II. Indications

  1. BMI >30 or
  2. BMI >27 and one comorbid condition

III. Dosing

  1. Phentermine/Topiramate
    1. Start: 3.75 mg/23 mg for the first 2 weeks
    2. Titrate to maximum of 15 mg/92 mg
  2. Discontinuation
    1. Discontinue if 5% weight loss not achieved at maximum dose at 12 weeks
    2. Taper off gradually (risk of Seizure)

IV. Efficacy

  1. Weight loss is promising at 24 pounds in one year or 10% of body weight
  2. Weight loss of at least 5% in up to 70% of patients at one year

V. Adverse effects

  1. Teratogenic (Topiramate)
    1. Precautions to avoid pregnancy (reliable Contraception) while on Qsymia are paramount
    2. REMS training program (Risk Management) has been developed
    3. Pregnancy Test when initiating medication and then monthly
  2. Tachycardia, Hypertension and Insomnia (Phentermine)
  3. Impaired memory or concentration (Topiramate)
  4. Dizziness
  5. Paresthesias in distal extremities
  6. Altered Taste Sensation

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