Combination Phentermine and Topiramate can be a good weight loss medication support option for people without coronary artery heart disease or uncontrolled high blood pressure. The combination medication (brand name Qsymia) is FDA approved for weight loss in adults with BMI above 30 or BMI above 27 with at least one weight-related comorbidity (like diabetes, high cholesterol, or hypertension).
Data
The combination of phentermine-topiramate was compared with placebo in almost 2500 adults with BMI of 27 to 45 kg/m2 and two or more comorbidities. After one year, the average weight loss was more than placebo (8 to 10 kg compared to 1.4 kg with placebo). In a second year extension of the same patients of this trial, the average total weight loss was still significantly better than placebo.
In another trial, patients with BMI ≥35 kg/m2 were randomly assigned to phentermine-topiramate or placebo. After 56 weeks, the average weight loss was more in the active treatment groups (6kg in the low dose and 12.6kg in the higher dose compared to placebo of 1.9 kg.
Understanding Phentermine
The mechanism of phentermine and it’s active metabolites stimulate the release of norepinephrine or inhibit its reuptake into nerve terminals. Sympathomimetic drugs reduce food intake by causing early satiety. It’s important to recognize that Phentermine is a schedule IV drug, a regulatory classification suggesting potential for abuse, although the actual observed rate is very low.
Potential side effects include: increase heart rate and blood pressure and cause insomnia, dry mouth, constipation, and nervousness.
While phentermine alone has been shown in short term studies to be more effective than placebo in weight loss studies, phentermine alone is only approved by the US Food and Drug Administration (FDA) for the short-term (up to 12 weeks) treatment of obesity because of their potential side effects, potential for abuse, limited duration of use, and regulatory surveillance.
Understanding Topiramate
The exact mechanism how topiramate promotes weight loss is not fully understood.
Topiramate may affect appetite regulation by influencing neurotransmitters and neuropeptides involved in appetite control. It may reduce hunger and increase feelings of satiety, leading to a decreased caloric intake.
Topiramate may affect the brain’s reward system, reducing the pleasure derived from food and diminishing cravings for high-calorie foods.
Topiramate increases the risk of fetal malformations and thus should not be used in women without birth control/ contraception.
Potential side effects include: irritability, mood changes, difficulty with concentration, attention, and memory, tingling or numbness sensations, nausea, abdominal discomfort.
Tips on How to Take Phentermine
Timing: The best time to take Phentermine is usually taken in the morning, at least 1-2 hours before breakfast. Taking it too late in the day can cause sleep disturbances.
Avoid Alcohol: Alcohol can interact with phentermine and may increase the risk of side effects, so it’s best to avoid alcohol while taking the medication.
Stay Hydrated: Drinking plenty of water is important while taking phentermine. It can help reduce the risk of side effects like dry mouth and constipation.
Less Caffeine: Phentermine is a stimulant, and combining it with excessive caffeine intake can lead to increased heart rate and other side effects.
Monitor Side Effects: Be aware of potential side effects such as increased heart rate, restlessness, insomnia, dizziness, and mood changes. If you experience severe or persistent side effects, contact your doctor.
Regular Check-ups: Your doctor will likely want to monitor your progress and check for any potential complications. Attend your follow-up appointments as scheduled. Long-term use can lead to reduced effectiveness and potential health risks.
Gradual Taper: When discontinuing phentermine, it’s important to follow your doctor’s guidance on how to gradually reduce the dose to avoid withdrawal symptoms.
Consult your doctor
Always consult with a healthcare professional to determine whether a treatment or medication is suitable for your specific case.