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Oral semaglutide (Rybelsus®) has a clear titration protocol, reflected in the FDA label and clinical guidelines.
Dose adjustment regimen (adults, type 2 diabetes):
- 3 mg / day is only a start for 30 days, not a therapeutic dose.
- 7 mg / day — therapeutic.
- 14 mg / day is the maximum dose prescribed for insufficient glycemic control at 7 mg (after ≥ 30 days of therapy).
Admission rules:
- Take immediately after waking up, on an empty stomach.
- After ingestion, wait ≥30 minutes before eating, drinking, or taking other medications.
- Swallow the tablet whole, do not break or chew.
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Recent research in the USA (PubMed, 2024-2025)
- Actual clinical outcomes and costs (EHR, 2 systems): 23,522 adults after semaglutide administration showed a decrease in body weight (-3.8% of the general cohort; -5.1% without diabetes) and a slight increase in medical expenses, if the cost of the drug is not taken into account. Source.
- Psychiatric safety: a retrospective analysis of the EHR (TriNetX, USA) did not confirm an increased risk of suicidal thoughts on semaglutide versus alternatives; the association is towards a lower risk. Nat Med, 2024. Source.
- Therapy behavior: in a multicenter analysis in the USA, termination of GLP-1 is often accompanied by a restart on the background of weight gain; in adults without DIABETES, the probability of reinitiation is lower than in patients with diabetes. JAMA Netw Open, 2025. Source.
