Qsymia is one of the newest prescription weight loss drugs on the market, but quickly gaining popularity. This combined pill of phentermine hydrochloride and topiramate extended-release allows patients to lose weight and manage their obesity as a chronic condition. Clinical trials have proven the medication's impressive effect, but also revealed a significant risk for side effects. As a result, Qsymia is only available under a doctor’s prescription and supervision, and at this time, only sold within the United States.
As of 2017, over two million Qsymia prescriptions had been filled in registered pharmacies .
Qsymia is a prescription weight loss drug that contains a combination of phentermine HCL (Adipex) and topiramate extended-release (Topamax). While phentermine HCL works as the appetite suppressant, topiramate-ER reduces cravings.
Unlike traditional phentermine pills, which can only be taken for up to 12 weeks, Qsymia has been approved for the chronic management of obesity (up to 3 years). Prior to earning its FDA approval in 2012, this combination pill was evaluated in several studies; five of which played a major role in ensuring the medication’s approval. During clinical trials this medication was known as Qnexa, but FDA officials eventually asked the manufacturer to change the pill’s name to avoid confusion [2,3].
Phentermine hydrochloride and topiramate extended-release work together to suppress appetite, control cravings and boost energy, all of which help patients lose weight faster and easier.
Phentermine HCL works as a central nervous system stimulant to activate a “fight or flight” -like response. Like amphetamines, phentermine sends signals to the brain to suppress huger and boost energy. These biological changes help humans evade danger in stressful situations, but the same reactions can also promote weight loss. With less appetite and more energy, it’s easier to eat reasonable portions and exercise regularly. So, phentermine is a highly-effective weight loss medication.
Topiramate extended-release (topiramate-ER), also known as Topamax, is an anti-seizure medication that also promotes weight loss as well. This combination helps patients lose more weight because topiramate increases feelings of fullness, makes food taste less appealing and increases caloric expenditure .
Qsymia is prescribed for the treatment of exogenous obesity in adults with a body mass index (BMI) greater than 30 kg/m2. It is also indicated for overweight adults with a BMI greater than 27 kg/m2 who suffer from an additional weight-related complication such as type 2 diabetes or high blood pressure .
However, weight status is not the only factor that indicates whether this medication is right and safe for a particular patient. Medical history, other medications/supplements and daily habits are also relevant. As a result, a medical doctor is the only person who can determine if Qsymia is right for you.
Like most weight loss drugs, Qsymia is prescribed alongside healthy diet and regular exercise . The medication suppresses appetite and boosts energy to facilitate faster weight loss, but lifestyle changes are key to long-term success.
Qsymia, like other prescription weight loss drugs, is generally regarded as safe when used as directed. However, this medication is not safe or appropriate for everyone. Qsymia is contraindicated (not safe) in the presence of:
In addition to outright contraindications, Qsymia use is prefaced by a number of warnings and precautions. Tell your doctor if you have, or have ever had:
Your doctor also needs to know if you have diabetes mellitus, use marijuana or think you may become pregnant in the imminent future.
Finally, due to the high potential for drug interactions, your doctor and pharmacist need to know about all prescription or OTC medications, herbal supplements, vitamins and drugs that you take right now, or have taken in the last 14 days. Take extra care to mention any birth control pills, diuretics, carbonic anhydrase inhibitors, seizure medications, or any other drugs that impair thinking, concentration or coordination .
Qsymia is currently available in 4 different doses .
Individual dosing can only be determined by a healthcare professional, but patients typically start on a very low dose and then gradually progress towards the maximum dose over the course of multiple months. All four doses of Qsymia are available as capsules, and all contain a combination of phentermine hydrochloride and topiramate extended-release. Daily dosage ranges from 3.75mg/23mg to 15mg/92mg .
To allow for progressive doses of Qsymia, and subsequent tapering, different colors of capsules contain different amounts of the two active ingredients. The first number in the imprint (before the slash) indicates how many milligrams of phentermine HCL are contained in the capsule, while the second number (after the slash) denotes the milligrams of topiramate-ER.
Doctors typically start patients on the lowest strength possible, and then gradually increase dosage according to a set schedule. However, individual dosing schedule can only be determined by a medical professional. That being said, here is a standard Qsymia dosage progression :
Start treatment with one 3.75mg/23mg capsule each morning for 2 weeks. Starting in week 3, take one 7.5mg/46mg capsule each morning. At 3 months, the doctor should either stop the medication (if it’s not proving effective) or increase dosage to 11.25mg/69mg once per day. After 2 weeks on 11.25mg/69mg, daily dosage will be increased to the maximum of Qsymia 15mg/92mg.
