Generic Name: phentermine and topiramate (FEN ter meen and toe PIR a mate)
Brand Name: Qsymia

What is phentermine and topiramate?

Phentermine is an appetite suppressant similar to an amphetamine. Topiramate is a seizure medication, also called an anticonvulsant.

The combination of phentermine and topiramate is used together with diet and exercise to treat obesity. This medication is sometimes used to treat obesity that may be related to diabetes, high cholesterol, or high blood pressure.

Phentermine and topiramate will not treat any underlying condition you have (such as heart disease, diabetes, high blood pressure). Keep taking any other medications your doctor has prescribed to treat these conditions.

Phentermine and topiramate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about phentermine and topiramate?

This medication can harm an unborn baby or cause birth defects. Do not use phentermine and topiramate if you are pregnant.

You should not take this medication if you are allergic to phentermine (Adipex-P, Oby-Cap, Suprenza, T-Diet, Zantryl) or topiramate (Topamax), or if you have glaucoma or overactive thyroid.

Do not use phentermine and topiramate if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

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Before you take phentermine and topiramate, tell your doctor if you have high blood pressure, heart disease, diabetes, liver or kidney disease, low blood levels of potassium, or if you have had a heart attack or stroke in the past 6 months.

Phentermine may be habit-forming and should be used only by the person for whom it was prescribed. Keep the medication in a secure place where others cannot get to it.

Do not stop taking phentermine and topiramate suddenly, or you could have a seizure (convulsions). You may need to use less and less before you stop the medication completely. Ask your doctor how to avoid seizures when you stop using phentermine and topiramate.

What should I discuss with my healthcare provider before taking phentermine and topiramate?

Do not use this medication if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

You should not take this medication if you are allergic to phentermine (Adipex-P, Oby-Cap, Suprenza, T-Diet, Zantryl) or topiramate (Topamax), or if you have:

  • glaucoma; or

  • overactive thyroid.

To make sure you can safely take phentermine and topiramate, tell your doctor if you have any of these other conditions:

  • high blood pressure, heart disease (coronary artery disease, heart rhythm problems, congestive heart failure, pulmonary hypertension);

  • diabetes;

  • liver or kidney disease;

  • low levels of potassium in your blood; or

  • if you have had a heart attack or stroke in the past 6 months.

FDA pregnancy category X. This medication can harm an unborn baby or cause birth defects. Do not use if you are pregnant. Weight loss during pregnancy also can harm an unborn baby, even if you are overweight. Before receiving this medication, you may need a pregnancy test to make sure you are not pregnant.

Use effective birth control while you are taking this medication. Phentermine and topiramate can cause irregular vaginal bleeding while you are taking birth control pills. This should not make the pills less effective in preventing pregnancy.

Phentermine and topiramate can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking this medication.

Do not give this medication to a child younger than 18 years old.

Phentermine may be habit forming and should be used only by the person for whom it was prescribed. Never share phentermine and topiramate with another person, especially someone with a history of drug abuse or addiction.

How should I take phentermine and topiramate?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Drink plenty of liquids while you are taking phentermine and topiramate. This will lower your risk of having kidney stones. You can also easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance.

Do not crush, chew, break, or open an extended-release capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

You should lose at least 3% of your starting weight during the first 12 weeks of taking phentermine and topiramate and eating a low calorie diet. Tell your doctor if you do not lose at least 3% of your starting weight after taking the medication for 12 weeks.

Talk with your doctor if you have increased hunger or if you otherwise think the medication is not working properly. Taking more of this medication will not make it more effective and can cause serious, life-threatening side effects.

Do not stop taking phentermine and topiramate suddenly, or you could have a seizure (convulsions). You may need to use less and less before you stop the medication completely. Ask your doctor how to avoid seizures when you stop using phentermine and topiramate.

Store at room temperature away from moisture and heat. Keep track of the amount of medicine used from each new bottle. Phentermine and topiramate is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of phentermine and topiramate can be fatal.

Overdose symptoms may include confusion, hallucinations, panic, feeling hostile or aggressive, nausea, vomiting, diarrhea, stomach cramps, irregular heartbeat, rapid breathing, overactive reflexes, or seizure (convulsions).

What should I avoid while taking phentermine and topiramate?

Do not take any other prescription or over-the-counter weight-loss products without your doctor's advice.

Drinking alcohol can increase certain side effects of phentermine and topiramate.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Phentermine and topiramate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking this medication and call your doctor at once if you have a serious side effect such as:

  • pounding heartbeats or fluttering in your chest;

  • depressed mood, thoughts of suicide or hurting yourself;

  • trouble concentrating, problems with thinking or speech, feeling like you might pass out;

  • blurred vision, eye pain, or seeing halos around lights;

  • low blood sugar (headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery);

  • severe pain in your lower back, red or pink urine;

  • feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, seizure).

Less serious side effects may include:

  • mild dizziness, anxiety, feeling tired or irritable;

  • constipation;

  • memory problems, sleep problems (insomnia);

  • numbness of tingly feeling; or

  • altered sense of taste, dry mouth, or an unpleasant taste in your mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect phentermine and topiramate?

Before using phentermine and topiramate, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for depression or anxiety). They can add to sleepiness and other side effects caused by phentermine and topiramate.

Tell your doctor about all other medicines you use, especially:

  • digoxin (Lanoxin, Lanoxicaps);

  • lithium (Eskalith, LithoBid);

  • a diuretic (water pill);

  • glaucoma medications such as acetazolamide (Diamox) or methazolamide (Glauctabs, MZM, Neptazane);

  • insulin or oral diabetes medication; or

  • seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal), phenytoin (Dilantin), valproic acid (Depakene, Stavzor), or zonisamide (Zonegran).

This list is not complete and other drugs may interact with phentermine and topiramate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about phentermine and topiramate.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.01. Revision Date: 2012-08-15, 12:00:08 AM.

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