Can You Take Rybelsus At Night? All You Need to Know

Key Takeaways

• Take Rybelsus as directed. Take it on an empty stomach in the morning and wait 30 minutes before eating, drinking, or taking medications.
• Food, water amount, and fasting duration affect absorption; eating too soon or drinking too much significantly reduces its effectiveness.
• If morning dosing is impossible, consult your healthcare provider about alternative schedules or medications.

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Rybelsus (semaglutide) is an FDA-approved oral prescription medication used alongside diet and exercise to improve blood glucose (sugar) levels in adults with type 2 diabetes.¹

Rybelsus should be taken on an empty stomach in the morning to maximize its effectiveness. However, alternative dosing is available when needed, although not as effective.¹

This article covers Rybelsus, its uses, how it works, its pros and cons when taken at night, its side effects, and who should or shouldn’t use it. 

What is Rybelsus Used For, and How Does it Work?

Rybelsus is the oral tablet form of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RAs).¹ 

GLP-1 RAs help lower hemoglobin A1c levels (a marker for long-term blood sugar control) and body weight. Semaglutide is the only GLP-1 RA available in both oral and injectable forms, such as Ozempic and Wegovy.²

The main active ingredient for Rybelsus is semaglutide, which mimics the GLP-1 hormone that suppresses appetite and intake in the following ways:

1. It helps your pancreas make more insulin in response to elevated blood sugar levels. Insulin helps your body use carbohydrates effectively. 
2. It prevents your liver from making and releasing too much sugar into your blood.
3. It slows down food leaving your stomach, so you stay full longer and have lower blood sugar levels after meals.^1,2 

Rybelsus has been shown to lower hemoglobin A1c by at least 1% after six months for most adults. It may also help you lose weight; most people in the same 6-month study lost about eight pounds. Rybelsus has not been found to increase the risk of major heart events such as heart attack, stroke, or death.^1,2 

Taking Rybelsus at Night: Pros and Cons

Rybelsus best lowers blood sugar when taken on an empty (or fasted) stomach when you first wake up. It should be taken with a sip of plain water (no more than four ounces) and followed by a 30-minute wait before eating, drinking, or taking any other medications or vitamins.^1.3

Some individuals may wonder if they can use an alternative dosing schedule. Here are some pros and cons of taking Rybelsus at night. 

Pros

• Potentially Fewer Side Effects: Rybelsus can cause side effects, including nausea, stomach pain, diarrhea, decreased appetite, and vomiting, especially right after starting the medication. Some people want to avoid these side effects during the day, opting for an evening dose. However, the reduced side effects may be due to less medication absorption.^1,3 
• Convenience: Some people struggle with a consistent morning routine, take other medications that require an empty stomach, or are too busy in the morning, leading to forgetting to take their Rybelsus. For it to work best, Rybelsus should be taken daily at the same time.^1,3 
• Work Routines: Night shift workers who eat most of their meals at night could benefit from an evening dose after sleeping and fasting during the day. This would mimic the fasted routine for a person starting their day in the morning.

Cons

• Reduces Absorption and Effectiveness: The main reason to avoid taking Rybelsus at night is its reduced absorption and effectiveness in lowering blood sugar. A 2023 study involving 150 healthy adults randomized to five different dosing schedules found that taking Rybelsus with a fasting period of 2 to 6 hours before taking the medication reduced semaglutide levels by more than 50% compared to the recommended dosing instructions.³
• Side Effects Disrupting Sleep:  Taking Rybelsus at night doesn’t guarantee you will sleep through any side effects. The side effects may disrupt your sleep, leaving you tired and uncomfortable. Managing gastrointestinal side effects may be easier when you are upright and awake. 
• Meal Timing: Food in the stomach reduces the absorption of Rybelsus. The study above showed that absorption decreased dramatically even with a 2- to 6-hour fasting period. You likely need to eat an evening meal and may not have enough fasting time to see the benefits of this medication. 

Work with your healthcare provider and pharmacist to determine the optimal dosing schedule for Rybelsus, other medications, and your lifestyle. 

They can also recommend other forms of semaglutide, like the injectable form, Ozempic, if scheduling Rybelsus is incompatible with your lifestyle. They may also recommend different oral diabetes medications, like Metformin.

What is the Best Time to Take Rybelsus?