If the medication is not working, use should be discontinued (not augmented). When the treatment period comes to an end, it is important to gradually decrease use instead of stopping suddenly. Abrupt cessation of this medication increases the risk of seizures .
Always take Qsymia EXACTLY as prescribed. Never take a different dose, or take the medication more or less often, than prescribed.
While taking this Qsymia, patients should avoid or minimize:
This medicine is taken once daily by mouth, typically first thing in the morning – either with or without food. Avoid taking Qsymia too late in the day given that phentermine can disrupt regular sleep patterns .
If you miss a dose of Qsymia, it is best to skip the missed dose and then continue taking the medication normally the following day. NEVER take a double dose to make up for a missed pill.
Taking more medicine than directed can lead to a dangerous, potentially fatal overdose.
Qsymia is a highly effective weight loss medication, but like all medications it also carries the risk of side effects. These possible side effects range from relatively minor to very severe. For this reason, it is important to speak with your doctor about potential reactions before starting Qsymia. As treatment progresses, stay in-touch so that he or she can work with you to manage any problems that arise while taking the medication.
While not common, some patients to experience serious - sometimes life threatening - side effects to this medication. Contact your doctor right away or seek immediate medical attention if you experience symptoms the following symptoms that indicate any of these serious Qsymia side effects :
When taken during pregnancy, Qsymia increases the risk of serious birth defects called cleft lip and cleft palate. These defects can occur early in pregnancy (even before a woman realizes she’s pregnant), so it’s critical that women use reliable contraception while taking this medication. You will also need a negative pregnancy test before starting this medication, and each month during treatment.
Qsymia can cause an increase in heart rate, so your doctor should monitor this vital throughout treatment with this medication. If you feel like your heart is racing or pounding at rest, call your doctor.
Call your doctor or seek immediate medical attention if you (or a loved one) have new, worse or worrying mental health symptoms while taking Qsymia.
One of the active ingredients in Qsymia, topiramate, can affect mood. Serious changes in mood may include: thoughts about suicide or dying, attempts to commit suicide, new or worse depression, new or worse anxiety, panic attacks, feeling agitated or restless, new or worse irritability, trouble sleeping (insomnia), an extreme increase in activity or talking (mania), acting aggressive, being angry, or exhibiting violent behavior, acting on dangerous impulses, or other unusual changes in behavior or mood.
Topiramate can also cause serious eye problems that, if left untreated, may lead to vision loss.
Symptoms of this side effect include sudden decreases in vision, with or without pain and redness, or a blockage of fluid that leads to pressure build-up (secondary angle closure glaucoma). Contact you doctor or seek medical attention right away if you experience either of these reactions.
Below are some of this medication’s other serious side effects. Tell your doctor or seek immediate medical attention if you experience any of the following:
A Risk Evaluation and Mitigation Strategy (REMS) is a strategy for healthcare professionals to ensure that a medication’s benefits outweigh risks for a specific patient. The FDA has required a REMS for Qsymia given the drug’s potential for serious side effects.
The Qsymia REMS is targeted at informing physicians and women of a reproductive age about the risks associated with taking this medication. More specifically, the Qsymia REMS emphasizes the importance of not becoming pregnant while using this medication because Qsymia’s potential to cause birth defects. Therefore, you and your doctor should take measures to ensure that you don’t become pregnant, and discontinue the medication immediately if pregnancy occurs .
Qsymia is a controlled substance and is not safe for everyone, so this medication is not available without a prescription. If you do not have a prescription, but are interested in exploring potential pharmaceutical weight loss options, schedule an appointment with your primary care doctor. If he or she does not prescribe Qsymia, consider speaking with a weight loss clinic or a specialist concerned with weight status (e.g. a gynecologist).
Qsymia is available from most major pharmacies in the United States, including certified mail-order pharmacies, but only with a valid doctor’s prescription.
Phentermine, one of the main ingredients in Qsymia, is a schedule IV controlled substance, so this medication is not available from all online pharmacies . At this time, you can only fill Qsymia prescriptions in-person or through the following certified mail-order pharmacies: Walgreens, Walmart and Kaiser Permanente .
Qsymia costs around $200 per month, on average, before discounts.
The table below provides an estimate of the price (pre-tax) for a 30-day supply of Qsymia, before insurance or manufacturer coupons.
|Dose||Estimated Monthly Cost|
|3.75mg / 23mg||$187||$198|
|7.5mg / 46mg||$193||$205|
|11.25mg / 69mg||$205||$219|
|15mg / 96mg||$206||$220|
NOTE: These prices are only estimates and do not represent any type of guarantee or coupon. Updated March 2019 .
