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This appears related to the peptides effects on sodium retention and vascular permeability

GLP-1 receptor agonists are medications that mimic a natural hormone in the body (glucagon-like peptide-1) to help regulate blood sugar and control appetite

Some studies have reported the beneficial effects of incretin mimetics as an effective therapy for hyperphagia and obesity in PWS, considering its potential effects on ghrelin suppression, central appetite suppression (through its action on pro-opiomelanocortin POMC/CART neurons and cocaine- and amphetamine-regulated transcripts in the arcuate nucleus (195),), increased energy expenditure (EE) and stimulation of insulin secretion, which could counterbalance the hypoinsulinemia reported in PWS (196200)

Similarly, Rybelsus has relatively low oral bioavailability and requires very specific conditions for absorption: it must be taken with no more than 120ml of water, on an empty stomach, with no food, drink, or other oral medications for at least 30 minutes afterwards