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Drug vs. Drug

Rybelsus vs. Farxiga: Differences, similarities & side effects

Rybelsus may be more effective for Type 2 diabetes, but it has fewer approved uses than Farxiga
Gerardo Sison medical writer headshot
By | Sep. 11, 2024
An oval tablet and a round tablet with "vs" between them: Rybelsus vs. Farxiga

Key takeaways

  • Rybelsus and Farxiga are oral medications used to manage Type 2 diabetes and are covered by most insurance plans.

  • Rybelsus is a GLP-1 receptor agonist that helps increase insulin production and decrease appetite.

  • Farxiga is an SGLT2 inhibitor that reduces blood sugar by promoting its excretion through urine.

  • Combining Rybelsus and Farxiga may improve blood sugar control, but they have different side effects and drug interactions to consider.

In this article:

Rybelsus (semaglutide) and Farxiga (dapagliflozin) are brand-name prescription drugs that help manage Type 2 diabetes mellitus. These medications are prescribed to help manage blood sugar levels, which may help reduce the risk of diabetes complications. 

Both are approved by the Food and Drug Administration (FDA) and are available as oral tablets to be taken once daily. Most Medicare and commercial insurance plans typically cover them. Although Rybelsus and Farxiga are used for similar purposes, they differ in several ways.

Rybelsus vs. Farxiga: Key differences

Rybelsus contains the active ingredient semaglutide, which is the same active ingredient in the injectable brand-name drugs Ozempic and Wegovy. It is classified as a glucagon-like peptide-1 (GLP-1) receptor agonist. It works by mimicking a hormone that stimulates insulin production after meals and reduces appetite. 

Rybelsus is taken as a tablet, starting at 3 milligrams (mg) once daily for about a month. After that, the dose usually increases to 7 mg once daily. Rybelsus is unique as the only oral GLP-1 receptor agonist.

Farxiga contains the active ingredient dapagliflozin. It belongs to a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors, which work by preventing the kidneys from reabsorbing sugar, which is then cleared through the urine. Farxiga is taken as an oral tablet at a dosage of 5 or 10 mg per day.

Compare Rybelsus vs. Farxiga key differences
Rybelsus Farxiga
Drug class GLP-1 receptor agonist SGLT2 inhibitor
Brand/generic status Brand only Brand and generic available
What is the generic name? Semaglutide Dapagliflozin
What form(s) does the drug come in? Oral tablet Oral tablet
What is the standard dosage? 3 mg once daily for 30 days, followed by an increase to 7 mg once daily. If additional glycemic control is needed after taking 7 mg once daily for 30 days, the dosage may be increased to 14 mg once daily.  5 or 10 mg once daily, depending on the condition being treated
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults 18 years and older Adults and children 10 years and older

 

Rybelsus vs. Farxiga: Conditions treated

Rybelsus is FDA approved to manage blood sugar levels in adults with Type 2 diabetes. It is meant to be used alongside a diet and exercise plan for maximum glycemic control.

Farxiga is a medication that helps manage several health conditions. When combined with diet and exercise, it improves blood sugar control in adults and children ages 10 years and older with Type 2 diabetes. Additionally, It can reduce the risk of severe kidney problems, heart-related deaths, and hospital stays for heart failure in adults with chronic kidney disease.

Farxiga is also approved for adults with heart failure, helping to lower the chances of heart-related deaths and hospital visits for heart issues. In adults with Type 2 diabetes who have existing heart disease or multiple heart risk factors, Farxiga can reduce the risk of hospital visits due to heart failure.

Compare Rybelsus vs. Farxiga conditions treated
Condition Rybelsus Farxiga
Type 2 diabetes Yes Yes
Chronic kidney disease No Yes
Heart failure No Yes
Reduce the risk of hospital visits in people with Type 2 diabetes and heart disease or multiple cardiovascular risk factors No Yes

 

Is Farxiga better than Rybelsus?

Farxiga and Rybelsus both help manage blood glucose levels. However, studies show Rybelsus may be more effective than Farxiga for treating Type 2 diabetes. 

One systematic review and network meta-analysis combined results from multiple clinical trials to compare the effectiveness of semaglutide (the active ingredient in Rybelsus) with SGLT-2 inhibitors in patients who weren’t well-controlled on other diabetes medications. The results showed that semaglutide was better at lowering blood sugar than SGLT-2 inhibitors like Farxiga. Those who took semaglutide also lost about 5 pounds more than those who took Farxiga. 

In some cases, Rybelsus and Farxiga may be prescribed together. In one observational study, researchers looked at 1,335 patients with Type 2 diabetes to see how well dapagliflozin and semaglutide worked together. They found that the combination therapy lowered blood sugar levels significantly more than dapagliflozin alone, with a 1.2% drop in glycated hemoglobin compared to a 0.5% drop. In addition, 55% of patients on the combination therapy nearly normalized their blood sugar levels.

Choosing the most effective medication depends on individual patient needs. Doctors and healthcare providers consider many factors, including medical history, current conditions, and other medications.

Rybelsus vs. Farxiga: Insurance coverage and cost comparison

Many insurance plans, including Medicare Part D plans, cover Rybelsus and Farxiga. However, the extent of coverage can vary depending on the specific plan and its formulary. In general, Rybelsus is a more expensive drug than Farxiga since it is only available in a brand-name form. Farxiga does have a generic version, which may be a more accessible option for some people. 

Without insurance, the prices of Rybelsus and Farxiga can vary depending on the pharmacy and location. Price-checking local pharmacies can help you find the most cost-effective option. At the time of publication, the average retail price of Rybelsus was $1,348 per 30, 7 mg tablets, and the average price of Farxiga was $799 for 30, 10 mg tablets. You may be able to save on these medications by using SingleCare coupons for Rybelsus and Farxiga.

