What to Expect With Qsymia

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Qsymia is one of the few drugs approved by the FDA specifically for the long-term treatment of obesity. It’s available by prescription, but is currently not approved for use in Canada.

You may have heard it’s quite effective. But what can you really expect if you take it?

Let’s shed some light into what you might expect if you try Qsymia yourself.

What is it?

Qsymia is a combination drug of both phentermine and topiramate.

Phentermine itself is actually a commonly used weight loss medication.

It has amphetamine-like stimulant properties which causes appetite suppression, but also has some of the potentially addictive qualities typically found in amphetamine drugs like Adderall.

Topiramate is used to treat epilepsy or migraine headaches. Its weight loss potential was recognized when patients being treated for epilepsy and seizures were found to have lost weight, as well as a reduction in visceral fat.

Together, both drugs work synergistically to aid in weight loss.

How does it work?

Both drugs combine to make Qsymia primarily an appetite suppressant.

Phentermine already works as an appetite suppressant.

Amphetamine-like stimulants often suppress appetite by stimulating the sympathetic nervous system, also known as the fight-or-flight nervous system.

Normally, this system is activated during times of acute stress, and prepares your body for fight-or-flight by getting your muscles ready to act.

It also shuts down unnecessary systems in your body, like your digestive system. A side effect of this shutdown is a suppression of appetite.

The way by which topiramate helps with weight loss is not exactly known. Studies on animals show a lot of potential mechanisms, like increased energy usage, decreased energy use efficiency, and appetite suppression.

In humans, the way it works best appears to be by appetite suppression.

Side effects of Qsymia

From clinician experience, common neurological side effects include tingling in your hands and feet, dizziness, and headaches.

The drowsiness effect of topiramate is somewhat counteracted by the stimulant effect of phentermine, however people still sometimes experience the negative side effects of taking both phentermine, such as insomnia, nervousness, and heart palpitations, as well as topiramate, like fatigue and drowsiness.

Gastrointestinal issues are also common, such as constipation or stomach pain.

In addition to suppressing your appetite, it may also modify the mouthfeel of some foods by changing the taste of these foods, or causing your mouth to feel very dry.

It’s also recommended you drink plenty of water while on Qsymia since it might increase your risk of developing kidney stones.

From research studies, an outline of the common and rare side effects associated with Qsymia is as follows:

Common side effects (reported in more than 1% of patients):

• Paresthesia (tingling, numbness) of the extremities (15-38%)
• Dizziness (11-28%)
• Dysgeusia (abnormal taste sensation) (6-19%)
• Insomnia (7-17%)
• Constipation (6-16%)
• Dry mouth (5-14%)
• Headache (5-14%)
• Nausea (5-13%)
• Diarrhea (4-11%)
• Upper respiratory tract infection (4-9%)
• Nasopharyngitis (4-7%)
• Sinusitis (3-6%)

Rare side effects (reported in less than 1% of patients):

• Acute angle-closure glaucoma (frequency unknown)
• Suicidal ideation and behavior (frequency unknown)
• Cognitive impairment (frequency unknown)
• Metabolic acidosis (frequency unknown)
• Renal impairment (frequency unknown)
• Hypoglycemia (frequency unknown)
• Decreased serum bicarbonate (frequency unknown)
• Mood disorders (frequency unknown)
• Cardiac valvulopathy (frequency unknown)

It’s important to note that Qsymia contains phentermine and topiramate, which can have an impact on the cardiovascular system and is contraindicated in patients with a history of cardiovascular disease or uncontrolled hypertension. Additionally, Qsymia can be habit-forming and may cause withdrawal symptoms if abruptly discontinued.

Qsymia is avoided in conditions like hyperthyroidism, glaucoma, or a history of strokes, since it can worsen those conditions. It’s also contraindicated in pregnancy, as it can harm your fetus.

Qsymia will also interact with many medications, and can potentially cause life threatening medical issues if taken with certain medications like monoamine oxidase inhibitors.

