Qsymia
Qsymia (phentermine / topiramate extended release) is a combination medication used to help with weight loss. It's approved for people over 12 who are considered obese and for some adults who are considered overweight. This medication is a tablet that you take once a day. You should also eat a balanced diet and exercise regularly for best results. Side effects include a "pins-and-needles" feeling, dry mouth, and constipation. You can only get this medication through the Qsymia REMS (Risk Evaluation and Mitigation Strategies) program because of the risk of birth defects if taken during pregnancy.
What is Qsymia (phentermine / topiramate ER)?
What is Qsymia (phentermine / topiramate ER) used for?
- Weight loss and long-term weight management, together with diet and exercise, for certain people:
- People age 12 years and older considered obese
- Adults considered overweight with at least one weight-related condition (e.g., heart disease, high blood pressure, Type 2 diabetes)
How Qsymia (phentermine / topiramate ER) works
Qsymia (phentermine / topiramate ER) is a combination of two active ingredients that work to help with weight loss.
- Phentermine is a sympathomimetic. It works in the brain to lower your appetite.
- Topiramate is an antiepileptic (anti-seizure medication). Scientists don't know exactly how it helps you lose weight. But it's thought to lower your appetite and also makes you feel more full.
Drug facts
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Risks and warnings for Qsymia (phentermine / topiramate ER)
Qsymia (phentermine / topiramate ER) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Harm to an unborn baby
- Risk factors: Currently pregnant | People who can become pregnant
Qsymia (phentermine / topiramate ER) can harm an unborn baby. So, you can't take this medication if you're pregnant. Studies show that taking topiramate, an ingredient in Qsymia, early in pregnancy can raise the risk of birth defects like cleft lip.
Because of this risk, the FDA put a special program called a Risk Evaluation and Mitigation Strategy (REMS) in place for the medication. Under the Qsymia REMS program, only certified pharmacies can fill your prescription for this medication.
If you can become pregnant, you'll need to follow specific directions to take Qsymia (phentermine / topiramate ER). Your prescriber will ask you to take a pregnancy test before starting the medication. You'll also need to take one every month during treatment. Use reliable birth control if you're having sex while taking this medication.
Mood problems and suicidal thoughts or behavior
- Risk factors: History of depression | History of attempted suicide
Qsymia contains the anti-seizure medication, topiramate. Topiramate can raise the risk of suicidal thoughts or behavior, depression, and anxiety. In particular, the risk of suicidal thoughts can be higher as early as the first week of treatment. People with suicidal thoughts or who've tried to hurt themselves shouldn't take Qsymia (phentermine / topiramate ER).
Watch for signs of worsening depression or any unusual changes in your mood or behavior. This is especially important during the first few months of treatment or when your dose changes. Tell a healthcare professional if you or your loved ones notice anything troubling. Your prescriber might need to lower your dose of Qsymia (phentermine / topiramate ER) or stop treatment.
Call 911 right away if there are any suicidal thoughts or behaviors. Your prescriber will stop your Qsymia (phentermine / topiramate ER) treatment.
Fast heart beat
Qsymia (phentermine / topiramate ER) can make your heart beat faster. In studies, some people's heart rates went up by 5 beats per minute (bpm) or more, sometimes even up to 20 bpm. It isn't known yet how this might affect people with heart conditions in the long run. Let your prescriber know if you have any heart conditions before you start this medication. They can weigh the risks and benefits of treatment to make sure you stay safe.
Call your healthcare team if it feels like your heart is beating really hard or fast while you're resting (when you're sitting and haven't done any physical activity recently). They might want to check your heart and see if you should keep taking Qsymia (phentermine / topiramate ER).
Vision problems
Qsymia (phentermine / topiramate ER) can cause eye problems and vision changes. They can sometimes be serious and lead to blindness if not treated. If these eye problems happen, the symptoms usually show up during the first month after you start the medication. But they can also happen at any time during treatment. Call your prescriber right away if you have sudden changes in your vision, trouble seeing far away, or eye pain.
Problems concentrating
- Risk factors: Raising the dose of Qsymia (phentermine / topiramate ER) too fast | Drinking alcohol | Taking other medications that can affect your concentration
Qsymia (phentermine / topiramate ER) can make it hard to concentrate. It can also cause problems with memory, speech, or language. This is more likely if you start treatment at a higher dose of Qsymia (phentermine / topiramate ER) or if your dose gets raised too quickly.
