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[16] Contact your GP or diabetes team if you experience: Symptoms of hypothyroidism (persistent fatigue, weight gain, constipation, feeling cold, low mood) or hyperthyroidism (palpitations, tremor, anxiety, weight loss, heat intolerance, diarrhoea) Severe or persistent gastrointestinal symptoms such as nausea, vomiting, diarrhoea, or abdominal paincommon with Rybelsus but may require dose adjustment Signs of hypoglycaemia (shakiness, sweating, confusion, dizziness), particularly if taking Rybelsus with other diabetes medications Difficulty swallowing or persistent heartburn , which may indicate oesophageal irritation Any concerns about medication absorption or if you're unable to follow the dosing instructions New or worsening visual symptoms , as rapid improvement in blood glucose control may temporarily worsen diabetic retinopathy [1] [17] Seek urgent medical attention if you develop: Severe abdominal pain with or without vomiting (potential pancreatitis)stop taking Rybelsus immediately Symptoms of thyroid storm (very rare): high fever, severe agitation, rapid heart rate Signs of severe allergic reaction: facial swelling, difficulty breathing, severe rash Maintaining open communication with your healthcare team and attending scheduled monitoring appointments will help ensure safe and effective management of both your thyroid condition and diabetes whilst taking these medications together

For patients with DKD, ACEi/ARBs, SGLT2i, and a non-steroidal MRA (finerenone) have demonstrated cardiovascular and kidney benefits in dedicated kidney disease outcome trials