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When to seek medical advice: Pain persists for more than three days despite regular paracetamol use You develop severe, persistent upper abdominal pain (possibly radiating to the back) with or without vomiting - stop taking Rybelsus and seek urgent medical attention as this could indicate pancreatitis You experience symptoms of hypoglycaemia (shakiness, sweating, confusion, rapid heartbeat) - this risk is higher if you also take insulin or sulfonylureas Nausea or vomiting prevents you from taking medications or staying hydrated You accidentally exceed the maximum paracetamol dose - contact NHS 111 or go to A&E even if you feel well If you are taking warfarin, be aware that your INR should be monitored when starting Rybelsus

Similar efficacy of DPP-4 inhibitors to either metformin or pioglitazone was also shown in formerly drug-nave patients who did not reach glycaemic goals with non-pharmacological interventions

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