RYBELSUS 14 mg TABLETS

2. What you need to know before you take Rybelsus

Do not take Rybelsus

• if you are allergic to semaglutide or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before you start taking Rybelsus.

Traceability

In order to improve the traceability of biological medicinal products, the name and batch number of the product (indicated on the packaging and blister) should be recorded and provided to the healthcare professional when reporting any adverse reaction.

General information

This medicine is not the same as insulin and should not be used if:

• you have type 1 diabetes (your body does not make any insulin)
• you develop diabetic ketoacidosis. This is a complication of diabetes characterized by high blood sugar levels, difficulty breathing, confusion, excessive thirst, sweet-smelling breath or a sweet or metallic taste in the mouth.

If you know you are going to have surgery where you will be under anesthesia (put to sleep), tell your doctor that you are taking Rybelsus.

Stomach and intestinal problems and dehydration

During treatment with this medicine, you may experience nausea, vomiting, or diarrhea. These side effects can cause dehydration (loss of fluids). It is important that you drink enough liquid to prevent dehydration. This is especially important if you have kidney problems. If you have any doubts, talk to your doctor.

Severe and persistent stomach pain which could be a sign of pancreatitis

If you have severe and persistent stomach pain, go to the doctor immediately, as it could be a sign of pancreatitis (inflammation of the pancreas).

Low blood sugar (hypoglycemia)

Taking a sulfonylurea or insulin with Rybelsus may increase the risk of experiencing low blood sugar levels (hypoglycemia). See section 4 for symptoms of low blood sugar levels.

Your doctor may ask you to measure your blood sugar levels. This will help decide if it is necessary to change the dose of sulfonylurea or insulin to reduce the risk of low blood sugar levels.

Diabetic eye disease (retinopathy)

A rapid improvement in blood sugar control may cause a temporary worsening of diabetic eye disease. If you have diabetic eye disease and experience eye problems during treatment with this medicine, talk to your doctor.

Response to treatment

If the response to treatment with semaglutide is less than expected, it may be due to low absorption due to variability in absorption and low absolute bioavailability. You should follow the instructions indicated in section 3 to achieve an optimal effect of semaglutide.

Children and adolescents

This medicine is not recommended for children and adolescents under 18 years of age, as safety and efficacy have not been established in this age group.

Other medicines and Rybelsus

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

In particular, tell your doctor, pharmacist, or nurse if you are using medicines that contain any of the following ingredients:

• levothyroxine used to treat thyroid-related diseases. This is because your doctor may need to check your thyroid hormone levels if you are taking Rybelsus with levothyroxine.
• warfarin or other similar oral medicines to reduce blood clotting (oral anticoagulants). It may be necessary to perform frequent blood tests to determine the blood clotting ability of your blood.
• If you are using insulin, your doctor will tell you how to reduce the insulin dose and recommend that you monitor your blood sugar levels more frequently in order to avoid hyperglycemia (high blood sugar) and diabetic ketoacidosis (a complication of diabetes that occurs when the body cannot break down glucose because there is not enough insulin).

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor for advice before taking this medicine.

This medicine should not be used during pregnancy because it is not known if it affects the unborn baby. Therefore, you must use contraceptive methods while taking this medicine. If you want to become pregnant, talk to your doctor about how to change your treatment, as you should stop using this medicine at least 2 months in advance. If you become pregnant while using this medicine, talk to your doctor immediately, as your treatment will need to be changed.

Do not use this medicine during breastfeeding. This medicine passes into breast milk, and it is not known how it may affect your baby.

Driving and using machines

Rybelsus is unlikely to affect your ability to drive or use machines.

Some patients may feel dizzy when taking Rybelsus. If you feel dizzy, be extra careful when driving or using machines. Talk to your doctor for more information.

If you use this medicine with a sulfonylurea or insulin, you may experience low blood sugar levels (hypoglycemia), which can reduce your ability to concentrate. Do not drive or use machines if you experience any symptoms of low blood sugar. See section 2, “Warnings and precautions”, for information on the increased risk of experiencing low blood sugar levels and section 4 for symptoms of low blood sugar levels. Talk to your doctor for more information.

Rybelsus contains sodium

This medicine contains 23 mg of sodium (a major component of cooking/table salt) in each tablet. This is equivalent to 1% of the maximum recommended daily intake of sodium for an adult.

3. How to take Rybelsus

Take this medicine exactly as your doctor has told you. If you are not sure, talk to your doctor or pharmacist.

How much to take

• The initial dose is one 3 mg tablet once a day for one month.
• After one month, your doctor will increase the dose to one 7 mg tablet once a day.
• Your doctor will tell you to keep the dose for at least one month before increasing to a higher dose.
• Your doctor may increase the dose stepwise to one 14 mg, 25 mg, or 50 mg tablet once a day if needed.
• Your doctor will prescribe the dose that is right for you. Do not change your dose unless your doctor has told you to.
• Rybelsus should always be taken as one tablet per day. Do not take two tablets to get the effect of a higher dose.

