Qsymia is a brand-name prescription drug that helps people lose and control their weight. The drug combines two generic drugs: phentermine and topiramate. Phentermine is a stimulant similar to amphetamines, while topiramate is an anti-seizure drug. Both suppress appetite. Phentermine is a potentially addictive drug that can cause serious side effects, so healthcare professionals closely monitor treatment. Qsymia is only available through specialty pharmacies.
Qsymia overview
BRAND NAMES:
Qsymia
Generic Names:
Phentermine/topiramate
Uses:
Used with diet and exercise for weight loss and weight maintenance
Therapeutic Classes:
Appetite suppressant, anorectic, anorexigenic, sympathomimetic, stimulant, anticonvulsant
Forms:
Extended-release capsule
How it’s taken:
By mouth
What is Qsymia used for?
Qsymia is a medication used—along with a doctor-approved weight loss plan—for weight loss in adults and teens diagnosed with obesity. It can also be prescribed to adults who are overweight and have weight-related complications such as diabetes or high blood pressure.
Expert tips for using Qsymia
Qsymia can cause increases in heart rate at rest. It isn’t well established if Qsymia increases the risk of heart problems like risk of stroke or even death.
Topiramate, one of the components of Qsymia, may cause suicidal thoughts or actions. Contact your healthcare provider right away with any symptoms that are new, worse, or bothersome related to thoughts about suicide or dying.
Decreases in vision, with or without eye pain and redness, can occur while taking Qsymia. These changes can be permanent, so any changes to vision should be immediately communicated to a healthcare provider.
Do not take Qsymia if you are pregnant or planning to become pregnant, as it may result in birth defects like cleft lip or palate.
Qsymia should not be used in patients with certain concomitant medical conditions and/or medications–always consult a healthcare provider while receiving Qsymia regarding any changes to your health record.
What form(s) does Qsymia come in
Extended-release capsule
3.75 mg phentermine/23 mg topiramate
7.5 mg/46 mg
11.25 mg/69 mg
15 mg/92 mg
What are common Qsymia doses?
For weight loss and weight management: 7.5 mg/46 mg–15 mg/92 mg capsule taken once daily in the morning. An upward titration to achieve desired effects is utilized.
Common Qsymia prescriptions
Qsymia
11.25mg/69mg capsuleQsymia
15mg/92mg capsuleQsymia
3.75mg/23mg capsuleQsymia
7.5mg/46mg capsule
How to take Qsymia
Take your medicine as directed.
Your dose may need to be changed, particularly at the beginning.
Carefully follow the doctor's instructions about diet and exercise.
Please read the medication guide for Qsymia.
Take this medicine in the morning with or without food.
Swallow the extended-release capsule whole. Do not crush, break, or chew it.
Drink extra fluids to avoid possible kidney problems.
Store Qsymia capsules in a tightly closed container in a dry place at room temperature. Protect the capsules from moisture.
What to do if you miss a dose of Qsymia
If you miss a dose or forget to take your medicine, skip the missed dose.
Take the next day’s dose the next morning.
Do not take an extra dose to make up for the missed dose.
Qsymia contraindications
This medicine is not right for everyone.
Do not use it if you have had an allergic reaction to phentermine or topiramate.
Qsymia is also contraindicated in people:
Who are pregnant
With glaucoma
With an overactive thyroid
Qsymia warnings
Tell any doctor or other healthcare provider who treats you that you are taking Qsymia.
The prescriber will need to schedule regular checkups, weight checks, and lab tests to monitor your use of this drug, the success of the treatment, and any possible problems. Keep all appointments.
Tell the doctor if you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed.
Before taking Qsymia, tell the doctor about all your medical conditions, especially:
Glaucoma
Thyroid problems
Kidney problems
Liver problems
Heart disease or heart rhythm problems
A history of heart attack or stroke
Type 2 diabetes
Depression or mood problems
A history of suicidal thoughts or behaviors
A history of depression or mood problems
A history of high acid levels
A history of seizures
A history of drug abuse
Qsymia can cause serious problems, including:
Kidney problems
Kidney stones
Suicidal thoughts or behaviors
Psychiatric or cognitive problems
Mood disorders
Sleep disorders
Vision changes
High acid levels in the blood
High ammonia levels in the blood
Fast heart rate
Elevated body temperature and decreased sweating
Low blood sugar (in people with Type 2 diabetes)
Low blood pressure (in people taking blood pressure medications)
Slowed growth (in children)
Severe drug or allergic reactions
It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Women of childbearing age should use effective birth control while taking this drug. Tell your doctor right away if you become pregnant.
Do not suddenly stop taking Qsymia except as directed by the prescriber. When it’s time to quit, doses may need to slowly decrease to prevent seizures or other withdrawal problems.
This medicine may increase the risk of suicidal thoughts or actions. Contact the prescriber if you have thoughts of hurting yourself, mood problems, or start engaging in worrisome behaviors.
This medicine may cause you to feel dizzy, drowsy, or confused or to have trouble thinking or speaking. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
The use of Qsymia can lead to addiction and abuse. An overdose can be fatal. Do not use more than your prescribed dose or take Qsymia for longer than prescribed. Call the prescriber if you think your medicine is not working.
Qsymia is a federally controlled substance. Giving or selling this drug to other people is against the law and hazardous. Keep this drug securely out of the reach of children and other people.
Qsymia interactions
Qsymia can never safely be taken with drugs called monoamine oxidase inhibitors (MAOIs). MAOIs must be discontinued 14 days before you can safely take Qsymia. You can find a list of MAO inhibitors here.
To avoid significant drug interactions, the prescribing healthcare provider should have a complete list of all the prescription drugs, over-the-counter medications, and supplements being taken, particularly:
Other diet pills
Anti-seizure medications
Other stimulants, including amphetamines
Drugs that make you sleepy, such as narcotic pain relievers, sleeping pills, benzodiazepines, barbiturates, antihistamines, or similar drugs
Drugs that make you pee (diuretics)
Oral diabetes medications
Birth control pills
Acetazolamide, amitriptyline, methazolamide, pioglitazone, zonisamide
Avoid alcohol or taking CBD products while taking Qsymia.
When taking phentermine, avoid other weight loss drugs or remedies unless cleared by the doctor. This includes weight loss drugs purchased with or without a prescription and weight loss supplements and herbal products.
Insulin and other diabetes medication dosages may need to be adjusted when phentermine is being used.
Tell doctors, dentists, or any other healthcare providers treating you about Qsymia before they prescribe new medications.
Qsymia side effects
Serious side effects
Talk to a doctor if you notice any signs or symptoms of a possible serious side effect, including:
Chest pain, fainting, trouble breathing, swelling of your feet or legs, blue skin or lips, dry cough
Bloody or dark urine, sudden back pain, stomach pain, painful urination
Fast, slow, pounding, or uneven heartbeat
Seizures
Unusual moods or behaviors, worsening depression, thoughts about hurting yourself, trouble sleeping
Problems with speech or memory, trouble concentrating, confusion
Lightheadedness, dizziness, or fainting
Eye pain, vision changes, vision loss
Dry mouth, increased thirst, muscle cramps, nausea or vomiting
Fast breathing, loss of appetite, unusual tiredness
Decreased sweating, fever, or feeling hot
Blistering, peeling, or red skin rash
Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
Less serious side effects
Numbness or tingling in the hands, arms, feet, or face
Dizziness
Trouble sleeping
Bad taste in your mouth
Dry mouth
Constipation
Sources:
Qsymia, Vivus LLC
Qsymia phentermine and topiramate capsule prescribing information, DailyMed (NIH National Library of Medicine)
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