Qsymia Review

Qsymia is a combination of two drugs – Phentermine and Topiramate, approved by the US FDA in July of 2012. In this article, we will review Qsymia including it’s dosage, effectiveness for helping overweight or obese people lose weight, side effects, indications, dosage, availability, cost, contra-indications, and answer commonly asked questions.
Phentermine is one of the most common prescription diet pills prescribed in the United States. However, patients taking Phentermine alone may not get as much weight loss results as those taking a combination medication such as the Phentermine and Topiramate due to the synergy in the combination.

What is drug synergy?

Synergy means that one the combined effectiveness of the combination is more than what you expect with individual ingredients of the medication.

Who is a candidate for the prescription appetite suppressant Qsymia?

Phentermine and topiramate extended-release (long-acting) capsules are used to help adults who are obese with a body mass index of 30 more more or those that are overweight and have weight-related medical problems to lose weight and to keep from gaining back that weight.

Is Phentermine and Topiramate (Qsymia) most effective drug for weight loss?

In a recent comparison study, Phentermine and Topiramate combination was found to be the most effective diet pill combination for weight loss.

In this large study published in JAMA, in a sample of 30,000 patients, this is what they found – the goal is a weight loss of at least 5%:

  • 75 percent of participants taking phentermine-topiramate
  • 63 percent of participants taking liraglutide
  • 55 percent taking naltrexone-bupropion
  • 49 percent taking lorcaserin
  • 44 percent taking orlistat and
  • 23 percent of placebo participants had at least 5 percent weight loss

Where can I get a prescription for Qsymia or Phentermine and Topiramate?

W8MD’s weight loss physicians are familiar with Qsymia, both the brand name and also the off label use of Phentermine in combination with Topiramate for best results on weight loss.

What diet should one follow while on Qsymia?

Phentermine and topiramate extended-release capsules must be used along with a reduced calorie diet and exercise plan.

How to get Qsymia savings card?

The manufacturer of Qsymia offers certain savings via savings card through their website which you can take advantage of.

Go to Qsymia.com and look for savings

The Qsymia Savings As of Jan 2019

Receive FREE 2-week starter dose of Qsymia (3.75 mg/23 mg)

OR save up to $95 on your first 30‑day prescription at any dose2

Then continue to save each month

Save up to $65 per monthly prescription for up to 36 months.

What type of medication is Qsymia?

Phentermine is in a class of medications called anorectics. It works by decreasing appetite. 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. Topiramate essentially takes the cravings for starchy or sugary foods and Phentermine helps with increasing metabolism and decreasing appetite.

How should Qsymia medicine be taken?

Phentermine and topiramate come as extended-release capsules to take by mouth.

Should Phentermine and Topiramate be taken with food?

Qsymia is usually taken with or without food once a day in the morning.

Can I take Qsymia in the evening?

Qsymia or the generic Phentermine may cause difficulty falling asleep or staying asleep if it is taken in the evening. However, Topiramate can be taken in the evening (and morning if prescribed so by the doctor) while taking Phentermine in the morning.

When is the best time of the day to take Qsymia?

Take phentermine and topiramate at around the same time every day, preferably in the morning.

How is Qsymia dose titrated?

Some doctors prescribe the lower doses of Qsymia to begin with although most experienced weight loss doctors might start at the regular dose of Phentermine.

How do you know if Qsymia is working for you?

After you take the new dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost at least 5 percent of the body weight after a trial of 12 weeks at the optimal dose (the time to titrate the dose is excluded from this), then the medication might be ineffective for you.

Is Qsymia habit forming?

Although the potential is limited, Phentermine and topiramate may be habit forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor.

How to stop taking Qsymia?

Phentermine and topiramate will help control your weight only as long as you continue to take the medication. Do not stop taking phentermine and topiramate without talking to your doctor. If you suddenly stop taking phentermine and topiramate, you may experience seizures. Your doctor will tell you how to decrease your dose gradually.

What special precautions should I follow while taking Qsymia?

Before taking phentermine and topiramate, tell your doctor and pharmacist 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.

What drug interactions should I be concerned about while taking Qsymia?

If you are currently taking or have taken the following medication in the last 2 weeks prior to starting Qsymia, please tell you doctor – Monoamine oxidase inhibitor (MAOI) including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate).

What drugs may interact with Qsymia?

Any of the following may have some interaction, so mention to your doctor if you are on any of the following: amitriptyline (Elavil); carbonic anhydrase inhibitors such as acetazolamide (Diamox), methazolamide, or zonisamide (Zonegran); diuretics (‘water pills’) including furosemide (Lasix) or hydrochlorothiazide (HCTZ); insulin or other medications for diabetes; ipratropium (Atrovent); lithium (Lithobid); medications for anxiety, high blood pressure, irritable bowel disease, mental illness, motion sickness, Parkinson’s disease, ulcers, or urinary problems; medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin), or valproic acid (Stavzor, Depakene); pioglitazone (Actos, in Actoplus, in Duetact); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

What are some contraindications for Qsymia?

