Qsymia is a prescription medication approved for chronic weight management in adults with obesity or overweight individuals with at least one weight-related condition, such as high blood pressure or type 2 diabetes. It combines two active ingredients: phentermine, an appetite suppressant, and topiramate extended-release, which is also used to treat epilepsy and migraines. This combination works to reduce hunger, increase feelings of fullness, and improve overall metabolic function. Like most other weight loss drugs, you must eat healthy and exercise for this medication to be effective and facilitate weight loss.
How Qsymia Works
Phentermine, similar to the phentermine found in Adipex and Fastin, which have been on the market since the mid-1970s, works as an appetite reducer. Topiramate has been available for a decade and is used for seizures and headaches. The combination of phentermine and topiramate in Qsymia works synergistically to reduce hunger, increase feelings of fullness, and improve overall metabolic function.
Dosage and Administration
Qsymia should be taken orally once daily in the morning, with or without food, as directed by your doctor. It is crucial not to take Qsymia before bed, as it can cause insomnia. The dosage of Qsymia depends on your condition, and your doctor will prescribe the right dosage for you. Adults typically start with 3.75 milligrams of phentermine and 23 milligrams of topiramate. After two weeks, your doctor might increase your dosage to 7.5 milligrams of phentermine and 46 milligrams of topiramate. After this, your doctor may adjust your dosage as needed.
Dietary Recommendations While Taking Qsymia
According to WebMD, Qsymia is most effective when combined with a low-calorie diet. Experts emphasize the importance of providing your body with a substantial amount of food for the medicine to be effective. Here's a breakdown of dietary guidelines to follow while on Qsymia:
Calorie Intake
A low-calorie diet is essential for maximizing the effectiveness of Qsymia. Consult with your healthcare provider or a registered dietitian to determine an appropriate daily calorie target based on your individual needs and activity level.
Read also: The Hoxsey Diet
Meal Frequency
Consistently supplying your body with food is important. Spacing out your meals can keep your body functioning and may actually help you eat less. Studies have shown that eating three meals can help you feel full longer, compared with skipping meals. There is no single eating schedule that is best or that works for everyone. Think about your day, consult with your healthcare provider, and find a schedule that works for you.
Healthy Food Choices
Focus on nutrient-dense foods that support weight loss and overall health.
- Lean Protein: Include sources like chicken, fish, turkey, beans, and tofu to help you feel full and maintain muscle mass.
- Fruits and Vegetables: These are low in calories and high in fiber, vitamins, and minerals.
- Whole Grains: Opt for whole grains like oats, brown rice, and whole wheat bread over refined grains.
- Healthy Fats: Incorporate sources like avocados, nuts, seeds, and olive oil in moderation.
Foods and Beverages to Avoid
- Caffeine: Caffeine can increase the side effects of Qsymia. It is best to avoid foods that contain caffeine or high amounts of the stimulant. This means you should not drink coffee, eat chocolate, or drink caffeinated sodas. You should also avoid non-prescription supplements that contain caffeine. Experts recommend weaning yourself off of caffeine before you start taking the drug, if possible. After an extended period of time, your body will no longer crave foods that contain large amounts of caffeine. Because of this, you will also need to eliminate tea and chocolate from your diet, no matter how much your body may crave it.
- Alcohol: You should completely avoid alcohol if you take Qsymia because alcohol affects the central nervous system and can cause cardiovascular problems. Drinking alcohol on Qsymia increases heart rate. One study found that drinking while on Qsymia increased heart rate by 24 beats per minute.
- Sugary Drinks and Processed Foods: These can hinder weight loss efforts and may exacerbate side effects.
Sample Eating Schedules
Sarah's Schedule: Sarah wakes up at 5:00 AM every morning, because she likes to avoid morning traffic. She eats breakfast-oatmeal with raisins and skim milk-at 6:00 AM. By 10:00 AM, she is hungry again. She used to have a few donuts. Now she has a whole wheat English muffin with 1 tablespoon of peanut butter. Lunch, usually a turkey sandwich and celery sticks, is at 12:30 PM. She used to go straight through to dinner without eating. She reviewed her food diaries and saw that she would get very hungry and snack as she cooked dinner. Her healthcare provider suggested that she have a healthy snack, such as yogurt, right before she leaves work. Now when she gets home, she is not ravenous.
Steve's Schedule: Steve has a very short commute and doesn’t need to wake up until 8:00 AM. (Lucky Steve!) He prefers to eat breakfast at 9:00 AM-a cereal bar and piece of fruit at his desk. For Steve, lunch at noon and dinner at 6:00 PM works just fine, but he is often up until midnight and gets hungry. Steve’s food diaries showed him that his nighttime snacking was really adding up. He used to eat a lot of chips and other crunchy, salty foods.
