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The Weight Loss Effects of Rybelsus and Phentermine/ Topiramate

Rybelsus and Phentermine

thin girl measuring waist Rybelsus and Phentermine topiramate Qysmia

Rybelsus and phentermine/ Topiramate (Qsymia) are two oral medicines that have got FDA approval for two separate indications – Diabetes and Obesity.

Rybelsus is the oral formulation of Semaglutide. It has been approved by the FDA for the treatment of diabetes as monotherapy or in combination with metformin or other diabetes drugs.

Phentermine/ Topiramate (Qsymia) is an FDA-approved weight loss medicine. It has no direct effects on blood glucose.

Rybelsus (Oral Semaglutide); Uses, Dose, MOA, & Side effects

Rybelsus and Phentermine/ Topiramate together for Weight Loss:

Rybelsus is oral Semaglutide. Although it has only been approved for the treatment of diabetes, it is associated with significant weight loss as well.

Phentermine/ Topiramate available by the brand name Qsymia is only approved for the treatment of obesity.

Since both drugs are associated with significant weight loss, it is logical that combining Rybelsus and Phentermine/ Topiramate will result in rapid and sustained weight loss.

How Effective is Topamax (Topiramate) for Weight Loss

Since Rybelsus is not approved for use in non-diabetic patients, its weight loss effects have mostly been studied in obese individuals with diabetes.

When used in diabetic patients, Rybelsus resulted in clinically significant weight loss compared to placebo in doses of 7 mg and 14 mg.

Baseline Weight Weight after 26 weeks Mean Weight Loss
Placebo 88.6 87.2 -1.4 kgs
Rybelsus 7 mg 89 86.7 -2.3 kgs
Rybelsus 14 mg 88.1 84.4 -3.7 kgs

Rybelsus monotherapy compared to placebo resulted in significant weight loss after 26 weeks.

rybelsus weight loss in diabetics after 26 weeks
The weight loss effects of Rybelsus 7 mg and 14 mg vs placebo medicine

Compared to the placebo, there was a mean difference in weight loss of 2.3 kgs after 26 weeks.

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Phentermine/ Topiramate, unlike Rybelsus, is only approved for the treatment of obesity in diabetic and non-diabetic individuals.

In nondiabetic individuals, Qsymia in a dose of 15/92 mg has been associated with weight loss exceeding 5% and 10% in 67% and 47% of the individuals.

qsymia and topiramate topamax for weight loss

In individuals with diabetes or other weight-related complications, Phentermine/ Topiramate (Qsymia) has been associated with a weight loss of 70% (>5% or more weight loss) and 48% (10% or more weight loss) when administered in a dose of 15/92 mg per day.

qsymia topiramate topamax weight loss

Thus, it is logical to use Rybelsus and Phentermine/ Topiramate in obese diabetic individuals where both the drugs have been approved.

However, like metformin, Rybelsus can also be used off-label with phentermine/ topiramate for the treatment of obesity in non-diabetic individuals.

Metformin for Weight Loss: Beyond Diabetes & Insulin Resistance

Compared to metformin, Rybelsus is associated with greater weight loss. The weight loss effects of Rybelsus have been comparable to Jardiance (Empagliflozin) and Liraglutide (Victoza and Saxenda) and are superior to Januvia (Sitagliptin).

The weight loss effects of Rybelsus were compared with Sitagliptin (Januvia). Rybelsus in a dose of 7 mg and 14 mg resulted in significantly greater weight loss compared to Sitagliptin 100 mg.

Baseline Weight Weight after 26 weeks Mean weight loss
Sitagliptin 100 mg 90.9 90.3 -0.6 kgs
Rybelsus 7 mg 91.3 89.1 -2.2 kgs
Rybelsus 14 mg 91.2 88.1 -3.1 kgs

The mean weight loss in the Rybelsus groups was significantly greater compared to Sitagliptin (Januvia).

rybelsus plus metformin compared to Sitagliptin 100 mg plus metformin for weight loss in diabetics after 26 weeks
Rybelsus plus metformin compared to Sitagliptin 100 mg plus metformin for weight loss in diabetics after 26 weeks

Compared to Januvia, there was a mean of -1.6 kgs and -2.5 kgs greater weight loss in the Rybelsus 7 mg and 14 mg groups respectively.

