Nov. 15, 2022 Updated Tue., Nov. 15, 2022 at 5:18 p.m.
Q. Because I have Type 2 diabetes, I’ve been taking Rybelsus since April. My HbA1c is now down to 6.0, and I have lost close to 30 pounds.
There’s a lot of noise around using semaglutide (the ingredient in Rybelsus) for weight loss. I am sick of it! They are literally leaving those of us who truly need the medication for diabetes in the lurch, since there’s a shortage of the injectable medication. Why would the Food and Drug Administration let doctors prescribe diabetes drugs for weight loss?
A. The FDA regulates drugs, but it has no authority over the practice of medicine. Semaglutide is the generic name for the self-injected weight loss drug Wegovy. The same injectable medication is found in Ozempic, a medication approved for treating Type 2 diabetes. The oral version of semaglutide, Rybelsus, was also approved by the FDA for Type 2 diabetes.
Ever since Elon Musk attributed his weight loss to “fasting … and Wegovy,” social media has been buzzing about this medication. The FDA reports that both Wegovy and Ozempic are “currently in shortage.” Oral semaglutide (Rybelsus) does not appear to be in short supply at this time.
Like you, we are dismayed that doctors would prescribe Ozempic for people without diabetes to lose weight. The drug can cause low blood sugar, abdominal pain, diarrhea or constipation, nausea and vomiting. There are also cautions about thyroid cancer, pancreatitis and gallbladder disease.
Q. I have taken metoprolol succinate ER for many years to control my heart rate. Back in 2007, I had lots of trouble when I was switched from brand name Toprol to the generic. So, I went back to the brand name from AstraZeneca or an authorized generic. Fortunately, the Veterans Affairs Hospital used the AstraZeneca version in its mail-order pharmacy program. Now it has switched to a generic pill made in China.
This generic form of metoprolol does not work well at all. My heart rate shot up to over 100, so my doctor ordered brand name only and my heart rate is back to normal.
The price is astronomical, though, and it is always a fight with the pharmacy. They prefer to dispense the generic. What do you recommend?
A. Beta blocker heart drugs like metoprolol, atenolol and propranolol have a distinctive action on the heart. They all slow the pulse. The fact that your heart rate jumped to more than 100 beats per minute strongly suggests that the generic you took was not working.
You have a couple of options. There is a pharmacy in Lakeland, Florida, that carries the authorized generic metoprolol succinate formulation. That means it should be identical to brand name Toprol. You can find it online at
Another option is to buy brand name Toprol from a legitimate Canadian online pharmacy. To learn more about authorized generic drugs and how to identify reputable Canadian pharmacies, you may wish to read our eGuide to Saving Money on Medicines. The online resource is available under the Health eGuides tab at
Q. My husband and I are taking a trip to Ecuador. Is there anything we can take to reduce the chance of traveler’s diarrhea?
A. According to the medical literature, bismuth subsalicylate (Pepto Bismol) appears to offer some protection against traveler’s diarrhea (Antimicrobial Agents and Chemotherapy, April 1986). The authors report that people taking two 262 milligram tablets twice daily were 35% less likely to report diarrhea.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
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