change, and the tablet strength that follows it, is set by the prescriber.
Why the tablet milligrams are higher
The tablet label reports that only about 0.4% to 1% of a Rybelsus® dose reaches the bloodstream (1% to 2% for Ozempic® tablets) [1]. That is why tablet strengths cannot be read against injection strengths.
Side by side, from the labels
| Label item | Rybelsus® (tablet) | Ozempic® (injection) |
|---|---|---|
| Active ingredient | Semaglutide, a GLP-1 receptor agonist, by mouth | Semaglutide, a GLP-1 receptor agonist |
| Maker | Novo Nordisk | Novo Nordisk |
| FDA-approved uses | Adults with type 2 diabetes: blood sugar control alongside diet and exercise, and lowering the risk of major cardiovascular events in those at high risk. [1] | Adults with type 2 diabetes: blood sugar control alongside diet and exercise; lowering the risk of major cardiovascular events in those with established cardiovascular disease; lowering the risk of kidney decline, kidney failure and cardiovascular death in those with chronic kidney disease. [2] |
| How it is taken | Once a day by mouth, in the morning on an empty stomach with up to 4 oz (about 120 mL) of plain water, swallowed whole; at least 30 minutes before food, drinks or other oral medicines. | Once a week, under the skin of the abdomen, thigh or upper arm, on the same day each week. |
| Forms in the US | Tablets in three strengths (section 3). In the US the same label covers Ozempic® tablets, a newer formulation; the label says the two are not substitutable milligram for milligram. | Multi-dose pens and single-dose prefilled syringes, in several strengths (section 3). |
| Dose steps | Section 2.2 of the label: a starting dose for the first 30 days that does not control blood sugar, then higher steps. Not repeated here; your prescriber sets your steps. [1] | Section 2.2 of the label: a low starting dose, raised in steps. Not repeated here; your prescriber sets your steps. [2] |
| Half-life (section 12.3) | About 1 week [1] | About 1 week [2] |
| Most common side effects (label) | Nausea, abdominal pain, diarrhea, decreased appetite, vomiting, constipation. | Nausea, vomiting, diarrhea, abdominal pain, constipation. |
| Storage (label) | Room temperature (20–25 °C), in the original bottle until use, to protect from moisture. | Refrigerated (2–8 °C) before first use. After first use a pen can be kept for up to 56 days at 15–30 °C or in the fridge. Not to be frozen. |
| Boxed warning | Yes: risk of thyroid C-cell tumors. | Yes: risk of thyroid C-cell tumors. |
| In the EU (EMA) | Authorised since 2020. In the EU the newer tablets keep the Rybelsus® name; EMA issued a medication-error notice about the change. [3] | Authorised since 2018 for adults with type 2 diabetes that is not controlled well enough. [5] |
Timing facts from the labels
| Label item | Rybelsus® (tablet) | Ozempic® (injection) |
|---|---|---|
| Half-life (section 12.3) | About 1 week [1] | About 1 week [2] |
| Time to peak level (section 12.3) | About 1 hour after a tablet [1] | 1 to 3 days after a dose [2] |
| Steady state (section 12.3) | After 4 to 5 weeks of daily tablets [1] | After 4 to 5 weeks of weekly doses [2] |
| After the last dose (section 12.3) | About 5 weeks in the circulation after the last tablet [1] | About 5 weeks in the circulation after the last dose [2] |
| Missed dose (section 2) | Skipped; the next tablet is taken the following day (section 2.1) [1] | Taken within 5 days of the missed dose (section 2.1) [2] |
| Section on switching | Section 2.3 (between Rybelsus® and Ozempic® tablets) and 2.4 (from Ozempic® injection to tablets) [1] | None in the injection label [2] |
Moving from tablet to injection
Neither label sets out a schedule for moving from Rybelsus® or Ozempic® tablets to Ozempic® injection [1][2]. If that change comes up, the gap and the first injected dose are set by your prescriber.
Ozempic®, Wegovy®, Rybelsus®, Saxenda®, Victoza® and FlexTouch® are registered trademarks of Novo Nordisk A/S. Mounjaro®, Zepbound® and KwikPen® are registered trademarks owned or licensed by Eli Lilly and Company; Foundayo™ is a trademark of Eli Lilly and Company. PepLabo is not affiliated with or endorsed by these companies.