Potential Side Effects
Like any medication, Qsymia comes with its own set of side effects. The most commonly observed side effects in controlled clinical studies, 5% or greater and at least 1.5 times placebo, in adults include paraesthesia, dizziness, dysgeusia, insomnia, constipation, and dry mouth. While side effects are generally mild, Qsymia does have some severe side effects to be aware of, including:
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- Low blood sugar
- Muscle pain or weakness
- Trouble focusing
- Vision changes
- Suicidal thoughts or actions
Because severe side effects are damaging, it is important to avoid high caffeine foods, as this leaves you more susceptible to other health conditions.
Serious Warnings
- Pregnancy: Qsymia can cause fetal harm. Data from a pregnancy registry and epidemiologic studies indicate that a fetus exposed to topiramate, a component of Qsymia, in the first trimester of pregnancy has an increased risk of oral clefts (cleft lip with or without cleft palate). Pregnancy testing is recommended before initiating Qsymia treatment in patients who can become pregnant and monthly during Qsymia therapy. Patients who are pregnant must not take Qsymia. Patients who can become pregnant should have a pregnancy test before taking Qsymia and every month while taking Qsymia and use effective birth control (contraception) consistently while taking Qsymia. If you become pregnant while taking Qsymia, stop taking Qsymia immediately, and tell your healthcare provider right away.
- Suicidal Thoughts or Behavior: Topiramate, a component of Qsymia, increases the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Discontinue Qsymia in patients who experience suicidal thoughts or behaviors.
- Acute Angle Closure Glaucoma: Acute angle closure glaucoma has been reported in patients treated with topiramate, a component of Qsymia. Symptoms include acute onset of decreased visual acuity and/or eye pain. The primary treatment to reverse symptoms is immediate discontinuation of Qsymia.
- Visual Field Defects: Visual field defects (independent of elevated intraocular pressure) have been reported in clinical trials and in postmarketing experience in patients receiving topiramate. In clinical trials, most of these events were reversible after topiramate discontinuation.
- Mood Disorders and Insomnia: Qsymia can cause mood disorders, including depression and anxiety, as well as insomnia. Patients with a history of depression may be at increased risk.
- Cognitive Dysfunction: Qsymia can cause cognitive dysfunction (e.g., impairment of concentration/attention, difficulty with memory, and speech or language problems, particularly word-finding difficulties).
- Reduction in Height Velocity: Qsymia is associated with a reduction in height velocity (centimeters of height gained per year) in obese pediatric patients 12 to 17 years of age. Monitor height velocity in pediatric patients treated with Qsymia.
- Metabolic Acidosis: Hyperchloremic, non-anion gap, metabolic acidosis has been reported in patients treated with Qsymia. Measurement of electrolytes including serum bicarbonate prior to starting Qsymia and during Qsymia treatment is recommended.
- Increase in Serum Creatinine: Qsymia can cause an increase in serum creatinine that reflects a decrease in renal function (glomerular filtration rate). Therefore, measurement of serum creatinine prior to starting Qsymia and during Qsymia treatment is recommended.
- Serious Skin Reactions: Serious skin reactions (Stevens-Johnson Syndrome [SJS] and Toxic Epidermal Necrolysis [TEN]) have been reported in patients receiving topiramate. Qsymia should be discontinued at the first sign of a rash, unless the rash is clearly not drug related.
- Central Nervous System (CNS) side effects: The use of prescription sleep aids, anxiety medicines, or drinking alcohol with Qsymia may cause an increase in CNS symptoms such as dizziness and light-headedness.
- Possible seizures: Seizures may happen in people who may or may not have had seizures in the past if you stop Qsymia too fast.
- Kidney stones: Drink plenty of fluids when taking Qsymia to help decrease your chances of getting kidney stones.
- Decreased sweating and increased body temperature (fever): People should be watched for signs of decreased sweating and fever, especially in hot temperatures.
Other important warnings
- Do not use this medicine if you have used an MAO inhibitor (MAOI) such as Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days. Using these medicines together may cause serious unwanted effects.
- This medicine may be habit-forming. If you think this medicine is not working properly after you have taken it for a few weeks, do not increase the dose. Instead, check with your doctor.
- This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these side effects, tell your doctor right away.
- Check with your doctor immediately if you have a decrease in vision, blurred vision, change in near or distance vision, or pain around the eyes during and after treatment with this medicine. Your doctor may want you to have your eyes checked by an eye doctor.
- This medicine may cause some people to become dizzy, drowsy, or have trouble in thinking or speaking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well.
