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Contact your GP or healthcare team if you experience: Persistent vomiting that prevents you from keeping down food, fluids, or other medications for more than 24 hours Signs of dehydration : excessive thirst, dark urine, dizziness, reduced urination, or confusion Abdominal pain , particularly if constant, worsening, or radiating to your back Right upper abdominal pain , especially if accompanied by fever or yellowing of the skin/eyes (possible gallbladder problems) Nausea that does not improve after 46 weeks of treatment at a stable dose Significant weight loss beyond what is expected or intended Blood in vomit or stools, or vomit that resembles coffee grounds Symptoms of hypoglycaemia (low blood sugar): trembling, sweating, confusion, rapid heartbeatparticularly if taking Rybelsus alongside insulin or sulphonylureas Changes in vision or worsening of existing eye problems, especially if you have diabetic retinopathy Seek immediate medical attention (call 999 or attend A&E) if you develop: Severe, persistent abdominal pain with vomiting (possible pancreatitis) stop taking Rybelsus immediately Signs of a severe allergic reaction: difficulty breathing, swelling of face or throat, severe rash stop taking Rybelsus immediately Symptoms suggesting diabetic ketoacidosis: excessive thirst, frequent urination, nausea, vomiting, abdominal pain, confusion, fruity-smelling breath Your GP can assess whether your symptoms represent normal adjustment to the medication or indicate a need for dose modification, additional supportive treatment, or medication discontinuation