Phentermine and Topiramate
With so many options for suppressing appetite for weight loss, what is the best weight loss medication?
The answer to this question depends on your medical situation, preferences, and the experience and training of the prescribing weight loss physician. Having said that, let us review the various weight loss medications in the order of their effectiveness.
By far, the most effective medications for suppressing appetite for losing weight are the combination weight loss medications such as Phetermine and Topiramate. Let us review this very effective weight loss combination of Phentermine and Topiramate a bit further.
Phentermine and topiramate is a combination weight loss medication that was approved as the brand name Qsymia in 2011 by the United States Food and Drug Administration. Phentermine is an amphetamine based, and traditionally, one of the most used weight loss medication. When combined with a low dose of a neuropathy, anti-seizure type medication that is commonly used to treat migraines etc. called Topiramate, there is significant synergy. With this synergy, the expected weight loss with the combination of Phentermine and Topiramate is higher than the sum of the expected weight loss from each of the two individual components used separately, hence the synergy in curbing appetite and helping one lose weight. Partly due to the Topiramate, this combination not only helps suppress the appetite but also takes away cravings for foods, such as carbohydrate, sugar or salt cravings thus reducing food intake and leading to effective and fast weight loss in most patients.
Who should consider Phentermine and Topiramate for losing weight?
Any adult who is obese defined as a body mass index of 30 or more, or any overweight person with a body mass index of 27 or more with one or more weight related medical problems such as high blood pressure, cholesterol problems, sleep apnea, diabetes etc. Interestingly, this is one of the few weight loss medications that is FDA approved not only to help one lose weight but also to maintain weight as obesity is now recognized as a chronic medical problem that needs long term medical management just like high blood pressure, high cholesterol or other life style related medical conditions.
This novel combination weight loss medication, Phentermine and topiramate should be used along with a reduced calorie diet and exercise plan.
What is Phentermine and how does it work for weight loss?
Phentermine is in a class of medications called anorectics. It works by decreasing appetite.
What is Topiramate and how does it work for weight loss?
Topiramate is in a class of medications called anticonvulsants. It works by decreasing appetite and by causing feelings of fullness to last longer after eating.
How should Phentermine and Topiramate be used?
Phentermine and topiramate is usually taken with or without food once a day in the morning and taken at around the same time every day.
Dose titration of Phentermine and Topiramate
It is recommended to start phentermine and topiramate at a lose dose and increase the dose after 14 days. If need be, the dose can be further titrated at regular intervals until the most effective combination is reached, not to exceed the maximum recommended dose of Phentermine 37.5 mg daily.
When will I know if Phentermine and Topiramate are working for me?
After you take this combination medication for 12 weeks, the weight loss doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, the weight loss doctor may tell you to stop taking phentermine and topiramate or may increase the dose. After you take the new dose of Phentermine and Topiramate for 12 weeks, your weight loss doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, it is not likely that you will benefit from taking phentermine and topiramate, so your doctor will most likely tell you to stop taking the medication.
Control of appetite with Phentermine and Topiramate
Phentermine and topiramate will help control your weight only as long as take the medication. Do not stop taking phentermine and topiramate without consulting with your doctor. If you suddenly stop taking phentermine and topiramate, you may experience seizures due to the Topiramate component, especially if you are at a higher dosage. Your weight loss physician will advise you to decrease your dose gradually and not stop suddenly.
Contra-indications for Phentermine and Topiramate
- Please let your weight loss doctor know if you are allergic to phentermine (Adipex-P, Suprenza); topiramate (Topamax); sympathomimetic amine medications such as midodrine (Orvaten, ProAmatine) or phenylephrine (in cough and cold medications); any other medications, or any of the ingredients in phentermine and topiramate capsules. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- Please let your weight loss doctor know if you are taking a monoamine oxidase inhibitor (MAOI) including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken one of these medications during the past two weeks. Your doctor will probably tell you not to take phentermine and topiramate if you are taking one or more of these medications or have taken one of these medications during the past 2 weeks.
- Please let your weight loss doctor know what other prescription and nonprescription medications, or supplements.
- Please let your weight loss doctor know if you have glaucoma (condition in which increased pressure in the eye can cause vision loss) or an overactive thyroid gland. Your doctor will probably tell you not to take phentermine and topiramate.
