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Hans Schmidt, a bariatric surgeon in New Jersey

Diabetes Med (2017) 34:5912

Patients with IBS-D (diarrhoea-predominant) may be particularly concerned about GLP-1-induced diarrhoea, whilst those with IBS-C (constipation-predominant) might experience either improvement or worsening depending on individual response

Recommended timing strategies: Option 1 (Morning dosing for both): Take Rybelsus immediately upon waking with up to 120ml water Wait 30 minutes Take levothyroxine with a full glass of water Wait another 30 minutes before eating breakfast or drinking coffee Total fasting time: approximately 60 minutes from waking Option 2 (Split dosing): Take Rybelsus first thing in the morning as directed Wait 30 minutes, then eat breakfast Take levothyroxine at bedtime (34 hours after last meal) The split-dosing approach may offer better adherence for some patients and ensures maximum separation between the two medications