is a brand name pharmaceutical COMBO medication that was FDA approved in July 2012 with varying prescriptions including phentermine 3.75 mg/topiramate 23 mg extended-release – up to phentermine 15 mg/topiramate 92 mg extended-release use to aid in weight loss and appetite control. Premier Age Management and Medical Weight Loss Center does not offer these exact dosages or prescriptions for these exact dosages. However, we do offer the Phentermine/Topiramate SR Combo capsule in many dosage combinations. 

Who can use Phentermine/Topiramate SR COMBO? 

The drug is approved for obese adults with a body mass index, or BMI, of 30 or higher. It can also be used by overweight adults, with a BMI of 27 or higher, if they have at least one weight-related condition such as high blood pressure, Type 2 diabetes or high cholesterol. Safety concerns led the FDA to reject Phentermine/Topiramate SR COMBO’s first bid for approval in 2010, but the agency and Vivus have now put in place strategies to reduce risk: for example, women of child-bearing age who want to take Phentermine/Topiramate SR COMBO must test negative for pregnancy before starting the drug and are expected to use contraception and take a pregnancy test once a month while on the drug. If you take Phentermine/Topiramate SR COMBO during pregnancy, your baby has a higher risk for birth defects called cleft lip and cleft palate. These defects can begin early in pregnancy, even before you know you are pregnant. Patients’ heart rate should also be monitored regularly while taking Phentermine/Topiramate SR COMBO.

People with recent or unstable heart disease or stroke are not recommended to take the drug because of the potential heart risks. Vivus has also agreed to continue monitoring Phentermine/Topiramate SR COMBO users for side effects after the drug reaches market; in particular, it will conduct a long-term cardiovascular outcomes trial to assess the effect of Phentermine/Topiramate SR COMBO on major events like heart attack and stroke. It is all very well to argue that the two active ingredients of Phentermine/Topiramate SR COMBO have both been prescribed successfully for years. The point is that one of those ingredients, topiramate, has not previously been registered for use in obesity, and its effects on weight loss when used as a single drug have not been thoroughly assessed. 

Side effects reported through various testing have generally been deemed acceptable. These include but are not limited to nausea, headaches, dry mouth, insomnia, tingling, altered taste, constipation, diarrhea, fatigue, respiratory infection. Some of these where experienced in some patients, some were not experienced at all. For those who may have experienced any of these, they were generally considered mild to moderate. In essence Qsymia acts as an appetite suppressant; decreasing ones hunger and therefore allows one to lose weight more easily. In clinical tests, Qsymia has been proven to help patients lose between 10% and 15% of their body weight over a year’s period as well as improve various cardiovascular aspects. Further studies have shown that this mixture has also had good results when studied as a sleep apnea treatment. Sleep Apnea is a disorder where peoples breathing is temporarily interrupted, or stops periodically.

Additional studies are also now showing that this drug lowers blood pressure. This is very welcomed news as there have been other diet drugs that have increase blood pressure which makes a less than desired side effect.

Important Information Do not take Phentermine/Topiramate SR COMBO if you:

  • are pregnant, planning to become pregnant, or become pregnant during Phentermine/Topiramate SR COMBO treatment
  • 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 Phentermine/Topiramate SR COMBO. See the end of this Medication Guide for a complete list of ingredients in Phentermine/Topiramate SR COMBO.

What should I tell my healthcare provider before taking Phentermine/Topiramate SR COMBO? Tell your healthcare provider if you:

  • are pregnant or planning to become pregnant
  • have had a heart attack or stroke
  • have or have had an abnormal heart rhythm
    have or have had depression, mood problems, or suicidal thoughts or behavior
  • have eye problems, especially glaucoma
  • have a history of metabolic acidosis (too much acid in the blood) or a condition that puts you at higher risk for metabolic acidosis such as chronic diarrhea, surgery, a diet high in fat and low in carbohydrates (ketogenic diet), weak, brittle, or soft bones (osteomalacia, osteoporosis, osteopenia), or decreased bone density
  • have kidney problems, have kidney stones, or are getting kidney dialysis
    have liver problems
  • have seizures or convulsions (epilepsy)
  • are breastfeeding. It is not known if Phentermine/Topiramate SR COMBO passes into your breast milk. You and your healthcare provider should decide if you will take Phentermine/Topiramate SR COMBO or breastfeed. You should not do both.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Phentermine/Topiramate SR COMBO taken with other medicines may affect how each medicine works and may cause side effects. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist each time you get a new medicine. Do not start a new medicine without talking to your healthcare provider. Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Especially tell your healthcare provider if you take:

