Rybelsus and Invokamet Comparison

Rybelsus ®(semaglutide)	Invokamet ®(canagliflozin / metformin)
Prescription Only Rybelsus tablets (semaglutide) are used by adults with type 2 diabetes to manage blood sugar levels. Taken once daily, Rybelsus is combined with diet and exercise. It boosts...	Prescription Only Invokamet is a medication that combines two active ingredients, canagliflozin and metformin. These components are both oral medications designed to help manage and regulate blood...
Administration
Oral. Learn more.	Oral. Learn more.
Dosing
Start RYBELSUS® with 3 mg once daily for 30 days. The 3 mg dosage is intended for treatment initiation. •After 30 days on the 3 mg dosage, increase the dosage to 7 mg once daily. •The dosage may be increased to 14 mg.. Learn more.	One tablet, twice daily with meals, recommended starting dose of canagliflozin is 50 mg twice daily and metformin HCl 500 mg twice daily. Learn more.
Latin Shorthand
Initiate RYBELSUS® at 3 mg qd for 30 days. Then, escalate to 7 mg qd after 30 days. Consider up-titrating to 14 mg qd.. Learn more.	1 tab BID with meals. Starting dose: canagliflozin 50 mg BID, metformin HCl 500 mg BID.. Learn more.
Out-Of-Pocket Costs With Copay Card
$25. Learn more.	$0. Learn more.
Annual Cap
$150 for a 1-month supply; $300 for a 2-month supply; $450 for a 3-month supply. Learn more.	$3,000 and $200 per month. Learn more.
Assistance Expiration
24 months. Learn more.	Calendar year. Learn more.
Generics
No lower-cost generic available	No lower-cost generic available
Adverse Reactions
Most common adverse reactions (incidence ≥5%) are nausea, abdominal pain, diarrhea, decreased appetite, vomiting and constipation.. Learn more.	Most common adverse reactions associated with canagliflozin (5% or greater incidence): female genital mycotic infections, urinary tract infection, and increased urination. Most common adverse reactions associated with metformin HCl (5% or greater incidence) are diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache. . Learn more.
Mechanism of Actions (MoA)
GLP-1 Receptor Agonists. Learn more.	SGLT2 Inhibitors. Learn more.
Special Populations
What is the risk of using RYBELSUS® during pregnancy? The available data with RYBELSUS® use in pregnant women are insufficient to evaluate the drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Clinical considerations should be noted regarding the risks of poorly controlled diabetes during pregnancy. How should RYBELSUS® be used during pregnancy? RYBELSUS® should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. What animal reproduction studies have been conducted with RYBELSUS®? In pregnant rats, embryofetal mortality, structural abnormalities, and alterations to growth occurred at maternal exposures below the maximum recommended human dose (MRHD) based on AUC. Similar findings were observed in rabbits and cynomolgus monkeys at exposures below the MRHD. What is the estimated background risk of major birth defects and miscarriage? The estimated background risk of major birth defects is 6–10% in women with pre-gestational diabetes with an HbA1c >7, and has been reported to be as high as 20–25% in women with a HbA1c >10. In the general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. What are the clinical considerations for poorly controlled diabetes during pregnancy? Poorly controlled diabetes during pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. It also increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity. Is there any information on RYBELSUS® use during lactation? There are no data on the presence of semaglutide (active ingredient in RYBELSUS®) in human milk, its effects on the breastfed infant, or milk production. Semaglutide was detected in the milk of lactating rats. Due to species-specific differences, the clinical relevance of these data is not clear. What should be considered regarding lactation and RYBELSUS®? Breastfeeding is not recommended during treatment with RYBELSUS® due to potential accumulation of certain substances (such as SNAC) in breast milk. There are alternative formulations of semaglutide that can be used during lactation. When should RYBELSUS® be discontinued in relation to a planned pregnancy? RYBELSUS® should be discontinued in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide. Is RYBELSUS® safe for pediatric use? The safety and effectiveness of RYBELSUS® have not been established in pediatric patients (younger than 18 years). How is RYBELSUS® affected by renal impairment? The safety and effectiveness of RYBELSUS® was evaluated in patients with moderate renal impairment, showing no clinically relevant change in semaglutide pharmacokinetics. No dose adjustment of RYBELSUS® is recommended for patients with renal impairment. How is RYBELSUS® affected by hepatic impairment? In subjects with different degrees of hepatic impairment, no clinically relevant change in semaglutide pharmacokinetics was observed. No dose adjustment of RYBELSUS® is recommended for patients with hepatic impairment.

