Qsymia: Effective Weight Loss — Well Tolerated-Few Side Effects, Appetite and Cravings Control

Review and Updated by Dr Richard Liipman M.D.
Board Certified Internal Medicine/Endocrinology

Qsymia, a combination of phentermine and Topamax, is one of the most effective weight loss pills that is taken orally.  Qsymia by Vivus Pharmaceuticals was the first new diet medication approved by the FDA in 15 years. After many years of frustration, the FDA concluded that most weight loss physicians already knew: it is almost impossible to lose large amounts of weight without some form of medical assistance.  Qsymia is a combination of two older medications, phentermine and topiramate, in an extended-release form. This medication reduces appetite and produces fullness and early satiety as well as eliminating most cravings which results significantly reduced food consumption. Health care providers have observed that this dual-action produces rapid weight loss that is both safe and extremely effective. 

The forces that tell some individuals to eat are so powerful they make “will power” almost useless over the long term. I am not talking about 10 or 15 pounds, but 50-100 lbs. and higher. The signals to eat converge on the appetite centers of the brain from the environment, nervous system, stomach, and even the body’s fat stores. Qsymia by several independent actions diminishes the urge to eat, especially pleasing high carb foods as it produces fullness. Its ideal for chronic weight management. All of these effects are very similar to what we see in the new GLP-1 injections. The difference is they happen quicker, but perhaps not as large an effect as the GLP-1s have. This makes Qsymia ideal for patients that have perhaps 20 or 25 lb to lose, as it happens so quickly. 

Qsymia: How Long Does it Take to Work?

Qsymia has 2 components–phentermine and Topamax.  Both medications produce effects in the brain very quickly; usually, some mild effect is seen even after 1 day. However, it takes much longer to reach the full effect of these drugs, as they work in different areas affecting various brain chemicals.  After 1 week, some of the effect is seen, but it actually takes as long as 3-4 weeks to get the full effect.  There is some variation in individuals.  The product is supplied in 4 doses, which are slowly increased as tolerated.

Qsymia Price  and Coupons

Qsymia costs more than generic phentermine because it’s a new drug. Coupons for price reduction are available on the qsymia.com website. Distribution by a new pharmacy provider has reduced prices fora month to less than one hundred dollars.  Compare this to the cost of GLP-1s, which can cost up to ten times as much per month. Combinations of different dosages are also offered.

Best Coupon can be obtained on line

Qsymia On-Line
Qsymia can be purchased easily on-line with a prescription. through the manufacturer’s website.

Dr. Lipman’s Experience Treating Patients with Qsymia since  2012

Individualizing Dosing of Qsymia for Maximal Weight Loss

Qsymia is a Class IV controlled drug and can only be obtained by prescription from a licensed physician. Each physician has to take a training course so he is familiar with the drug and it’s side effects.

I have treated several thousand patients with Qsymia since it’s approval 10 years ago. Patients lose between 2.5 and 3.5 lbs per week over the average of 8 weeks. Many lost more in the beginning. Many who had a large amount of weight to lose took the medication for 8 to 12 months with excellent results.

Cravings are well-controlled on Qsymia, similar to GLP-1s.

The people that do best on Qsymia are those that have a large element of cravings and unusual hunger as compared to the more average obese person. The combination of Topamax and Phentermine suppresses cravings and hunger at the same time. Unlike GLP-1s, they work from the very first day they’re taken.

Side effects were few and did not limit its use. I was able to eliminate most side effects by individualizing dosage according to patient responses. Many patients, especially older individuals, do very well on the starter dose of 3.75 mg/23 mg. A majority of my patients lose the most weight on the “recommended dose” of 7.5 mg/46 mg and elect to remain at that dose. I have learned that there is a considerable difference in response to the medication from person to person. The most successful weight loss patients are those who take the lowest effective dose.

Qsymia Dosages: Extensive Range of Doses Permits Individual Dosing 

Qsymia  Dosages come in four dosage strengths: 3.75/23, 7.5/46, 11.25/69, and 15/92. The first number is the phentermine, and the second is the topiramate. There are two starter doses and two treatment doses suggested. In adjusting Qsymia dosages, each individual needs to start with the lowest dose and gradually increase the dose until he/she is receiving maximum benefit without side effects. Note there is almost a 5-fold difference between the lowest and highest doses. This permits the physician to individualize the dose to get the most therapeutic benefit with the least side effects.

Qsymia Advantages over Phentermine Alone

Qsymia is the most effective weight loss medication because its action is by combining phentermine’s reduction of appetite with topiramate’s effect on cravings,  satiety and reduction in impulsive eating. This allows patients to achieve greater weight loss results. This leads to increased efficacy with lower doses, often leading to fewer side effects. Qsymia’s advantages come from synergism.  Synergism in medication is the combining of two different chemicals, each one affecting the target organ along a different pathway yet producing results greater than the sum of the individual components.