- Please let your weight loss doctor know if you have had a heart attack or a stroke in the past 6 months, if you have ever thought about killing yourself or tried to do so, and if you are following a ketogenic diet (high fat, low carbohydrate diet used to control seizures). Also tell your doctor if you have or have ever had depression; an irregular heartbeat; heart failure; seizures; metabolic acidosis (too much acid in the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are brittle or weak and may break easily); ongoing diarrhea; any condition that affects your breathing; diabetes; kidney stones; or kidney or liver disease.
Pregnancy and Phentermine with Topiramate
Please let your weight loss doctor know if you are pregnant or plan to become pregnant. If you take phentermine and topiramate during pregnancy, your baby may develop a birth defect called cleft lip or cleft palate. Your baby may develop this birth defect very early in the pregnancy, before you know that you are pregnant. You must use birth control to prevent pregnancy during your treatment. You must take a pregnancy test before you begin your treatment and once every month during your treatment. If you become pregnant while taking phentermine and topiramate, stop taking the medication and call your doctor immediately.
How does Phentermine and Topiramate (Qsymia) compare with Belviq?
The other new weight loss medication that was approved around the same time as Phentermine and Topiramate is Belviq(Lorcaserin). Lorcaserin is a weight-loss drug developed by Arena Pharmaceuticals. It has serotonergic properties and acts as an anorectic. On 10 May 2012, after a new round of studies submitted by Arena, an FDA panel voted to recommend lorcaserin for patients with a BMI of over 30, or with a BMI over 27 and a comorbidity like high blood pressure or type 2 diabetes. In studies, the combination of Phentermine and Topiramate (Qsymia) showed about 9% weight loss on an average while Belviq showed about half the same in terms of weight loss. In general, Phentermine and Topiramate is considered a bit more effective although it may vary in individuals.
Prevention of pregnancy and contraceptive options
Since Topiramate is known to cause neural tube defects if you get pregnant while taking it, it is recommended that all women of child bearing age should check to make sure they are not pregnant before starting and use double protection throughout the course of treatment.
One can use oral contraceptives (birth control pills) to prevent pregnancy during your treatment with phentermine and topiramate. You may experience unusual spotting (unexpected vaginal bleeding) if you use this type of birth control. You will still be protected from pregnancy if you are spotting, but you can talk to your doctor about other forms of birth control if the spotting is bothersome.
Please let your weight loss doctor know if you are breast-feeding.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking phentermine and topiramate.
Phentermine and topiramate may slow your thinking and movements and affect your vision. Do not drive a car or operate machinery until you know how this medication affects you.
You are advised not to drink alcoholic beverages while you are taking phentermine and topiramate. Alcohol can make the side effects of phentermine and topiramate worse.
Phentermine and topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual.
While the medication combination takes your interest in food, you should know that sometimes your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking phentermine and topiramate.
A small number of adults and children 5 years of age and older (about 1 in 500 people) who took antiepileptics such as topiramate to treat various conditions during clinical studies became suicidal during their treatment although this is rare. If you notice any significant mood changes or suicidal ideation, please talk to your doctor.
What special dietary instructions should I follow?
Drink extra fluids during your treatment with phentermine and topiramate.
What should I do if I forget a dose?
Skip the missed dose and take your usual dose the next morning. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Phentermine and topiramate may cause side effects including but not limited to the following:
- numbness, burning, or tingling in the hands, feet, face, or mouth
- decreased sense of touch or ability to feel sensation
- difficulty concentrating, thinking, paying attention, speaking, or remembering
- excessive tiredness
- dry mouth
- unusual thirst
- changes or decreased ability to taste food
- painful menstrual periods
- pain in the back, neck, muscles, arms or legs
- tightening of the muscles
- painful, difficult, or frequent urination
- hair loss
- Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:
- racing or pounding heartbeat that lasts several minutes
- sudden decrease in vision
- eye pain or redness
- fast, shallow breathing
- severe pain in the pack or side
- blood in urine
- rash or blisters, especially if you also have fever
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
Store phentermine and topiramate in a safe place so that no one else can take it accidentally or on purpose. Keep track of how many capsules are left so you will know if any are missing.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include the following:
- uncontrollable shaking of a part of the body
- fast breathing
- hallucinations (seeing things or hearing voices that do not exist)
- excessive tiredness
- irregular heartbeat
- stomach pain or cramps
- coma (loss of consciousness for a period of time)
- speech disturbances
- blurred or double vision
- problems with coordination
What other information should I know about Phentermine and Topiramate?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to phentermine and topiramate. Do not let others take your medication. Giving or selling phentermine and topiramate to others may harm them and is against the law. Phentermine and topiramate is a controlled substances.