  • Birth control pills. Tell your healthcare provider if your menstrual bleeding changes while you are taking birth control pills and Phentermine/Topiramate SR COMBO.
  • Water pills (diuretics) such as hydrochlorothiazide (HCTZ)
  • Any medicines that impair or decrease your thinking, concentration, or muscle coordination
  • Carbonic anhydrase inhibitors [such as ZONEGRAM® (zonisamide), DIAMOX® (acetazolamide) or NEPTAZANE® (methazolamide)]
  • Seizure medicines such as Valproic acid (DEPAKENE® or DEPAKOTE®)
  • Low blood sugar (hypoglycemia) in people with type 2 diabetes mellitus who also take medicines used to treat type 2 diabetes mellitus. Weight loss can cause low blood sugar in people with type 2 diabetes mellitus who also take medicines used to treat type 2 diabetes mellitus (such as insulin or sulfonylureas). You should check your blood sugar before you start taking Phentermine/Topiramate SR COMBO and while you take Phentermine/Topiramate SR COMBO.
  • Possible seizures if you stop taking Phentermine/Topiramate SR COMBO too fast. Seizures may happen in people who may or may not have had seizures in the past if you stop Phentermine/Topiramate SR COMBO too fast. Your healthcare provider will tell you how to stop taking Phentermine/Topiramate SR COMBO slowly.
  • Kidney stones. Drinking plenty of fluids when taking Phentermine/Topiramate SR COMBO to help decrease your chances of getting kidney stones. If you get severe side or back pain, and/or blood in your urine, call your healthcare provider
  • Decreased sweating and increased body temperature (fever). People should be watched for signs of decreased sweating and fever, especially in hot temperatures. Some people may need to be hospitalized for this condition.

Common side effects of Phentermine/Topiramate SR COMBO include:

  • numbness or tingling in the hands, arms, feet, or face (paresthesia)
  • dizziness
  • change in the way foods taste or loss of taste (dysgeusia)
  • trouble sleeping (insomnia)
  • constipation
  • dry mouth

*Tell your healthcare provider if you have any side effect that bothers you or that you may experience, tolerable or not. 

Why is excess weight such an issue? Well, firstly, in Western society it is regarded as not good to carry extra weight. Thinner people are seen to be more attractive and to have a higher status than overweight people. But it is not only a matter of appearance: obese people struggle with various health issues which are brought on by the fact that they are obese. Type 2 diabetes, for example, is caused by being overweight. The incidence of high blood pressure, heart disease, strokes and heart attacks are all higher in obese people than in the general population. The extra weight places great stress on the joints: so obese people have a greater tendency to get osteoarthritis, and at a younger age than slender people. Some cancers are much more prevalent in the obese. 

Obese people tend to be less mobile than their slimmer colleagues because they find it difficult to move around as much or as quickly: so many of them are less productive in the workplace. Society loses out as a result of obesity, as obese people tend to take more sick days, and they may earn less than they would if they were slimmer. They may also need to take earlier retirement as their ill health prevents them from working. So their families lose out on the income they would have earned. How does it come about that our people so easily become obese? It is largely due to our love for fast foods. These are very high in fats and refined carbohydrates, so are high in calories. 

We love sweet foods and eat vast quantities of them. Foods which are sweet and rich in fats are very appetizing, so people keep eating more of them than what their bodies need. And over-eating becomes a habit. Then our children learn the eating habits in the home, so they develop a preference for such foods too, and they learn to keep eating beyond the point where their bodies tell them that they have eaten enough. So our children carry these habits over to the next generation. Having become overweight, people find it very difficult to lose the weight and achieve a healthier and more attractive body size. There are all sorts of reasons for this. It is difficult to change one’s habits: having become accustomed to eating certain kinds of foods, and certain quantities, it is not easy to break away from such habits. Then, eating is a social activity. When one is in the company of others, and everyone is indulging in foods of a certain type, it is difficult to be different. People feel they are being deprived when they cannot join in with feasting, or enjoy treats that they have become used to. 

For some people food has an emotional connotation and such people will eat in order to gain comfort. Plus, there is no doubt that a lot of people’s satiety center seems to not function as well as it should. People continue to experience the sensation of hunger even though they have eaten as much as their bodies need, and crave more foods. For such people as the latter, taking an appetite suppressant is a useful part of the treatment of their obesity. An appetite suppressant makes it easier to adhere to a healthy eating plan. This is where medication such as phentermine, long used by obese people, is such a great help. And, when it is found that phentermine’s action can be enhanced by adding a second active ingredient to it, and formulating both so that their actions work sequentially, then there is a great deal of interest in that kind of medication.

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