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Rybelsus in a dose of 14 mg was compared with Liraglutide in a dose of 1.8 mg. Significant weight loss was observed after 26 weeks in the Liraglutide and Rybelsus groups compared to placebo.

Baseline Weight Weight after 26 weeks Mean weight loss
Placebo 93.2 92.7 -0.5 kgs
Liraglutide 1.8 mg 95.5 92.4 -3.1 kgs
Rybelsus 14 mg 92.9 88.5 -4.4 kgs

The mean weight loss was significant in the liraglutide and Rybelsus groups compared with the placebo medicine.

rybelsus 14 mg compared to liraglutide 1.8 mg for weight loss in diabetics after 26 weeks
Rybelsus 14 mg compared to liraglutide 1.8 mg for weight loss in diabetics after 26 weeks

It can be observed here, that Rybelsus, although not FDA-approved for weight loss in non-diabetic patients, it seems superior to Liraglutide (an FDA-approved weight-loss drug).

Comparing Weight loss effects of Semaglutide vs Liraglutide vs Dulaglutide

Furthermore, Rybelsus is available as an oral pill. Thus, it may be preferred to Liraglutide which is an injectable medicine.

How much weight loss is expected when Rybelsus and Phentermine/ Topiramate are combined?

Rybelsus has been associated with a weight loss of about 4 kgs over 6 months. Phentermine/ Topiramate (Qsymia) use has resulted in a weight loss ranging from 3 to 7 kgs over 6 months to one year.

It is expected that the combined use of Rybelsus and Phentermine/ Topiramate may cause a weight loss of 8 to 10 kgs (17 to 22) over 6 months to one year.

This much weight loss has only been seen with Wegovy and Tirzepatide (Mounjaro). It is interesting to note that Wegovy is the same drug as Rybelsus except that Rybelsus is given orally while Wegovy is administered into the skin.

Rybelsus Vs Wegovy: A Comparison of Weight Loss Effects

Side effects of combining Rybelsus and Phentermine/ Topiramate:

Rybelsus is associated commonly with gastrointestinal side effects. Patients feel full all the time and may develop severe constipation (or diarrhea). Abdominal pain, nausea, and bloating are common side effects of Rybelsus.

What is Rybelsus? Side effects, Drug Interactions, & Concerns

Phentermine is a stimulant drug. It is contraindicated in patients with angina or heart diseases. It is also associated with significant neuropsychiatric side effects.

Common side effects of Phentermine/ Topiramate (Qsymia) include:

  • Fatigue and getting tired easily
  • Lethargy
  • Numbness and tingling sensations
  • Lack of focus and concentration
  • Palpitations and apprehension
  • Impaired sleep and thought processes
  • Impaired coordination
  • Abnormal bowel habits especially constipation [Ref]

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Side effects that are common with both Rybelsus and Phentermine/ Topiramate include gastrointestinal side effects, palpitations, and depression.

It is important to watch for neuropsychiatric symptoms, especially suicidal ideation. Loss of appetite may make the patient intolerant to the combination of these drugs.

Rybelsus and Depression: Symptoms Reported on Reddit

In Summary:

Rybelsus and Phentermine/ Topiramate (Qsymia) may be used in combination as both drugs are associated with significant weight loss. The combination may multiply the weight loss results.

However, it is important to watch for the side effects as the risk of GI-related and neurological side effects may also increase significantly.

For detailed Discussion, Read the following topics:

What do you think?

Written by Diabetes Doctor

I am an Internist practicing medicine for the last fifteen years. Over the years, I have learned that medicine is not about prescribing pills. True medical practice is helping people.
I do prescribe pills as well but the best results I get are when I motivate people to overcome their problems with little changes in their lifestyles.
Since most of my patients are obese, have diabetes, hypertension, high cholesterol levels, I am writing at dibesity.com when free.
Dibesity, I know the correct word is diabesity. Ignore this! Be with us.

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