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Switching Between Escalation or Maintenance Dosage of RYBELSUS Formulations *Discontinue this formulation and initiate the alternate formulation the day after Switching from OZEMPIC to RYBELSUS (formulation R1) or RYBELSUS (formulation R2) Switching from OZEMPIC to RYBELSUS (formulation R1) One week after discontinuing 0.5 mg of subcutaneous OZEMPIC, start 7 mg or 14 mg of RYBELSUS (formulation R1) orally once daily

71 NAC also appears to have a balancing effect on neurotransmitter dysregulation, in particular glutamate homeostasis

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Probiotic strains with urease activity or D-lactate production could theoretically contribute to hyperammonemia or metabolic acidosis in patients with hepatic or renal impairment (193)

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