- This medicine may cause nausea, muscle tremors, fast breathing, problems eating, fast heartbeat, restlessness, and abdominal or stomach pain. Tell your doctor right away if you have any of these symptoms. This may be a sign that you may be having a metabolic acidosis (too much acid in the blood).
- This medicine may decrease the density of bones, which can make your bones weak. Talk with your doctor if you have any concerns about this.
- This medicine may cause slow growth. For children, the doctor will need to keep track of height and weight to make sure that the child is growing properly.
- This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, prescription pain medicines, or sleep medicines. Check with your doctor before taking any of the above while you are using this medicine.
- Do not suddenly stop taking this medicine without first checking with your doctor. Stopping the medicine suddenly may cause your seizures to return or to occur more often. Your doctor may want you to gradually reduce the amount you are using before stopping completely.
- Check with your doctor right away if you have sudden back pain, stomach pain, pain while urinating, or bloody or dark urine. These may be symptoms of kidney stones.
- This medicine may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine. Overheating may result in heat stroke. Also, hot baths or saunas may make you dizzy or faint while you are taking this medicine.
- Check with your doctor right away if you have decreased urine, dry mouth, irregular heartbeat, increased thirst, loss of appetite, mood changes, muscle pain or cramps, nausea or vomiting, numbness or tingling in the hands, feet, or lips, seizures, trouble breathing, or unusual tiredness or weakness. These may be symptoms of hypokalemia.
- Serious skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness with this medicine.
- This medicine may cause your body temperature to go down especially when taking valproic acid, which is a medicine to control seizures. You may have tiredness, weakness, confusion, and abnormal heartbeat and breathing. Tell your doctor right away if you feel any of these side effects.
- Birth control pills (containing estrogen) may not work properly if you take them while you are taking this medicine. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are using this medicine. If you have any questions about this, check with your doctor or pharmacist.
- Check with your doctor right away if you are having unusual drowsiness, dullness, tiredness, weakness, or feelings of sluggishness, mental depression or anxiety, nightmares or unusually vivid dreams, or vomiting. These may be symptoms of a serious condition called hyperammonemic encephalopathy.
- Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements (including any weight loss products).
Precautions and Contraindications
Before starting Qsymia, inform your doctor if you:
- Are pregnant or planning to become pregnant
- Have glaucoma
- Have thyroid problems (hyperthyroidism)
- Are taking certain medicines called monoamine oxidase inhibitors (MAOIs) or have taken MAOIs in the past 14 days
- Are allergic to topiramate, sympathomimetic amines such as phentermine, or any of the ingredients in Qsymia
- Have a history of depression or mood disorders
- Have kidney or liver problems
Avoid the use of Qsymia with other drugs that inhibit carbonic anhydrase (e.g., zonisamide, acetazolamide or methazolamide). Use of topiramate by patients on a ketogenic diet may also result in a physiological environment that increases the likelihood of kidney stone formation. Patients treated with Qsymia should be advised to monitor for decreased sweating and increased body temperature during physical activity, especially in hot weather. When prescribing Qsymia, patients should be monitored for hypokalemia.
Monitoring and Follow-Up
It is essential that your doctor monitors your progress when you take Qsymia. Your doctor may request regular blood and urine tests to monitor your progress. After 12 weeks of treatment with QSYMIA 7.5 mg/46 mg, evaluate weight loss for adults or BMI reduction for pediatric patients aged 12 years and older. After 12 weeks of treatment with QSYMIA 15 mg/92 mg, evaluate weight loss for adults or BMI reduction for pediatric patients aged 12 years and older. Monitor the rate of weight loss in pediatric patients.
Cost and Availability
The cost of Qsymia can vary based on your insurance coverage and pharmacy. Without insurance, the monthly cost can range from $200 to $300. $98 home delivery pharmacy pricing includes 6-week New Patient Packs, 6-week Titration Packs and all 30-day prescriptions. Additional shipping and handling costs will apply. This is a cash only program - insurance claims will not be processed. Please see QsymiaEngage.com for full program details. Virgin Islands. and is neither sponsored by nor affiliated with the makers of Qsymia. Costco pricing and program is exclusive to Costco Members paying cash.
Read also: Weight Loss with Low-FODMAP
Lifestyle Modifications
Qsymia is most effective when combined with lifestyle modifications. These include:
- Healthy Eating: Focus on a balanced diet with plenty of fruits, vegetables, lean protein, and whole grains.
- Regular Exercise: Aim for at least 150 minutes of moderate-intensity exercise per week.
- Behavioral Changes: Practice mindful eating and develop strategies to manage stress and emotional eating.
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