II. Indications
- BMI >30 or
- BMI >27 and one comorbid condition
III. Dosing
-
Phentermine/Topiramate
- Start: 3.75 mg/23 mg for the first 2 weeks
- Titrate to maximum of 15 mg/92 mg
- Discontinuation
- Discontinue if 5% weight loss not achieved at maximum dose at 12 weeks
- Taper off gradually (risk of Seizure)
IV. Efficacy
- Weight loss is promising at 24 pounds in one year or 10% of body weight
- Weight loss of at least 5% in up to 70% of patients at one year
V. Adverse effects
-
Teratogenic (Topiramate)
- Precautions to avoid pregnancy (reliable Contraception) while on Qsymia are paramount
- REMS training program (Risk Management) has been developed
- Pregnancy Test when initiating medication and then monthly
- Tachycardia, Hypertension and Insomnia (Phentermine)
- Impaired memory or concentration (Topiramate)
- Dizziness
- Paresthesias in distal extremities
- Altered Taste Sensation
VI. References
- (2013) Presc Lett 20(7): 37
- Erlandson (2016) Am Fam Physician 94(5): 361-8 [PubMed]
- Garvery (2012) Am J Clin Nutr 95:297–308 [PubMed]