Qsymia (Phentermine and Topiramate) – Oral

What Is Qsymia?

Qsymia is a prescription medication that, along with changes in eating habits and exercise, can aid in weight loss in certain people. It's classified as a Schedule IV drug (controlled substance). Qsymia combines Adipex-P (phentermine), an anorexiant (reduces food intake), and Topamax (topiramate), an anti-seizure medicine. It contains a synthetic yellow dye called tartrazine. 

Qsymia works by releasing certain chemicals in the brain (hypothalamus), suppressing appetite, and reducing the amount of food you eat. However, the exact way it works is unknown.

What Is Qsymia Used For?

Qsymia (phentermine and topiramate) is used in addition to diet and exercise to help with weight loss and weight management. Body mass index (BMI), a measure of body fat in adults, is considered when prescribing this medicine.

Qsymia may be prescribed to adults with a BMI greater than or equal to 30 kilograms per square meter (kg/m2) (considered obesity) or people with a BMI greater than or equal to 27 kg/m2 (considered overweight) and with one or more weight-associated medical condition. Qsymia may also be prescribed to people aged 12 years and older with a BMI in the 95th percentile or greater.

It's important to note that the BMI metric is thought to be flawed. BMI does not necessarily consider important body composition factors like frame size and muscle mass. And BMI definitely does not give the complete picture of an individual's well-being.

Consider requesting a body composition test—for example, a skinfold measurement or a DEXA (dual energy X-ray absorptiometry) body composition scan—from your healthcare provider in addition to other parameters that they may measure.

It's essential to note that obesity is also linked to a host of other social, economic, and environmental causes (known as determinants of health). These systemic issues are larger components of health that also need to be addressed.

How to Take Qsymia 

Take Qsymia as directed by your healthcare provider in the morning. Take with or without food. Do not take close to your sleep time to avoid sleep problems like insomnia.

Avoid drinking alcohol while taking Qsymia. Doing so may increase topiramate levels in your body and worsen its side effects.

Storage

Store Qsymia at room temperature (59 to 77 degrees Fahrenheit) in a dry place with a tightly closed lid. Do not store it in a bathroom or any room with moisture. Keep it in a locked box, where people may not be able to get to it. Store this medicine away from children and pets, ideally locked in a cabinet or closet.

If you plan to travel with Qsymia, get familiar with your final destination's regulations. In general, be sure to make a copy of your Qsymia prescription. Keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, ask your pharmacist or healthcare provider.

Discard all unused and expired medications, but do not pour them down the drain or in the toilet. Ask your pharmacist or medical provider about the best ways to dispose of this medicine. And check out drug take-back programs in your area.

What Are the Side Effects of Qsymia?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Many people notice no negative side effects at all from taking Qsymia. However, some people do experience problems while taking the medication.

Common Side Effects

Common side effects of Qsymia include:

• Dry mouth
• Headache
• Constipation
• Dry mouth
• Numbness and tingling in the arms, feet, or face
• Change in taste or having a loss of taste
• Nausea
• Diarrhea
• Stuffy nose
• Loss of strength
• Insomnia

Severe Side Effects

Qsymia can cause many side effects. Some may be life-threatening. Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Severe side effects include:

• Low blood sugar 
• Mood changes
• Muscle pain or weakness
• Abnormal heartbeat
• Urinary tract infection
• Kidney stone
• Trouble focusing
• Trouble sleeping
• Lack of sweat
• Panic attacks
• Vision changes
• Eye redness, irritation, or pain

This medication may cause severe eye problems. If left untreated, this can result in permanent vision loss. Contact your healthcare provider if you notice any new eye symptoms, such as blurred vision, eye pain, or redness.

People taking Qsymia may have an increased risk of having thoughts or actions of suicide. Let your healthcare provider know if you have any thoughts of hurting yourself. 