Try to avoid alcohol or limit how much you drink while taking Qsymia (phentermine / topiramate ER). This is because alcohol can make these problems worse. Don't drive or do anything that needs a lot of focus until you know how this medication affects you.
Tell your prescriber if you have trouble thinking or focusing. Also let them know if you feel dizzy, drowsy, or unsteady on your feet. Your prescriber might need to lower your dose of Qsymia (phentermine / topiramate ER) or stop your treatment altogether.
Higher level of acid in blood (metabolic acidosis)
- Risk factors: Kidney problems | Severe breathing problems | Serious seizure situation called status epilepticus | Diarrhea | Keto diet | Taking medications called carbonic anhydrase inhibitors
Although rare, some people have had high acid levels in the blood while taking Qsymia (phentermine / topiramate ER). This condition is called metabolic acidosis. If not treated for a long time, it can lead to kidney problems or weak bones.
Your prescriber might have you get regular blood tests so they can check your blood acid levels. Tell your prescriber right away if you have fast and shallow breathing, feel nauseous, feel very tired, and have a fast heartbeat. These can be signs of metabolic acidosis.
Possible lower kidney function
Qsymia (phentermine / topiramate ER) can cause a rise in the creatinine levels in your blood. This can be a sign that your kidneys aren't working as well as they should. In studies, these lab changes usually showed up after a month or two of treatment.
To help keep you safe, your prescriber will check your kidney function before you start Qsymia (phentermine / topiramate ER) and during treatment. If your creatinine levels stay too high, your prescriber might lower your dose or stop treatment.
Kidney stones
- Risk factors: Keto diet | Taking medications called carbonic anhydrase inhibitors
Qsymia (phentermine / topiramate ER) might cause kidney stones. The risk might be higher if you're on a ketogenic (keto) diet. You can also be at risk if you take medications called carbonic anhydrase inhibitors like acetazolamide. Be sure to drink plenty of fluids to prevent kidney stones from forming.
High body temperature and inability to sweat
- Risk factors: Being outside at very hot temperatures | Taking medications called carbonic anhydrase inhibitors | Taking anticholinergic medications
Some people who take topiramate, one of the ingredients in Qsymia, have had a lower ability to sweat. This can make it harder to control your body temperature. Pay attention to how much you sweat or how hot you feel while you're exercising or in hot weather. Stay hydrated and take rest breaks in the shade on hot days.
Serious allergic reactions and skin reactions
- Risk factors: Allergy to Yellow No. 5 dye
Qsymia (phentermine / topiramate ER) can cause severe allergic reactions and skin reactions. Call your prescriber if you notice a rash. And get medical help right away if you have trouble breathing, swelling of the face or lips, blisters on the skin, or fever.
Possible slowed growth in children
Studies show that Qsymia (phentermine / topiramate ER) might slow down growth in children 12 and older who are considered obese. In one study, children who took the medication for a year grew about 1 cm less than those who didn't take it.
Make sure your child goes to all their checkups so their prescriber can keep track of their growth. If your child isn't growing as expected, the prescriber might need to lower the dose of Qsymia (phentermine / topiramate ER).
