Can You Take Levothyroxine, Fosamax and Rybelsus Together?

Answer

Hi Rose and thank you for your really great question.

This is a great question because all three medications are ideally taken first thing in the morning on an empty stomach and there is only so much morning in every day.

First and foremost, alendronate and levothyroxine shouldn’t be taken together.

Avoid Taking Fosamax And Levothyroxine Together

Alendronate (or under the brand, Fosamax) is an oral bisphosphonate used to help maintain strong bones. Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. If you take both of these at the same time, you won’t absorb the full dose of the alendronate.

Rybelsus Can Interact With Levothyroxine

Rybelsus (generic name, semaglutide) is an oral Glucagon-Like Peptide-1 (GLP-1) Agonist that is used to help treat Type 2 diabetes.

These drugs are most commonly given as a once-weekly injection, but this new once-daily oral formulation was just recently introduced. If taken orally, it is recommended to take it first thing in the morning on an empty stomach. The oral formulation seems to have a small interaction with levothyroxine. It may increase the concentration of levothyroxine and the levothyroxine dose might need to be adjusted in the future.

How To Manage Dosing Of All Three Drugs

I think the easiest way to manage is to take the alendronate first. Since you only take it once a week, it is hopefully not too inconvenient.  I would wake up, take the alendronate dose with a full glass of water, and then remain upright for at least 30 minutes (this helps to prevent GI irritation).

After 30 minutes, the majority of the dose should be absorbed. Then, you have two options for the remaining two meds:

• Take your morning levothyroxine dose with a glass of water. After 30-45 minutes the majority of the dose should be absorbed, so take your Rybelsus. Again, wait at least 30 minutes and you can eat breakfast and begin to go about your normal day.

• You can take both your levothyroxine and Rybelsus at the same time BUT this might lead to an increase in levothyroxine concentration, and you might need to work with your physician to get on a lower dose if you find your labs being affected. However, you should be routinely monitored anyways, so this is probably the easier option as long as you consistently take the meds this way to avoid fluctuations.

I think that option 2 is much easier in the long run, but both should be fine, and option 1 is likely what would be recommended to you both most health care providers.

Final Words

Thanks for reaching out to us and I hope this helps.