What Is It Like to Take Qsymia for Weight Loss?
Key takeaways:
Qsymia is an FDA-approved medication for weight loss that contains two ingredients: phentermine and topiramate.
It’s considered an effective oral weight-loss option, but some healthcare professionals are cautious because it can cause serious birth defects and carries a risk of misuse and dependence.
Here, three women describe the positives and negatives of taking Qsymia.
Qsymia is a combination prescription medication that’s FDA approved for weight loss. It’s made up of two medications: phentermine, a stimulant medication that affects the brain’s appetite center, and topiramate, an antiseizure medication that’s thought to help you eat less and feel fuller.
While newer weight-loss injectables such as Wegovy (semaglutide) and Zepbound (tirzepatide) are getting lots of attention lately, Qsymia is a lower-cost alternative that’s taken as a once-daily pill. It’s considered to be one of the most effective oral weight-loss medications available.
But since Qsymia has a high risk of birth defects, it’s not prescribed during pregnancy. In fact, women are required to use birth control and have regular pregnancy tests while taking it. Qsymia also includes phentermine, a controlled substance that carries a risk of misuse and dependence.
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Those who take Qsymia in combination with a lower-calorie intake and regular exercise report losing weight. But some report side effects such as mood changes. Here’s how three people describe their experiences with Qsymia.
It suppressed her hunger — and her ‘pleasure center in general’
It took 35-year-old Mia Joiner, of Santa Monica, California, a long time to find the right answer to dealing with her weight.
“I’ve had lifetime obesity,” Mia says. “I was told that it was my fault — lack of willpower, that I’m lazy, that I must be lying about what I’m consuming.”
When Qsymia became available, Mia tried it for 8 months. She lost 20 lbs.
“I had never, ever, lost any weight in that amount without severely restricting myself with food and overexercising,” Mia says. “So it was really nice to take something that assisted with me eating a little bit less. Although I didn’t feel great.
“I remember feeling very melancholy. The purpose of Qsymia is to make your mind relax so that you’re not thinking about food. But it also relaxes your pleasure center in general. Thoughts of food were not as exciting, but neither was the rest of my life.”
A job change upended Mia’s insurance coverage, so she had to hunt for a new doctor. She found an endocrinologist and asked about staying on Qsymia. The doctor first wanted a thorough set of tests.
When the results came back, Mia was shocked. The endocrinologist said Mia had prediabetes, based on her hemoglobin A1C test, which measures blood glucose (sugar) levels over the previous 2 to 3 months.
The endocrinologist prescribed Mounjaro (tirzepatide) instead, a medication approved for people with Type 2 diabetes to help improve blood sugar. Tirzepatide under the brand name Mounjaro is approved for Type 2 diabetes, not weight loss, but studies show that people can experience weight loss while taking it. (Tirzepatide sold under the brand name Zepbound is FDA approved for weight loss.)
For Mia, switching to Mounjaro has been successful. “I lost 100 lbs,” she says. “I got lucky that I found the endocrinologist. If I hadn’t, I don’t think it would have ended up with the same result.”
After trying ‘every diet in the book,’ Qsymia helped her drop 35 lbs
Colleen O’Connor, a 32-year-old public relations executive in Long Beach, New York, tried many ways to lose weight before she turned to Qsymia.
“I’ve always struggled with my weight,” she says. “I’ve done every diet in the book.”
When new weight-loss medications such as Wegovy came to market, her doctor said she was a candidate for injectable semaglutide. But her insurance didn’t cover the cost, so she turned to Qsymia.
She pays for it herself. With a manufacturer’s coupon, her cost for daily pills is about $100 a month.
Colleen lost 35 lbs in her first 3 months of taking Qsymia.
She says her doctor warned of possible side effects — “nausea, dizziness, fatigue, things like that,” she says. But she has experienced none of them.
“I did a lot of research before getting into it,” Colleen says. “I know people have said their sense of taste changed, but it hasn’t affected me at all.”
Her doctor added one pointed warning. “She did stress that if I was going to be pregnant, I could not be on this medication,” Colleen says. For now, that is not an issue.
Colleen says her weight loss recently started to plateau. Her doctor has spoken about raising her dosage by a small amount, “to see if that could kick-start anything.”
Exercise and healthy eating are key parts of her program, Colleen says.
The basics of weight loss are still the same, she says. “You still have to work at it. I still have a healthy diet — low carb, high protein, keep my water intake up. It’s not like this is a magic pill. You have to be committed to putting in the time yourself,” Colleen says.
Mood changes made her decide Qsymia was not the answer
Before she tried Qsymia, Katrina Hereford had been using prescription Mounjaro — the medication approved for diabetes that also has been found to have weight-loss benefits — for 6 months. Short supplies prompted her doctor to switch her to Qsymia.
But Katrina found she experienced mood changes, a possible side effect of topiramate, one of the ingredients in Qsymia.
“My anxiety continued to go through the roof,” says Katrina, a 40-year-old South Carolina healthcare worker. “I would have a really good morning, be very alert, and also be really productive in the afternoon. But then in the evening, at night, it was just miserable.”
In the 6 months she took Qsymia, her dose was increased, but her side effects also increased, she says. She found herself on edge, quick to anger, and unable to handle frustration.
When she went back to her doctor, they pinpointed topiramate as the likely problem — although Katrina’s anxiety could also have been a reaction to the phentermine in Qsymia, since it is a stimulant. She decided to stop taking it.
“I have lost weight on it. That is true,” Katrina says. “But at what cost?”
Her doctor agreed she should stop taking it. Now she says, “I feel like I’m a lot more in control of my emotions.”
She says the experience has taught her to listen to her body.
“If your body is telling you, ‘This is not a good combination; we need to bail,’ you know it’s time to figure out what your alternatives are,” Katrina says.
What does the pharmacist say?
Stacia Woodcock, PharmD
Pharmacy Editor
Qsymia (phentermine / topiramate ER) is a once-daily oral capsule that’s effective for weight loss when combined with a reduced-calorie diet and regular exercise. Its two ingredients help reduce appetite and help you feel full with less food.
In studies, about 70% of adults lost at least 5% of their body weight after taking Qsymia for 1 year. It seems to be the most effective weight-loss medication that doesn’t require an injection.
You’ll start with a low dose of Qsymia and slowly increase it over time based on how well you respond to the medication. This helps minimize side effects, such as tingling in your hands or feet, dizziness, and insomnia. Most people see noticeable weight loss within the first 8 weeks of taking Qsymia. But it may take longer in some cases.
It’s best to avoid alcohol while you’re taking Qsymia. You’ll also need to use consistent, effective birth control and have regular pregnancy tests while you’re taking it. This is because Qsymia can cause serious birth defects.
Phentermine, one of the ingredients in Qsymia, is a controlled substance. This means it carries a risk of misuse and dependence and may not be the best treatment option if you have a history of substance use disorder.
Your healthcare professional can discuss the pros and cons of Qsymia with you based on your medical history. They can also suggest alternative options if Qsymia isn’t the best fit for your needs.
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