A randomized study further illustrates that Rybelsus is best absorbed and most effective at lowering blood sugar levels after an overnight fast, first thing in the morning, with minimal water, and then waiting at least 30 minutes before drinking, eating, or taking other medications or vitamins.^1,3 

Other studies have shown even better results and increased semaglutide absorption when waiting longer than 30 minutes after taking Rybelsus in the morning.⁴ 

It's best to take Rybelsus at the same time each day as directed and store the medication in its original bottle with the blue cap on. The blue cap is made to protect the tablets from any excess moisture.^1,3,4  

Rybelsus Side Effects 

Most GLP-RAs have digestive-related side effects since the medication slows digestion. They tend to resolve after your body adjusts to the medication and dosage.^1-4 

Here are the most common side effects:

• Nausea
• Stomach pain
• Diarrhea
• Decreased appetite
• Vomiting
• Constipation

Other serious side effects include:

• Possibly thyroid tumors, including medullary thyroid cancer. If a family history of MTC is noted, Rybelsus should never be used
• Acute pancreatitis (swelling of the pancreas)
• Diabetic retinopathy complications (damage to the blood vessels of the eyes)
• Acute kidney injury or failure
• Acute gallbladder disease (swelling of the gallbladder)
• Hypersensitivity or allergic reactions
• Low blood sugar (hypoglycemia) with the use of insulin or sulfonylureas
• Severe gastrointestinal adverse reactions
• Food or liquids getting into the lungs during general anesthesia or deep sedation

Rybelsus and Food Interactions

Taking Rybelsus as directed, on an empty stomach after fasting overnight, ensures the medication works properly.^1,3,4While there are no specific food interactions with Rybelsus, all foods and even too much water can impact its absorption and effectiveness.^3,4 Having food in the stomach before taking Rybelsus or eating food within thirty minutes after taking it drastically limits its absorption, making it less effective. 

A 2021 study of 78 healthy adults found that eating within 30 minutes before taking Rybelsus resulted in limited or no measurable semaglutide levels.⁴ Furthermore, drinking 240ml of water (one cup) with Rybelsus reduced semaglutide levels by 40% compared to drinking 120mL (half a cup), indicating that the water amount also affects absorption and effectiveness.⁴

Who Should Avoid Rybelsus?

Individuals with certain health conditions should not take Rybelsus. The prescribing information available on its website informs that you should avoid Rybelsus with the following:⁵

• Possibly thyroid tumors, including medullary thyroid cancer. If a family history of MTC is noted, Rybelsus should never be used.
• Type 1 diabetes
• Past severe allergic reaction to semaglutide

Work with your healthcare provider to see if Rybelsus is safe for you with the following:

• If you have or have a history of pancreas or kidney problems
• History of vision problems related to diabetes
• Have a surgery or procedure planned that will use anesthesia or sedation
• Planning to be pregnant or pregnant. It is unknown how Rybelsus affects an unborn baby, and it is recommended to stop taking it 2 months before you plan to be pregnant.
• Breastfeeding or planning to breastfeed. Breastfeeding is not recommended during Rybelsus treatment.

You should also consider whether you can follow the prescribed dosing schedule for Rybelsus. If you cannot take Rybelsus on an empty stomach first thing in the morning and wait 30 minutes before eating, drinking, or taking other medications or vitamins, consider different semaglutide medications. 

The Bottom Line

To maximize Rybesus’s effectiveness, take it on an empty stomach in the morning with a sip of water and wait at least 30 minutes before eating, drinking, or taking other medications or vitamins. 

Taking Rybelsus at night, with food, with a cup of water, or fasting for less than 6 hours can significantly reduce its absorption, resulting in less effective blood sugar level reductions. 

Understanding how a medication works, how it impacts your lifestyle, and possible side effects can help you make an informed decision about whether Rybelsus is a good fit for you. If the recommended dosing schedule doesn’t fit your needs, consult your healthcare provider about alternative options, such as injectable semaglutide. 

Learn More About How to Improve Blood Sugar Health With Signos’ Expert Advice

Choosing the right medication is pivotal for managing diabetes, improving your health, and supporting healthy weight loss. The effectiveness of medications like Rybelsus depends on your ability to take it as prescribed in the morning after fasting all night while sleeping to lower blood sugar levels. 

Tracking your blood sugar response alongside medications like Rybelsus can help you balance your meals, lose weight, and improve your overall health. 

A Signos’ CGM can help you improve your health and prevent type 2 diabetes and related health conditions. A healthcare professional can help you choose the proper medication to help manage your health conditions, blood sugar levels, and weight. 

Learn more about nutrition and healthy habits on Signos’ blog. Take a quick quiz to determine if Signos fits your needs.