Side effects of Qsymia (phentermine / topiramate ER)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Adults:
- Feeling of pins and needles (up to 20%)
- Dry mouth (up to 19%)
- Constipation (up to 16%)
- Upper respiratory tract infection (up to 16%)
- Headache (up to 11%)
- Change in taste (up to 9%)
- Trouble sleeping (up to 9%)
- Dizziness (up to 9%)
Children:
- Depression (up to 4%)
- Nausea (up to 4%)
- Fever (up to 4%)
- Dizziness (up to 4%)
- Joint pain (up to 4%)
Less Common Side Effects
Adults:
- Nausea
- Diarrhea
- Back pain
- Tiredness
- Blurry vision
- Lower blood pressure
- Sinus infection
- Bronchitis
- Cough
- Urinary tract infection (UTI)
Children:
- Feeling of pins and needles
- Anxiety
- Stomach pain
- Muscle pain in the chest area
- Tiredness
- Ear infection
Qsymia (phentermine / topiramate ER) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Vision problems: sudden changes in vision, sudden eye pain
- High acid levels in your body (metabolic acidosis): fast and shallow breathing, loss of appetite, tiredness, irregular heartbeat
- Severe skin reaction: rash, blisters, peeling skin, fever, body aches
- Serious allergic reaction: dizziness, flushing, trouble breathing, nausea, vomiting, fast heartbeat, rash, swelling in the face or tongue, trouble swallowing
- Seizure (after suddenly stopping the medication)
More on Qsymia (phentermine / topiramate ER) side effects
The following Qsymia (phentermine / topiramate ER) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Difficulty with paying attention, memory, or speech
- Fast or irregular heartbeat
- Fever that does not go away, decreased sweating
- High acid level—trouble breathing, unusual weakness or fatigue, confusion, headache, fast or irregular heartbeat, nausea, vomiting
- High ammonia level—unusual weakness or fatigue, confusion, loss of appetite, nausea, vomiting, seizures
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Kidney stones—blood in the urine, pain or trouble passing urine, pain in the lower back or sides
- Low potassium level—muscle pain or cramps, unusual weakness or fatigue, fast or irregular heartbeat, constipation
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Burning or tingling sensation in hands or feet
- Change in taste
- Constipation
- Dizziness
- Dry mouth
- Trouble sleeping
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Pros and cons of Qsymia (phentermine / topiramate ER)
Pros
- A pill that's taken once a day
- Combines two ingredients that help lower appetite into one pill for convenience
- An option for certain children 12 years and older, if diet and exercise aren't enough
Cons
- Can raise the risk of depression or thoughts of self-harm
- Controlled substance and only available through a REMS program
- Not safe during pregnancy
Pharmacist tips for Qsymia (phentermine / topiramate ER)
- Take Qsymia (phentermine / topiramate ER) in the morning with or without food. Taking it earlier in the day can help prevent insomnia (trouble falling and staying asleep), which can be a side effect of the medication.
- If you can have children, your prescriber might ask you to take a pregnancy test before starting Qsymia (phentermine / topiramate ER). You'll also need to take one every month during treatment. This medication can harm an unborn baby, so it's important to make sure you're not pregnant.
- If you can have children, also talk to your prescriber about birth control methods to use while you're taking Qsymia (phentermine / topiramate ER). You might have more spotting (bleeding between periods) with some birth control pills.
- You might notice or feel your heart beating faster than usual while taking Qsymia (phentermine / topiramate ER). It's not always dangerous, but it might be concerning. Let your prescriber know if you feel your heart pounding or racing.
- Qsymia (phentermine / topiramate ER) can make you feel dizzy or confused. It can also cause changes in vision or make it hard to focus. Don't drive or do anything that needs your full attention until you know how this medication affects you.
- Stay well hydrated during treatment. This can prevent kidney stones, which can form when you take medications that contain topiramate (like Qsymia). Tell your healthcare team know if you have severe back or side pain or any blood in your urine. These can be signs of a kidney stone.
- It's best to avoid alcohol while taking Qsymia (phentermine / topiramate ER). Alcohol can make side effects like dizziness worse. It can also make it even harder for you to think clearly. And alcohol has extra calories that can contribute to weight gain. This isn't helpful if you're trying to lose weight. Talk to your prescriber if you drink alcohol often to see what's best for you.
- Tell your prescriber if you take any medications that can lower your potassium, like furosemide (Lasix) or hydrochlorothiazide. Your potassium levels might drop even more if you take them with Qsymia (phentermine / topiramate ER). You might need blood tests to check your potassium levels regularly. Let your care team know if you have muscle cramps, constipation, weakness, dizziness, or trouble breathing. These can be signs of low potassium.
- Don't stop taking Qsymia (phentermine / topiramate ER) without talking to your prescriber first, especially if you've been taking it for a long time. Stopping it too quickly can raise your risk of having a seizure. Your prescriber can help you stop the medication safely by lowering your dose slowly over time.
- Breastfeeding isn't recommended while you're taking Qsymia (phentermine / topiramate ER). This medication can pass into your breast milk. It can raise the risk of side effects in your baby, like sleep problems, fussiness, high blood pressure, vomiting, and weight loss. Talk to your prescriber or a lactation consultant about your options.