Phentermine has been used for over 60 years as an appetite suppressant. It is the most famous and widely used of all diet medications. Marketed as Adipex, Iona-min and Fasten, it has seen widespread use around the world. Topiramate (Topamax) has been used for a long time as a treatment for headaches and seizures. Each drug has a different effect in the brain. Scientists believe catecholamine reuptake inhibition in the hypothalamus of the brain may result in reduced appetite and thermogenesis (an increase in metabolism). Topiramate works by decreasing appetite and increasing satiety in another part of the brain.

            Graph 1

graph 2

The above graph shows the synergism of the two drugs that make up Qsymia. In the “Dual Action of….” graph above hunger is first controlled by the phentermine early release in the morning and by Topiramate in the evening.

Qsymia Weight Loss Results: How Effective is Qsymia?

Qsymia results are somewhat surprising for the large amounts of weight loss. It is especially effective for those with cravings, compulsive eating and large appetites. The feelings of fullness produced by the drug are as important as the significant reduction in appetite. This is a drug approved for long-term use – months and even years! Here are some of the Qsymia in Graph  3results:    Notr the rapid onset of the effect 1/2 of the wt loss happened in the first 8 weeks of the 56 week of the|study. Much faster than GLP-1 which involces months of buildups. Note in the graph below the dose effectiveness of Qsymia.

      Graph 3

Qsymia Results: Weight Loss in Patients Without Medical Complications-as much as 14.4% weight loss from baseline!

The graph above shows the results of a Qsymia clinical trial. It compares the Qsymia weight loss results over 52 weeks of 680 subjects (that completed the trial) treated with either 3.75mg/23mg capsules, 15mg/92mg capsules, or placebo. Weight loss is expressed as percent change in baseline weight at 52 weeks.

Qsymia results showed a mean weight loss  of 6.7% in the starter dose group and 14.4% in the high dose group compared to 2.1% in the placebo group. Weight loss in the starter dose group was over 3 times that of the placebo group. Patients in the high-dose group lost almost 7 times as much weight as the placebo group!

Qsymia Results:  Weight Loss in Patients With Medical Complications

This graph shows the results of a Qsymia clinical trial on subjects with co-morbid medical conditions such as hypertension (high blood pressure), hyperlipidemia (high cholesterol), and diabetes. 1,542 subjects participated in the 52-week trial.

The mean weight loss was 9.6% in the low dose (7.5 mg/46 mg) group and 12.4% in the high dose group compared to 1.6% in the placebo group. Weight loss in the recommended dose group was 6 times that of the placebo group. Patients in the high-dose group lost almost 8 times as much weight as the placebo group.

Side Effects of Qsymia

Side effects of Qsymia in patients taking it for up to one year were paraesthesia (tingling or pins-and-needles sensations most often in the hands, feet, or face), dizziness, dysgeusia (distortion of the sense of taste), insomnia, constipation, and dry mouth. This medication can cause a mild (2 bpm) increase in resting heart rate.

Side effects of Qsymia that were more serious, but less common side effects can include acute angle closure glaucoma, suicidal thoughts or behavior, depression, and anxiety. In some patients, Qsymia can cause cognitive dysfunction (e.g., impairment of concentration/attention, difficulty with memory, and speech or language problems, particularly word-finding difficulties). These side effects of Qsymia are very rare and I have not seen them.

Who Can Take Qsymia?

Qsymia is indicated as an adjunct to a reduced-calorie diet. You can qualify for Qsymia therapy with the following BMI’s: 1. 30 kg/m2 without medical problems, or 2. 27 kg/m2 with medical problems. Medical problems include hypertension, diabetes mellitus, and hyperlipidemia.

The effect of Qsymia on cardiovascular morbidity and mortality is unknown. it’s safety when used with other weight loss products is also unknown. Do not take Qsymia if you are pregnant, planning to become pregnant, or become pregnant during treatment, as it can cause fetal harm.

Qsymia is also contraindicated in breastfeeding, children under 18 years of Age, people with hyperthyroidism, patients taking mono-amine oxidase inhibitors (MAOIs) or who have taken MAOIs in the past 14 days, patients hypersensitive to sympathomimetic amines, patients with glaucoma, and people with renal or hepatic Impairment.

The components of the drug have a 25-year proven safety record. After millions of treatment encounters and ongoing safety tests by the drug companies, the FDA is confident about effectiveness and safety of Qsymia.

Each individual needs to discuss the use of these medications with their personal physician to see which medications will be safe and effective.