Tell your doctor if you have glaucoma (condition in which increased pressure in the eye can cause vision loss) or an overactive thyroid gland.

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. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • dizziness
  • 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
  • diarrhea
  • constipation
  • heartburn
  • painful menstrual periods
  • pain in the back, neck, muscles, arms or legs
  • tightening of the muscles
  • painful, difficult, or frequent urination,hair loss

What are the serious side effects of Qsymia?

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
  • hives

What other side effects can be caused by Qsymia?

Phentermine and topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What are the ingredients in Qsymia?

Qsymia comes in three doses, both with combination of Phentermine and Topiramate. Phentermine / Topiramate 3.75 mg/23 mg, 7.5 mg/46 mg, and 15 mg /92 mg. 

Do doctors prescribe generic Phentermine and Topiramate?

Yes. Over 50% of all weight loss doctors prescribe this combination of Phentermine and Topiramate albeit in various doses of Phentermine and Topiramate. Although the highest dose of Phentermine used in the brand name Qsymia is only 15 mg, most weight loss doctors prescribe Phentermine at the usual dose of 30 mg or 37.5 mg. For the topiramate, a starting dose of 25 mg once or twice a day to be gradually titrated to the most effective dose of 100 mg to 200 mg daily.

How does qsymia make you lose weight?

Phentermine is an appetite suppressant while Topiramate helps with cravings for carbs.

How expensive is qsymia?

Phentermine is an appetite suppressant while Topiramate helps with cravings for carbs.

How much does qsymia cost without insurance?

The retail price of Qsymia is $250.00 although there are coupons available that might bring the cost to about $130.00 or so.

Is there a generic form of qsymia?

Although there is no official generic available due to the odd dosing of Topiramate of 92 mg in the highest dose and extended release formulation, weight loss physicians use the generic Phentermine at 7.5, 15, 30 and 37.5 mg of Phentermine and 25, 50 and 100 mg of Topiramate to make similar combination dosage to that of Qsymia.

Can Qsymia cause heart attack?

It is possible although it is extremely rare. Qsymia contains Phentermine which should not be used in those that cannot take Amphetamines or had recent heart attack within the past 6 months.

Is topiramate an appetite suppressant?

Not directly but can have synergistic effects in combination with Phentermine such as in the combination diet pill Qsymia.

What is the highest mg of Qsymia you can take?

Phentermine Topiramate 15 mg /92 mg is the highest dose of Qsymia.

What are the long term effects of taking Qsymia?

The medication Qsymia is relatively new and we do not know the long term effects. However, a recent study that looked at the safety of Phentermine found it to be relatively safe and not very addictive even in patients taking this for as long as 21 years. See the study here that showed Phentermine not addictive.

Can I just stop taking Qsymia?

A gradual tapering of the dose is advised due to the Topiramate component in Qsymia leading to the rare possibility of withdrawal seizures.

Do you gain weight after Qsymia?

If you go back to eating a high calorie diet, you might gain the weight back. It is important to note that once you lose the weight, you should go on a maintenance plan.

Is Qsymia bad for you?

The risk benefit ratio depends on the individual as obesity can affect over 50 different medical problems and losing weight with or without the help of medications such as Qsymia should be weighed against the potential side effects of Qsymia.

How long does Qsymia stay in your body?

The half life is about 20 hours for Phentermine and 65 hours for Topiramate.

Does Qsymia get you high?

Not usually although you might feel the stimulant effect of Phentermine

Can I drink while taking Qsymia?

You are advised against drinking alcoholic beverages while on Qsymia although in practice, one to two drinks of alcohol pose little risk.

Can Qsymia cause hair loss?

Thinning of hair is seen in some especially on higher doses of Topiramate.

Is it best to take Qsymia on an empty stomach?

Yes, in the morning.

Can you take Qsymia on a full stomach?

You can although empty stomach is better.

How long do you have to wait to eat after taking Qsymia?

About 30 minutes is recommended.

Can Qsymia cause you to fail a drug test?

Yes, due to Phentermine although your prescriber or pharmacist would be able to provide proof that it is legally prescribed for a medical purpose in which case the drug test would be considered medically negative.

Can you drink caffeine while taking Qsymia?

Caution is advised due to the stimulant effect of Caffeine and Phentermine

What is the best prescription diet pill?

Phentermine and Topiramate is proven to be the most effective diet pill combination for weight loss in a large study comapring diet drugs.

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