Qsymia is an expensive medication and it is NOT covered under most insurance plans, including Medicaid in most states . Thankfully, VIVUS, Inc. offers a generous manufacturer’s discount. The Qsymia coupon below entitles you to 2 weeks FREE of the starter dose (3.75mg/23mg), plus as much as $65 off each month’s refill for up to 36 months of treatment.
Qsymia is a popular and effective, but it is not the only prescription appetite suppressant available to doctors and patients. Below is a quick breakdown of how Qsymia compares to some of the other popular, US medications.
Qsymia and Contrave are both combination medications for weight loss, but they contain different active ingredients. Contrave uses a combination of naltrexone and bupropion extended-release to suppress appetite and control cravings. Naltrexone is individually used to manage addiction, while bupropion is an anti-depressant that’s also used to facilitate smoking cessation. Similar to Qsymia, Contrave’s suggested dosing schedule directs doctors to gradually increase patients’ dose over time. Like Qsymia, Contrave can also be taken more chronically than some other prescription weight loss medications, including phentermine .
Many people wonder "Which is better: Qsymia or Belviq?" There is no universally better pill given that the answer to this question depends heavily on each patient's specific needs and concerns.
Instead of combining two medications, Belviq contains just one active ingredient: lorcaserin hydrochloride (lorcaserin HCL). This second medication works by priming our brain register and respond to signals of fullness (circulating serotonin) more quickly. While Qsymia is always taken once a day, Belviq can either be taken once or twice a day depending on formulation. While common side effects are similar between the Qsymia and Belviq, serious side effects differ .
Qsymia contains phentermine as one of its active ingredients, so the medications are very similar. Phentermine alone is typically cheaper than Qsymia (or buying the two medications separately), but should only be used for 12 weeks at a time. On the other hand, Qsymia can be taken for a longer period of time. A downside of this combined pill is that it can cause additional serious side effects including vision problems, depression and – if taken while pregnant – serious birth defects. Still, some patients report that they lose more weight with Qsymia than with phentermine alone [1,9,13].
Now you have the factual information you need about Qsymia, but will this medication really help you reach your weight loss goals? Here are the latest Qsymia reviews submitted on the phentermine reviews page:
The Phentermine.com Facebook groups are also great sources of information and motivation! Join these active, engaging communities to find support and encouragement on your weight loss journey:
Here are three women's recent Qsymia reviews from Facebook:
This medication is manufactured by VIVUS, Inc. – a California-based pharmaceutical company. They currently produce medications related to obesity, sleep and sexual health .
Please find their contact information below:
1172 Castro Street
Mountain View, CA 94040
Company Phone: 650-934-5200
Medical Information Phone: 1-888-998-4887
Corporate website: www.vivus.com
Medication Website: www.qsymia.com
1. VIVUS, Inc. (2018). Lose weight and keep it off with Qsymia.
2. U.S. Food & Drug Administration. (2012, July 17). Drug Approval Package: Qsymia (phentermine and topiramate extended-release) Capsules CIV. Drug Approvals and Databases.
4. Drugs.com. (2019, January 15). Phentermine and Topiramate (Professional Patient Advice).
5. VIVUS, Inc. (2014, September). Medication Guide: Qsymia® (Kyoo sim ee’ uh) (phentermine and topiramate extended-release) Capsules CIV.
6. VIVUS, Inc. (2017). Medication Guide.
7. VIVUS, Inc. (2014). Risk Evaluation and Mitigation Strategy (REMS).
8. U.S. National Library of Medicine. (2006, January 12). Hazardous Substances Data Bank (HSDB): Phentermine.
9. GoodRx. (2019, March). Qsymia: Phentermine and Topiramate.
10. Gomez, G., & Stanford, F. C. (2017). US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. International Journal of Obesity, 42(3), 495-500. doi:10.1038/ijo.2017.287
11. Nalpropion Pharmaceuticals, Inc. (2018). #1 Branded Weight Loss Pills: CONTRAVE (naltrexone HCl/bupropion HCl).
12. Eisai Inc. (2018, August). Patient Website for BELVIQ® BELVIQ XR®.
13. U.S. Food and Drug Administration. (2012). Adipex-P (phentermine hydrochloride) capsules label [Brochure].
14. VIVUS Inc. (2018). VIVUS: About VIVUS Inc.