Compare Rybelsus vs. Farxiga cost & coverage
Rybelsus Farxiga
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Quantity 7 mg (30 tablets) 10 mg (30 tablets)
SingleCare cost* $829 $403
*Prices fluctuate. This is the average retail price at the time of publication.

Rybelsus vs. Farxiga side effects

Rybelsus and Farxiga generally have different side effects because they work differently in the body. The most common side effects of Rybelsus include digestive problems like nausea, vomiting, diarrhea, and stomach pain. 

In contrast, Farxiga can lead to more frequent urination, urinary tract infections, and yeast infections because it helps the body get rid of extra sugar through urine. In addition, Farxiga may cause other side effects like nausea, back pain, and stuffy or runny nose. 

Both drugs can have more serious side effects, such as pancreatitis and allergic reactions, though these are not as common. If you notice any side effects, it’s important to talk to a healthcare provider to manage them.

Compare Rybelsus vs. Farxiga side effects
Rybelsus Farxiga
Side effect Applicable? Frequency Applicable? Frequency
Nausea Yes 11% Yes 3%
Stomach pain Yes 10% No –
Diarrhea Yes 10% No –
Vomiting Yes 6% No –
Constipation Yes 6% Yes 2%
Decreased appetite Yes 6% No –
Vaginal yeast infections No – Yes 8%
Penile yeast infections No – Yes 3%
Stuffy or runny nose and sore throat No – Yes 7%
Back pain No – Yes 3%
Increased urination No – Yes 3%
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your healthcare provider to learn more.
Source: DailyMed (Rybelsus), DailyMed (Farxiga)

Rybelsus and Farxiga drug interactions

Rybelsus and Farxiga interact with many of the same types of drugs. Knowing about these interactions is important to use these medications safely and effectively. 

Both Rybelsus and Farxiga can cause low blood sugar (hypoglycemia) when taken with insulin or insulin-releasing medications like sulfonylureas (e.g., glipizide and glyburide). To avoid severe low blood sugar, the dose of insulin or these other medications may need to be lowered when starting Rybelsus or Farxiga.

Rybelsus can slow down the stomach’s emptying rate, which can affect the absorption of other oral medications. For example, the level of levothyroxine, a thyroid medication, can increase when taken with Rybelsus. Some people may need extra monitoring for medications that require precise dosing.

Farxiga can lower the levels of lithium in the blood. This means that when starting or changing the dose of Farxiga, the levels of lithium may need to be checked more often to make sure they stay stable.

Compare Rybelsus vs. Farxiga drug interactions
Drug Drug class Rybelsus Farxiga
Humalog (insulin lispro)

NovoLog (insulin aspart)

Lantus (insulin glargine)

 Insulin  Yes Yes
Glucotrol (glipizide)

Amaryl (glimepiride)

 Sulfonylureas Yes Yes
Prandin (repaglinide)

Starlix (nateglinide)

 Glinides Yes Yes
Eskalith (lithium) Mood stabilizer No Yes
Consult a healthcare professional for other possible drug interactions.

Rybelsus and Farxiga Drug warnings

Both Rybelsus and Farxiga can cause serious side effects and carry specific warnings. For example, they can both lead to pancreatitis, which is inflammation of the pancreas. If severe stomach pain, vomiting, and rapid heartbeat occur, it’s recommended to seek immediate medical attention. 

Both drugs can also increase the risk of hypoglycemia when taken with insulin or other diabetes medications. Signs of hypoglycemia include shaking, sweating, and confusion, requiring changes in other diabetes medications if needed. 

Unique warnings for Rybelsus

Rybelsus may carry a risk of thyroid C-cell tumors. Although this has been observed in animal studies, it’s unclear if this risk applies to humans. Patients with a personal or family history of thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN 2) should not use Rybelsus. Symptoms of thyroid tumors include a lump in the neck, trouble swallowing, and persistent hoarseness. 

Additionally, Rybelsus can cause complications with diabetic retinopathy, especially in patients with a history of this eye condition. Rapid improvement in blood sugar control can temporarily worsen diabetic retinopathy, so regular eye check-ups are important. 

Unique warnings for Farxiga

Farxiga may increase the risk of diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition, particularly in individuals with Type 1 diabetes or those with risk factors like low insulin, dehydration, or acute illness. Symptoms of DKA include nausea, vomiting, stomach pain, and difficulty breathing. If DKA is suspected, it’s important to discontinue Farxiga and seek immediate medical attention. 

Farxiga can also cause serious urinary tract infections, including urosepsis, pyelonephritis, and genital infections. Symptoms like pain, fever, or swelling in the genital area often require prompt medical treatment. 

In addition, Farxiga can lead to volume depletion, which may cause low blood pressure or kidney problems, especially in older adults or those on diuretics. Regular monitoring of hydration and kidney function is recommended. 

Consult a healthcare provider for medical advice and other precautions or warnings before starting Rybelsus or Farxiga. Tell a healthcare provider about any medical conditions and other medications being taken, including prescription drugs, over-the-counter medicine, and herbal supplements. 

Can you take Rybelsus and Farxiga together?

Taking Rybelsus and Farxiga together is generally considered safe and may be beneficial for managing Type 2 diabetes, especially in those who don’t have enough blood sugar control with just one. Combining these medications may provide a complementary way to manage blood sugar levels. However, combining these medications may not be right for everyone, and only a healthcare professional familiar with your medical history can determine what’s best for you.