Taking this medicine

• Take the Rybelsus tablet on an empty stomach after at least 8 hours of fasting.
• Swallow the Rybelsus tablet whole with a sip of water (up to 120 ml). Do not split, crush, or chew the tablet, as it is not known if this affects the absorption of semaglutide.
• After taking the Rybelsus tablet, wait at least 30 minutes before eating, drinking, or taking other oral medicines. Waiting less than 30 minutes reduces the absorption of semaglutide.

If you take more Rybelsus than you should

If you take more Rybelsus than you should, talk to your doctor immediately. You may experience side effects such as nausea.

If you forget to take Rybelsus

If you forget a dose, skip the missed dose and take your normal dose the next day.

If you stop taking Rybelsus

Do not stop taking this medicine without talking to your doctor. If you stop, your blood sugar levels may increase.

If you have any other questions on the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Serious side effects

Common(may affect up to 1 in 10 people)

• complications of diabetic eye disease (retinopathy). Talk to your doctor if you experience eye problems, such as changes in vision during treatment with this medicine.

Rare(may affect up to 1 in 1,000 people)

• severe allergic reactions (anaphylactic reactions). You should seek immediate medical help and tell your doctor immediately if you experience symptoms such as breathing problems, swelling of the face and throat, wheezing, palpitations, pale and cold skin, dizziness, or weakness.
• inflammation of the pancreas (acute pancreatitis) that can cause severe stomach and back pain that does not go away. You should talk to a doctor immediately if you experience these symptoms.

Frequency not known(frequency cannot be estimated from the available data)

• intestinal obstruction. A severe form of constipation with other symptoms such as stomach pain, abdominal swelling, vomiting, etc.

Other side effects

Very common(may affect more than 1 in 10 people)

• low blood sugar (hypoglycemia) when this medicine is used with other medicines that contain a sulfonylurea or insulin. Your doctor may reduce the dose of these medicines before you start taking this medicine.
• nausea; this side effect usually goes away with time.
• diarrhea; this side effect usually goes away with time.

The warning signs of low blood sugar may appear suddenly. Some of these signs are: cold sweat, cold and pale skin, headache, palpitations, nausea, or excessive hunger, changes in vision, drowsiness, or feeling weak, nervousness, anxiety, or confusion, difficulty concentrating, or trembling.

Your doctor will tell you how to treat low blood sugar and what to do if you experience these warning signs.

Common(may affect up to 1 in 10 people)

• low blood sugar (hypoglycemia) when this medicine is used with oral diabetes medicines other than sulfonylurea or insulin
• decreased appetite
• feeling dizzy
• vomiting – this side effect usually goes away with time and may occur more frequently when increasing the dose to 25 mg and 50 mg
• stomach pain
• stomach swelling
• constipation
• stomach upset or indigestion
• inflamed stomach (gastritis); symptoms include stomach pain, nausea, or vomiting
• reflux or heartburn; also known as “gastroesophageal reflux disease”
• gas (flatulence)
• fatigue
• increased pancreatic enzymes (such as lipase and amylase) in blood tests
• change in skin sensitivity – this side effect usually goes away with time and may occur with the 25 mg and 50 mg doses
• headache.

Uncommon(may affect up to 1 in 100 people)

• allergic reactions such as rash, itching, or hives
• change in the taste of food and drink.
• rapid heartbeat
• belching
• a delay in emptying the stomach
• gallstones
• weight loss

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Rybelsus

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the blister and carton after EXP. The expiry date is the last day of the month stated.

Store in the original package to protect from light and moisture.

This medicine does not require any special storage temperature.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. Contents of the pack and other information

What Rybelsus contains

• The active substance is semaglutide. Each tablet contains 3, 7, 14, 25, or 50 mg of semaglutide.
• The other ingredients in the 3 mg, 7 mg, and 14 mg tablets are sodium caprylate, povidone K90, microcrystalline cellulose, and magnesium stearate. See also section 2, “Rybelsus contains sodium”.
• The other ingredients in the 25 mg and 50 mg tablets are sodium caprylate and magnesium stearate. See also section 2, “Rybelsus contains sodium”.

Appearance of Rybelsus and pack contents

The Rybelsus 3 mg tablets are white to light yellow in color and oval in shape (7.5 mm x 13.5 mm). They have a "3" on one side and the word "novo" on the other.

The Rybelsus 7 mg tablets are white to light yellow in color and oval in shape (7.5 mm x 13.5 mm). They have a "7" on one side and the word "novo" on the other.

The Rybelsus 14 mg tablets are white to light yellow in color and oval in shape (7.5 mm x 13.5 mm). They have a "14" on one side and the word "novo" on the other.

The Rybelsus 25 mg tablets are white to light yellow in color and oval in shape (6.8 mm x 12 mm). They have a "25" on one side and the word "novo" on the other.

The Rybelsus 50 mg tablets are white to light yellow in color and oval in shape (6.8 mm x 12 mm). They have a "50" on one side and the word "novo" on the other.

The 3 mg, 7 mg, 14 mg, 25 mg, and 50 mg tablets are available in aluminum/aluminum blisters, and the pack sizes available are 10, 30, 60, 90, and 100 tablets.

Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Novo Nordisk A/S

Novo Allé

DK-2880 Bagsværd

Denmark

Date of last revision of this leaflet:

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency website: https://www.ema.europa.eu/