Qsymia is associated with the worsening of certain health conditions, such as:

• Glaucoma (group of diseases that can damage the optic nerve, causing vision loss)
• Kidney stone formation
• Suicidal ideation
• Diabetes
• Heart conditions, including low blood pressure
• Cognitive dysfunction and psychiatric disturbances

Note that prolonged use of this medicine may lead to dependency. Hence, sudden discontinuation may lead to withdrawal symptoms, including seizures. Your healthcare provider may taper your dose for at least one week, taking Qsymia every other day.

Dosage: How Much of Qsymia Should I Take?

Modifications

Severe allergic reaction: Avoid using Qsymia if you have a known allergy to it or any of its ingredients.

Pregnancy: Qsymia is harmful to an unborn fetus. It increases the risk of cleft lip (tissue making up the lip does not form completely) or cleft palate (tissue in the mouth does not fuse properly, causing an opening or split in the roof of the mouth) in your fetus, especially during the first trimester. Therefore, a negative pregnancy result is required before starting this medicine. Also, use effective contraception while on Qsymia.

Breastfeeding: Topiramate is present in breast milk. Due to the potential for adverse reactions in breastfed infants (for example, tremors, weight loss, high blood pressure), it is not recommended to breastfeed while taking this medicine.

Children: This drug is not approved for use in children younger than 12 years of age.

Adults over 65 years: This population generally tolerates Qsymia. However, doses may start at the lower range due to possible kidney or liver function differences.

Missed Dose

If you miss a dose of Qsymia, skip the missed dose and take your next dose at the regularly scheduled time. Do not double your dose or take more than one dose at a time.

Try to find ways that work for you to help yourself remember to routinely take your medication. If you miss too many doses, Qsymia might be less effective at treating your condition.

Overdose: What Happens If I Use Too Much Qsymia?

Convulsions, hallucinations, tremors, aggressiveness, and rapid breathing are possible indications of an overdose. Individuals who have consumed alcohol while on this medicine are more prone to have severe symptoms.

Precautions

What Are Reasons I Shouldn't Take Qsymia? 

Avoid taking Qsymia if you have:

• Hypersensitivity to phentermine (a type of stimulant) or other sympathomimetic amines, or any ingredient in its formulation
• Glaucoma
• A positive pregnancy test or suspected pregnancy 
• Hyperthyroidism (overactive thyroid)
• Used during or within 14 days after MAO-A (monoamine oxidase-A) inhibitor therapy
• Used alcohol within six hours of taking Qsymia
• Aniline dye allergy (tartrazine dye)

What Other Medications Interact With Qsymia?

Certain medications interact with Qsymia. These include:

• Alcohol
• Oral contraceptives
• Non-potassium-sparing diuretics like furosemide

What Medications Are Similar?

Other drugs similar to Qsymia that may be used to help with weight loss include:

• Alli (orlistat)
• Contrave (naltrexone-bupropion)
• Saxenda, Victoza (liraglutide)

Qsymia and liraglutide may have the highest possibility of achieving an "ideal" weight compared to other weight loss medications like Alli or Contrave.

Above is a list of medications also prescribed to help with weight loss. It is not a list of medicines recommended to take with Qsymia. You should not take these drugs together unless your healthcare provider tells you to. Ask your pharmacist or a healthcare practitioner if you have questions.

How Can I Stay Healthy While Taking Qsymia?

Although dieting and exercise help with weight loss, they may not be enough for some people. Using weight loss pills like Qsymia may help. However, it may cause severe and sometimes long-term problems, including eye and heart issues.

Watch your body closely while on this medicine. Do not minimize any side effects that you experience. Talk to your healthcare provider immediately if you have any side effects while on this drug.

Work with a healthcare team that includes a registered dietitian (RD) or registered dietitian nutritionist (RDN)—and perhaps one who is a board-certified specialist in obesity and weight management (CSOWM). RDs/RDNs can help you explore your eating, movement, and medication habits. RDs can also help you eat better to feel better.

It can be difficult to give yourself permission to ask for and accept help. But be open when communicating your needs with your family and friends, as well as your healthcare team. You don't have to do this alone.

Continuous data collection is being conducted to track pregnancy and baby outcomes following exposure. All pregnancies exposed to Qsymia should be reported to the Qsymia Pregnancy Surveillance Program (888-998-4887).