Scroll down to learn more about Qsymia and see if it is the right medication for you.

What is Qsymia?

A unique blend of two powerful ingredients – phentermine and topiramate, Qsymia is FDA approved for weight loss. Qsymia offers a dynamic approach to shedding unwanted pounds. Phentermine, renowned for its appetite-suppressing properties, with topiramate, a trusted anti-seizure medication, to form a formidable duo. Through carefully calibrated dosages, Qsymia delivers significant results, helping individuals combat obesity.

How Does Qsymia Work?

Qsymia combines phentermine and topiramate to suppress appetite and enhance weight loss. Phentermine activates the sympathetic nervous system to reduce cravings, while topiramate amplifies its effects. Together, they deliver effective and sustainable weight loss.

Who Qualifies for Qsymia?

Qsymia is FDA-approved for the treatment of obesity. If you have a BMI of 30 or higher or a BMI of 27 or higher and at least one weight-related condition such as high blood pressure, diabetes, or high cholesterol, then you may be eligible to take Qsymia

Effectiveness of Qsymia for Weight Loss

Several large clinical trials have demonstrated the effectiveness of Qsymia in managing obesity when combined with diet and exercise. The CONQUER trial, conducted in 2011, showed that participants experienced an average weight loss of 8-10 kg (17-22 lbs) after 56 weeks of treatment with varying doses of Qsymia. The subsequent SEQUEL trial demonstrated sustained weight loss of around 9-10% of initial body weight after 108 weeks, with improved tolerance and beneficial effects on blood pressure and diabetes. In the EQUIP trial, conducted in 2011, participants with severe obesity experienced significant weight loss and improvements in waist circumference, blood pressure, and cholesterol levels after 52 weeks of Qsymia treatment combined with a calorie-restricted diet.

Qsymia vs Other Prescription Weight Loss Medications

Qsymia vs Contrave

Contrave, an FDA-approved prescription for obesity, combines Naltrexone and Bupropion. In the COR-II trial, participants using Contrave alongside a calorie-restricted diet and exercise lost approximately 6% of their body weight over 56 weeks, while also experiencing reductions in cardiometabolic risk factors. Compared to Qsymia, Contrave’s weight loss effects appear lesser, but it may be preferable for individuals with a history of heart conditions due to its composition. Additionally, its inclusion of bupropion may offer benefits for those with depression.

Qsymia vs GLP-1 medications

The GLP-1 agonist medications are a group of medications that are used to treat type 2 diabetes and obesity. They are mostly once-weekly to once-daily pen injections, except of  Rybelsus, which is an oral form of the GLP-1 agonists. Some examples are:

• Mounjaro (Tirzepatide)
• Wegovy, Ozempic, and Rybelsus (Semaglutide)
• Trulicity (Dulaglutide)
• Victoza and Saxenda (Liraglutide)

GLP-1 agonists mimic a natural hormone, regulating blood sugar, reducing appetite, and curbing food cravings. Studies show weight reductions of 10-20%, especially when combined with diet and exercise. For instance, in the SURMOUNT-1 Trial, participants using Mounjaro experienced a 15% average weight loss over 72 weeks. While effective, Qsymia may be preferable for those averse to injectable medications and can be more cost-effective.

Qsymia Side Effects

The most common side effects occur in around 5% of people taking Qsymia. This includes:

• Paraesthesia
• Dizziness
• Dysgeusia
• Insomnia
• Constipation
• Dry mouth

Qsymia Dosage and Administration

Qsymia is given as a once-daily oral capsule taken in the morning without food. You should not take Qsymia in the evening as it may cause insomnia. It is started at a dose of 3.75mg/23mg (phentermine 3.75mg/topiramate 23mg) for 14 days. After 14 days, it is increased to the recommended dose of 7.5mg/46mg. It can be gradually increased based on how well you tolerate the medication or if you are seeing results. The maximum dose of Qsymia is 15 mg/92mg.

Qsymia Contraindications and Warnings

Severe Allergic Reaction

You may experience a severe allergic reaction to Qsymia when first taking it. Signs of a severe allergic reaction include swelling of your face, lips, tongue, or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat. Let your provider know immediately if you have experienced this when taking Qsymia in the past.

Glaucoma

A serious condition affecting the eye called Acute Angle Closure Glaucoma has been reported in people who take Topiramate, which is a component of Qsymia. Acute Angle Closure Glaucoma has the potential to damage vision if not treated early on permanently. Therefore, if you have a history of glaucoma, then you should avoid Qsymia.

Acute Angle Closure Glaucoma symptoms include decreased vision or severe eye pain around one hour after taking Qsymia. If you experience these symptoms, notify your provider and visit the nearest medical facility.

Arrhythmias or Fast Heart Rate (Tachycardia)

Qsymia can increase your heart rate due to the component, Phentermine. This can be dangerous for those with a history of arrhythmias like atrial fibrillation, atrial flutter, and supraventricular tachycardia (SVT). For this reason, Qsymia should not be given to these patients.

Hyperthyroidism

Qsymia should be avoided for those with a history of hyperthyroidism and taking Levothyroxine. Since both medications can raise the heart rate, it could lead to troubles with the heart.

Drug Interactions

Qsymia should not be combined with Monoamine Oxidase Inhibitors like Marplan, Nardil, Emsam, and Parnate.

Pregnancy

Qsymia should not be taken if you are pregnant or planning to become pregnant. Qsymia can cause fetal harm and malformations during early pregnancy.

Qsymia Cost

$250/month

Where Can I Get Qsymia?

Compounding and commercial pharmacies by prescription.

Omni Health NP is a virtual wellness practice that connects you with medical providers, like licensed nurse practitioners, to help you optimize your weight loss journey. We provide monthly video chats with actual medical providers to provide guidance about weight management and to get you started on prescription weight loss medications to supplement your weight loss plan.

References

1. Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, Day WW. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial. Lancet. 2011 Apr 16;377(9774):1341-52. doi: 10.1016/S0140-6736(11)60205-5. Epub 2011 Apr 8. Erratum in: Lancet. 2011 Apr 30;377(9776):1494. PMID: 21481449.
2. Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, Schwiers M, Day WW, Bowden CH. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012 Feb;95(2):297-308. doi: 10.3945/ajcn.111.024927. Epub 2011 Dec 7. PMID: 22158731; PMCID: PMC3260065.
3. Allison DB, Gadde KM, Garvey WT, Peterson CA, Schwiers ML, Najarian T, Tam PY, Troupin B, Day WW. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012 Feb;20(2):330-42. doi: 10.1038/oby.2011.330. Epub 2011 Nov 3. PMID: 22051941; PMCID: PMC3270297.
4. Apovian, C.M., Aronne, L., Rubino, D., Still, C., Wyatt, H., Burns, C., Kim, D., Dunayevich, E. and (2013), A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity, 21: 935-943. https://doi.org/10.1002/oby.20309
5. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038. Epub 2022 Jun 4. PMID: 35658024.