Rybelsus ®(semaglutide)

Invokamet ®(canagliflozin / metformin)

Prescription Only

Rybelsus tablets (semaglutide) are used by adults with type 2 diabetes to manage blood sugar levels. Taken once daily, Rybelsus is combined with diet and exercise. It boosts...

Prescription Only

Invokamet is a medication that combines two active ingredients, canagliflozin and metformin. These components are both oral medications designed to help manage and regulate blood...

Dosage & Administration

Administration

Oral. Learn more.

Dosing

Start RYBELSUS® with 3 mg once daily for 30 days. The 3 mg dosage is intended for treatment initiation. •After 30 days on the 3 mg dosage, increase the dosage to 7 mg once daily. •The dosage may be increased to 14 mg.. Learn more.

One tablet, twice daily with meals, recommended starting dose of canagliflozin is 50 mg twice daily and metformin HCl 500 mg twice daily. Learn more.

Latin Shorthand

Initiate RYBELSUS® at 3 mg qd for 30 days. Then, escalate to 7 mg qd after 30 days. Consider up-titrating to 14 mg qd.. Learn more.

1 tab BID with meals. Starting dose: canagliflozin 50 mg BID, metformin HCl 500 mg BID.. Learn more.

Financial Assistance

Out-Of-Pocket Costs With Copay Card

$25. Learn more.

$0. Learn more.

Annual Cap

$150 for a 1-month supply; $300 for a 2-month supply; $450 for a 3-month supply. Learn more.

$3,000 and $200 per month. Learn more.

Assistance Expiration

24 months. Learn more.

Calendar year. Learn more.

Generics

No lower-cost generic available

Physician Advisory

Adverse Reactions

Most common adverse reactions (incidence ≥5%) are nausea, abdominal pain, diarrhea, decreased appetite, vomiting and constipation.. Learn more.

Most common adverse reactions associated with canagliflozin (5% or greater incidence): female genital mycotic infections, urinary tract infection, and increased urination. Most common adverse reactions associated with metformin HCl (5% or greater incidence) are diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache. . Learn more.

Mechanism of Actions (MoA)

GLP-1 Receptor Agonists. Learn more.

SGLT2 Inhibitors. Learn more.

Special Populations

What is the risk of using RYBELSUS® during pregnancy?

The available data with RYBELSUS® use in pregnant women are insufficient to evaluate the drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Clinical considerations should be noted regarding the risks of poorly controlled diabetes during pregnancy.

How should RYBELSUS® be used during pregnancy?

RYBELSUS® should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

What animal reproduction studies have been conducted with RYBELSUS®?

In pregnant rats, embryofetal mortality, structural abnormalities, and alterations to growth occurred at maternal exposures below the maximum recommended human dose (MRHD) based on AUC. Similar findings were observed in rabbits and cynomolgus monkeys at exposures below the MRHD.

What is the estimated background risk of major birth defects and miscarriage?

The estimated background risk of major birth defects is 6–10% in women with pre-gestational diabetes with an HbA1c >7, and has been reported to be as high as 20–25% in women with a HbA1c >10. In the general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

What are the clinical considerations for poorly controlled diabetes during pregnancy?

Poorly controlled diabetes during pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. It also increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity.

Is there any information on RYBELSUS® use during lactation?

There are no data on the presence of semaglutide (active ingredient in RYBELSUS®) in human milk, its effects on the breastfed infant, or milk production. Semaglutide was detected in the milk of lactating rats. Due to species-specific differences, the clinical relevance of these data is not clear.

What should be considered regarding lactation and RYBELSUS®?

Breastfeeding is not recommended during treatment with RYBELSUS® due to potential accumulation of certain substances (such as SNAC) in breast milk. There are alternative formulations of semaglutide that can be used during lactation.

When should RYBELSUS® be discontinued in relation to a planned pregnancy?

RYBELSUS® should be discontinued in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide.

Is RYBELSUS® safe for pediatric use?

The safety and effectiveness of RYBELSUS® have not been established in pediatric patients (younger than 18 years).

How is RYBELSUS® affected by renal impairment?

The safety and effectiveness of RYBELSUS® was evaluated in patients with moderate renal impairment, showing no clinically relevant change in semaglutide pharmacokinetics. No dose adjustment of RYBELSUS® is recommended for patients with renal impairment.

How is RYBELSUS® affected by hepatic impairment?

In subjects with different degrees of hepatic impairment, no clinically relevant change in semaglutide pharmacokinetics was observed. No dose adjustment of RYBELSUS® is recommended for patients with hepatic impairment.

Rybelsus ® Alternatives