Qsymia for Obesity

What is Qsymia?

Qsymia is a prescription medication that combines two active ingredients: phentermine and topiramate. It is intended for individuals with obesity who have previously attempted diet and exercise but now require additional medication to support their weight loss journey.

This medication is approved for weight loss when used in conjunction with an improved diet and regular exercise for obese adults who meet the following criteria:

• Those with a Body Mass Index (BMI) of 30 kg/m² or higher
• Those with a BMI of 27 kg/m² or higher AND have comorbid weight-related risk factors like type 2 diabetes mellitus, high blood pressure, and high cholesterol

BMI is calculated using your weight and height to estimate your body's weight distribution. While BMI may not account for variations in body shape and muscle mass, a significantly high BMI often serves as an indicator of obesity.

How Does Qsymia Work for Weight Loss?

Qsymia achieves its weight loss effects through a combination of phentermine and topiramate, each with distinct mechanisms of action that work in tandem to promote weight reduction.

Phentermine

Phentermine, closely related to amphetamines, exerts its influence on the central nervous system. It accomplishes this by augmenting the release of specific neurotransmitters, such as norepinephrine, which then transmit signals to the brain to decrease hunger and increase the sensation of fullness. Consequently, this leads to a diminished appetite and a reduction in overall food consumption.

Topiramate

Topiramate, on the other hand, is an antiepileptic medication known to impact appetite and metabolism. While its precise mechanism concerning weight loss is not entirely clear, it is theorized to affect neural pathways governing appetite and food cravings. Moreover, topiramate may alter taste perception, diminishing the pleasure derived from certain foods, ultimately resulting in a lower calorie intake.

The synergy between phentermine and topiramate within Qsymia is thought to be the key to its weight loss effectiveness. Phentermine aids in appetite control and the reduction of food intake, while topiramate potentially amplifies these effects and may also influence the body's metabolism and energy expenditure.

What to Expect from Qsymia

The outcomes from clinical trials conducted for Qsymia approval are quite promising. They reveal significant weight loss in the majority of individuals who were prescribed doses of 7.5/46 mg and 15/92 mg of phentermine/topiramate. In just one year, more than 60% of patients achieved a minimum reduction of 5% in their initial body weight, while over 35% experienced a substantial 10% decrease.

However, it's essential to keep in mind that a significant portion of individuals may regain the weight they've lost once they discontinue the treatment. This highlights the importance of maintaining a balanced diet and a consistent exercise routine even after completing a Qsymia regimen. Using weight loss medication should be seen as a kickstart to your weight loss journey, with the understanding that sustainable results rely on ongoing lifestyle efforts.

Common Side Effects of Qsymia

The likelihood of experiencing side effects increases with higher doses of the medication. While not everyone experiences all potential side effects, it's important to remain informed about potential changes that may arise while taking Qsymia.

• Tingling or prickling sensations
• Dizziness
• Altered taste perception
• Difficulty falling asleep or staying asleep
• Constipation
• Dry mouth

A rare side effect of Qsymia is the development of self-harming thoughts and behaviours. This is serious and requires immediate medical intervention.

How Do I Take Qsymia?

Qsymia is an oral medication taken once daily. Typically, treatment begins with a low dose, progressively increasing every two weeks until reaching the optimal dose of 7.5/46 mg of phentermine/topiramate.

Several important instructions about taking Qsymia:

• Morning Administration
  Qsymia should be taken in the morning as it can lead to difficulty sleeping.
• Weight Loss Assessment
  Every 12 weeks, a re-evaluation of weight loss progress is recommended. If a reduction of 3% of body weight has not been achieved during this period, the dosage may need to be increased or the medication might need to be discontinued.
• Dose Adjustment at 15/92 mg
  Following a dosage elevation to 15/92 mg of phentermine/topiramate, if a weight loss of 5% of body weight does not occur, discontinuation of the medication is advised as significant weight loss is unlikely.
• Gradual Discontinuation
  When discontinuing Qsymia at the 15/92 mg dose, it's important to taper the dosage gradually. This involves taking a dose every other day for at least one week before stopping completely. This gradual approach reduces the potential risk of experiencing seizures.
• Dose Reduction for Kidney/Liver Conditions
  Individuals with moderate kidney and/or liver diseases should not exceed a dose higher than 7.5/46 mg of phentermine/topiramate. This limitation is in place to prevent potential toxicity issues.

Medications to Avoid While on Qsymia

Several medications should not be taken with Qsymia, as their combination can pose risks and should be avoided.

• Alcohol
  Combining Qsymia with alcohol or other nervous system depressants, like benzodiazepines and sleeping pills can lead to an intensified depressive effect on the nervous system, which can be hazardous.
• Non-Potassium Sparing Diuretics
  Qsymia and non-potassium sparing diuretics both contribute to a reduction in your body's potassium levels. Taking them together is risky due to the potential danger posed by decreased potassium levels.
• Monoamine Oxidase Inhibitors (MAOIs)
  Qsymia and MAOIs must never be taken simultaneously as it can cause dangerous elevation of blood pressures. There must be a 14-day period after stopping MAOIs before starting Qsymia.
• Anti-Seizure Medications
  Since topiramate is an anti-seizure medication, the use of other anti-seizure medications alongside Qsymia requires consultation and guidance from a healthcare provider.
• Oral Birth Control Pills
  While safe to use birth control pills concurrently with Qsymia, these pills might exhibit increased concentration in the body. This elevation could potentially lead to heightened birth control side effects, but it is not hazardous and should not compromise the effectiveness of the birth control pills.

Who Should Avoid Qsymia

There are specific conditions where using Qsymia may pose risks, and these include:

• Pregnancy
  Real-world data suggests that Qsymia can be harmful to a developing fetus. Its use during the first trimester of pregnancy has been associated with an increased risk of cleft palate/cleft lip. It is not only advisable to avoid Qsymia during pregnancy but also essential to confirm a negative pregnancy test before starting this medication.
• Glaucoma
  In rare instances, Qsymia has been linked to closed-angle glaucoma. Individuals with a known history of glaucoma should refrain from using this medication. Additionally, if you experience symptoms of glaucoma, such as visual changes or eye pain, seek immediate medical attention.
• High Blood Pressure and Type 2 Diabetes
  Individuals with high blood pressure and type 2 diabetes should exercise caution when considering Qsymia. It can lower blood sugar and raise blood pressure. It's crucial to ensure that a healthcare provider has provided proper instructions for managing your diabetes and blood pressure medications while taking Qsymia.
• Monitoring Blood Levels
  Qsymia may lead to an increase in sodium bicarbonate and creatinine levels in the blood while decreasing potassium levels. These levels should be monitored before and throughout treatment to ensure the safety of Qsymia use.