Common questions about Qsymia (phentermine / topiramate ER)
In studies, adults who took the recommended dose of Qsymia (phentermine / topiramate ER) lost about an average of 18 lbs after a year of treatment. People who only managed their weight through diet and exercise (the placebo group) lost an average of 3 lbs. Keep in mind that each person can have a difference experience with treatment. So, your results might not be the same as those from the study. Keep track of your weight loss journey. And ask your prescriber if you have more questions about how well this medication will work for you.
Some side effects of Qsymia (phentermine / topiramate ER) get better as your body gets used to the medication and usually go away on their own. These can include numbness, tingling, dizziness, and a faster heart rate. But other side effects, like dry mouth or changes in taste, might bother you for a longer period of time. Be sure to let your medical team know if side effects worsen or don’t go away. They can help suggest ways to manage them.
Small amounts of Qsymia (phentermine / topiramate ER) can stay in your body for up to 2 weeks after your last dose. This is because the topiramate component of Qsymia has a very long half-life. In other words, it takes a long time for the amount of topiramate from a single dose of Qsymia to drop by half in the blood. Ask your prescriber if you have questions about how long the medication stays in your system.
You should start to see noticeable weight loss over about 8 to 12 weeks of taking Qsymia (phentermine / topiramate ER) at the recommended dose. Keep in mind that everyone can respond differently to the medication. So, your results might not be exactly the same as someone else's. Talk to your prescriber if you don't notice any weight loss while taking the medication as instructed.
There's no set time for how long you can take Qsymia (phentermine / topiramate ER). Studies show that it can be safe and work well for weight loss for up to 2 years. You might need to stop the medication early if you have serious side effects from it. Your prescriber might also recommend stopping if it doesn't seem to be helping you lose enough weight after 3 months of taking the highest dose. You might gain back some weight after stopping the medication. Check with your prescriber about how long you should take Qsymia (phentermine / topiramate ER).
Yes. Qsymia (phentermine / topiramate ER) is a controlled substance. This is because it contains phentermine, which can be misused and cause physical dependence. To keep people safe, the government has placed special rules on how the medication is prescribed and dispensed. Talk to your prescriber about the risks and benefits of taking Qsymia (phentermine / topiramate ER).
Phentermine, one of the ingredients in Qsymia, works in your brain to lower your appetite. The other ingredient, topiramate, also helps make you feel more full. Taking Qsymia (phentermine / topiramate ER) along with eating a balanced diet and exercising can help you lose weight.
Qsymia and Contrave are two different weight loss pills. They're both combination medications, which means that they have two ingredients that work together in one pill. Qsymia contains phentermine and topiramate. It's approved for adults and certain children 12 years and older. And you take 1 pill of Qsymia once a day. But Contrave contains naltrexone and bupropion. It's only approved for adults. And you have to take 2 tablets of Contrave twice a day after a ramp-up month. Ask your prescriber to learn more about the differences and to see which is right for you.
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Qsymia (phentermine / topiramate ER) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 3.75mg/23mg | 30 capsules | $89.10 | $2.97 |
| 7.5mg/46mg | 30 capsules | $89.10 | $2.97 |
| 11.25mg/69mg | 30 capsules | $89.10 | $2.97 |
| 15mg/92mg | 30 capsules | $89.10 | $2.97 |
Typical dosage for Qsymia (phentermine / topiramate ER)
The typical starting dose is Qsymia 3.75 mg/23 mg (phentermine/topiramate) by mouth once a day in the morning for 2 weeks.
After that, your prescriber will raise your dose to the recommended dose of Qsymia 7.5 mg/46 mg (phentermine/topiramate) once a day.
Depending on how well the medication is working for you, your prescriber might adjust your dose. You must take Qsymia (phentermine / topiramate ER) along with eating a balanced diet and getting regular exercise.
The maximum dose is Qsymia 15 mg/92 mg (phentermine/topiramate) once a day. The maximum dose might be different if you have kidney or liver problems.
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Qsymia (phentermine / topiramate ER) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Qsymia (phentermine / topiramate ER) will not be safe for you to take.
- Currently pregnant
- Glaucoma
- Hyperthyroidism (overactive thyroid condition)
- Currently take or have taken medications called monoamine oxidase inhibitors (MAOIs) within the last 14 days
- Allergy to phentermine or topiramate
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