So there are a lot of potentially serious side effects and drug interactions with Qsymia, you’ll need to talk to your doctor before taking it.

Is Qsymia addictive?

Qsymia contains phentermine, which is considered an amphetamine-like stimulant.

Amphetamine stimulants have a long history of having addictive qualities, and being on amphetamines for a long period of time can increase one’s dependence and cravings to continually use it.

Interestingly, Qsymia does not appear to have as strong addictive qualities, and patients who use Qsymia for long periods of time do not seem to develop a strong physiological dependence or craving for the drug as often as other amphetamines.

However, while there might not be a strong medical addiction, some patients may in a sense still be addicted to its weight loss effects, since some patients do report that rebound weight gain is common after discontinuing Qsymia, so they continue to take Qsymia to prevent this rebound.

Also, discontinuing the drug can result in a drop in energy and accompanying headaches and fatigue, since some people on Qsymia find that the medication significantly improves their energy.

Nevertheless, if you discontinue Qsymia, you will still need to be slowly weaned off of it, especially since sudden discontinuation of topiramate, which is in Qsymia, can also potentially cause seizures.

Qsymia diet plan

There is no specific dietary plan you need to follow with Qsymia. However it is often recommended you drink plenty of water since it might help you to mitigate some of Qsymia’s side effects like dry mouth or kidney stones.

I recommend following a stricter dietary routine, since Qsymia can help you to more easily adhere to dietary restrictions and eliminate foods you shouldn’t be eating.

However, avoid extreme dieting like fasting for most of the day.

Extreme diets are not sustainable and work only in the short-term. They frequently result in weight rebound once the diet is stopped, and can result in nutritional deficiencies that will make it harder for your body to burn fat.

Additionally, rapid weight loss followed by weight regain is known as yoyo dieting, and may cause additional health risks in addition to not helping you lose weight.

You should make sure your dietary plan has a good variety of macronutrients, like protein and fat, and micronutrients, like vitamins and minerals, for example by following a calorie controlled Mediterranean Diet.

How effective is Qsymia?

According to some research studies, as well as some of my colleagues in the US who have experiences using Qysmia with patients, Qsymia appears to be one of the more effective drugs for weight loss approved by the FDA.

While it doesn’t work for everyone, many people find it’s quite effective as an appetite suppressant, reducing your desire and need to eat.

The way it reduces your food intake may range from a simple reduction in hunger to changing the taste and feel of food in your mouth, potentially giving you less enjoyment out of eating.

Should you try Qsymia?

If you have issues dealing with hunger and appetite, and tend to overeat, Qsymia can be quite useful in suppressing that appetite.

If you do decide to use it, keep in mind these few things:

1. If you’re looking to become pregnant, Qsymia should be avoided. Also some of its side effects may not make it appropriate for some people to take. You will need to see your doctor about whether it’s safe for you to use.
2. Qsymia can be quite expensive, at around a few hundred dollars per month, and is rarely covered by insurance. You can consider asking your clinician if prescribing you phentermine and topiramate seperately is appropriate, as it can serve as an effective alternative for some patients.

Learn more about

• Phentermine, a closely related weight loss drug
• 5 Things To Know Before Starting Weight Loss Medication
• Other weight loss medications

See also

• 
  Comparing Weight Loss Drugs in 2024
  Ozempic and Mounjaro are highly effective at treating obesity, however there are many other approved and off-label options that also work.
• 
  Bupropion vs Contrave vs Naltrexone
  Contrave is a synergistic combination of buproprion and naltrexone, which can be replicated to some degree using the generics individually.
• 
  New Obesity Drugs in 2024
  New obesity drugs target more than just GLP-1 and do much more than suppress appetite for a more nuanced approach to weight loss.
• 
  Mounjaro: Who Loses the Most Weight?
  White or Asian younger women who use metformin and have lower sugar and lipid levels tend to experience more weight loss with Mounjaro.
• 
  How does Oforglipron compare?
  Orforglipron, Semaglutide, and Danuglipron are oral GLP-1 agonists that are all similar enough that cost may end up being the winning factor.