Dr. Ahmed Can you drink alcohol while taking Rybelsus? Do Rybelsus and alcohol interact with each other? Will alcohol cause more problems when used with Rybelsus? Or, will you develop side effects of Rybelsus if you are drinking too much alcohol?
These are some of the questions that we’ll try to answer in this post. But, before answering these questions, here are some of the common health issues or side effects of alcohol use and Rybelsus.
Alcohol is one of the most commonly used drinks worldwide. It has a strong addictive potential and is also associated with significant health issues.
Rybelsus, on the other hand, is a novel oral GLP-1 analog and is used to treat diabetes. It is also associated with significant weight loss and can potentially treat alcohol addiction and alcohol use disorder.
Rybelsus has not been studied for the treatment of alcohol use disorder. However, GLP-1 analogs are considered to have a strong potential as a treatment modality for treating alcohol use disorder, as these drugs significantly reduce cravings for alcohol, other drugs of addiction, and food.
Rybelsus and Alcohol Drug Interactions:
There are no known drug interactions between Rybelsus and alcohol. Drug interactions are those pharmacokinetic or pharmacodynamic changes that may result in either an increase or decrease in the effectiveness of the drugs or the side effects of the drugs.
However, because Rybelsus slows gastric emptying, it may worsen the gastrointestinal side effects of alcohol.
People who drink alcohol may feel full, nauseated, or have severe episodes of vomiting. In addition, the risk of hyperglycemia and hypoglycemia is increased when alcohol is used in moderate to large amounts.
Both drugs increase the risk of pancreatitis, and therefor,e combining both Rybelsus and Alcohol may increase the risk of pancreatitis manyfold.
The risk of developing other side effects of alcohol and Rybelsus may also increase.
Common Side Effects of Rybelsus and Alcohol:
The most important side effects that are common to both Rybelsus and alcohol are:
- Hypoglycemia
- Gastrointestinal side effects, and
- Pancreatitis.
It is important to monitor blood glucose frequently and avoid excessive use of alcohol. Patients may develop severe GI upset, manifesting as nausea, vomiting, and abdominal pain,n which can further increase the risk of hypoglycemia.
Pancreatitis is a well-known side effect of both Rybelsus and alcohol intake. The risk may be increased many times. It is important to seek an expert opinion from your doctor if you develop upper abdominal pain that radiates sharply to the back and does not respond to the usual home remedies.
The risk of other side effects that may or may not worsen when both Rybelsus and alcohol are taken together is discussed below:
Gastrointestinal side effects:
Here is a table of the gastrointestinal side effects that are common in individuals taking both Rybelsus and Alcohol:
Gastrointestinal Side Effects | Risk | Alcohol | Rybelsus |
| Nausea | ⇑⇑⇑ | Common | Common |
| Diarrhea | ⇑ | Possible | Mild to moderate |
| Vomiting | ⇑⇑ | Common | Possible |
| Abdominal Pain | ⇑⇑ | Possible | Possible |
| Indigestion or Dyspepsia | ⇑⇑ | Possible | Possible |
Gastric upset is the most common side effect of Rybelsus, and it worsens when you take alcohol, especially in moderate to large amounts.
In an observational study, out of a total of 213 alcohol users, 12.2% were taking Rybelsus tablets for diabetes. 35.7% of all the participants (including those using Ozempic, Mounjaro, or other GLP-1 analogs) reported severe gastric symptoms.
Nausea, vomiting, and heartburn were the most common side effects reported.
Endocrine Side Effects:
Endocrine side effects include hypoglycemia and hyperglycemia, sexual dysfunction, and thyroid and adrenal impairment.
Hypoglycemia can occur in heavy drinkers, especially individuals taking antidiabetic drugs like Insulin and insulin secretagogues.
However, the risk is also increased in individuals with Semaglutide. Hypoglycemia can also occur as a result of liver cirrhosis in patients with alcoholic liver disease.
Hyperglycemia may occur if the person develops cognitive impairment and misses their diabetes medications, is non-compliant with diet, and is a heavy drinker.
Sexual dysfunction is very common in diabetics because of diabetic autonomic neuropathy. However, it is also common in alcoholics.
Although sexual dysfunction with Rybelsus has not been studied, it may improve in some individuals and worsen in others.
Thyroid and adrenal dysfunction is also common in alcohol users. Rybelsus, on the other hand, is associated with an increased incidence of medullary thyroid cancer.
Here is a table of the endocrine side effects of both Alcohol and Rybelsus:
Endocrine Side Effects | Risk | Alcohol | Rybelsus |
| Hormonal Imbalances | ⇑ | Yes | May be |
| Thyroid Dysfunction | ⇑ | Possible | Rare (risk of Thyroid C cell tumors) |
| Insulin Resistance | ⇔ | Increased | Decreased |
| Adrenal Dysfunction | ⇔ | Yes | No |
| Sex Hormone Changes | ⇑ | Yes | May be |
Neurological side effects:
Alcohol users may develop a variety of neurological side effects, including cognitive decline, Korsakoff psychosis, Neuropathy, depression, and anxiety.
Rybelsus, on the other hand, may improve some of these symptoms owing to better well-being, improvement in metabolic parameters, and self-care.
The Neurological side effects of Alcohol and Rybelsus are given in the table below:
Neurological Side Effects | Risk | Alcohol | Rybelsus |
| Depression and Anxiety | ⇔ | Yes | Increased or Decreased |
| Neuropathy | ⇑ or ⇔ | Increased | May improve |
| Cognitive Impairment | ⇔ | Increased | No effect or may reduce the risk |
| Dizziness or Fatigue | ⇔ | Yes | Rare |
| Psychosis | ⇔ | Yes | No |
The Cardiovascular side effects of alcohol and Rybelsus:
Rybelsus is one of the drugs recommended by the ADA after metformin for treating patients with uncontrolled diabetes who have ASCVD (atherosclerotic cardiovascular disease).
Alcohol consumption of more than 60 g per day in men and 40 g per day in women may increase the risk of developing heart disease [Ref]
Here are the cardiovascular side effects of Alcohol and Rybelsus when taken together:
Cardiovascular Side Effects | Risk | Alcohol | Rybelsus |
| High Blood Pressure | ⇔ | Raise Blood Pressure | No effect of reduce |
| Heart Disease | ⇔ | Increase the risk | No effect or reduce the risk |
| Arrhythmias | ⇑ | Risk is Increased | Increase heart rate |
| Stroke | ⇔ | No effect of reducing | Reduce the risk |
Rybelsus has been associated with improved cardiac health. In a clinical trial, it was associated with a reduced number of deaths due to cardiovascular causes compared to placebo medicine, however, the results were not statistically significant [Ref].
Can You Drink Alcohol While Taking Rybelsus?
Yes, you can. However, you should limit your alcohol consumption. Alcohol consumption in small quantities, occasional drinking, and social drinking in limited amounts may not cause significant side effects compared to daily drinking or heavy drinking.
Alcohol consumption is classified as mild, moderate, and heavy drinking:
Alcohol Consumption | Men | Women |
| Mild | Up to 2 standard drinks | Up to 1 standard drink |
| Moderate | Up to 3 standard drinks | Up to 2 standard drinks |
| Heavy | More than 4 standard drinks | More than 3 standard drinks |
In addition, beer contains the least amount of alcohol compared to liquor. Thus, one would expect fewer side effects with beer or other alcoholic drinks that are less concentrated.
Here is the percentage of alcohol in various alcoholic drinks:
Alcohol Drink | Alcohol Content | Amount |
| Beer | 5% | One 12-ounce (355 ml) can or bottle |
| Wine | 12% | One 5-ounce (148 ml) glass |
| Distilled Spirits/Liquor | 40% | One 1.5-ounce (44 ml) shot |
Vodka, Whiskey, Rum, Tequila, Gin, and Liqueurs (Various alcohol contents) also have 40% of alcohol content.
Alcohol and Rybelsus can be used together, but one should be prepared for more severe side effects, hangovers, fluctuations in blood glucose, and long-term cardiac, endocrine, and especially sexual side effects.
Rybelsus for Treating Alcohol Use Disorder:
Rybelsus, like Ozempic and Mounjaro, may be one of the potential drugs to treat alcohol use disorder. The results were promising when we analyzed the data taken from people who were using Rybelsus.
Most people did not have the urge or cravings anymore. Other alcohol lovers had so severe gastrointestinal side effects that they could not tolerate more than a single drink.
GI side effects were the most bothersome, including nausea, vomiting, and stomach fullness even after a single drink. Some people observed that even after getting a night’s sleep, they still felt as if their stomach was full.
This delayed gastric emptying was also one of the reasons that some people had severe hangovers in the morning.
Not because of the side effects, but because of the suppressed cravings for alcohol, could motivate researchers to see if Rybelsus can be used as a drug therapy for alcohol use disorder.
Here is a table summarizing the results of an observational study in which alcohol users reported reduced cravings, more gastrointestinal side effects, and no desire to drink any more:
The table below summarizes the results:
Why Alcohol Intake Reduced? | No. | % |
| Side effects (Gastric issues) | 34 | 19.9 |
| Both No Desire plus Side effects | 27 | 15.8 |
| No Desire to Drink Alcohol | 101 | 59.1 |
| Not drinking so as to lose more weight | 4 | 2.3 |
| Other side effects such as a hangover the next day | 8 | 4.7 |
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