NEW DIET DRUG UPDATE
For those who watch the news, you may have noticed
that the FDA has approved a new diet drug in 2012. The name of the drug is Qsymia
and it is manufactured by Vivus. Dr. Simonds wants to give you the “scoop” in
advance. Qsymia is a combination of 2 older drugs – phentermine and
topiramate. The phentermine is a drug we all know about. Read on for more.
Topiramate is the generic form of the drug
Topamax. It was initially approved 15 years ago by the FDA for treatment of
seizure disorder. It now is used by physicians to treat multiple disorders such
as migraine headaches, depression, neuropathy, obesity, etc. There are three
benefits of this drug that make it useful in the treatment of obesity.
Curbs
Carb Cravings - In a majority of
patients who take it, they will report a change in the taste of and desire for
processed carbohydrates – sugary drinks, snacks, breads, etc. This change leads
to reduced consumption of these items in the diet.
Curtails
Bing Eating - Topiramate is known to
curb binge eating in many of the patients who take it. The reduction in binge
eating promotes weight loss.
Decreased
Calorie Consumption - Patients eat fewer
calories while taking topiramate.
Doctor Simonds has been prescribing this drug
with phentermine since 2005. However, it was not available in a generic form,
and the cost was prohibitive to patients, which limited its use. Now
it is available in an inexpensive generic form. The
Good News – At PAWL, we now carry this drug, and it can be added to
your medicine regimen to help you lose weight! In other words, you can take the
components of Qsymia now – even before it comes to market. It is inexpensive,
and it can be used along with almost all prescription medicines with no
interaction. It is a nice drug to add to your regimen if your weight loss has
slowed, or if you just need a “jumpstart.” A final advantage to
using this drug combination at PAWL, is that we use phentermine at its normal,
effective dosages. Qsymia only has 15mg of phentermine. As most of you know, this
dose is entirely too low to adequately suppress your appetite. At
PAWL, we tailor the dosages of phentermine and topiramate to your specific
needs to get the best result. If you are interested in adding this drug to
your regimen, let us know.
DOSING
INSTRUCTIONS FOR TOPIRIMATE
Patients who take topiramate for other disorders
usually take doses in the range of 400mg per day. The dose needed to treat obesity is a much
lower dose - only 100mg per day.
When this drug is first started it requires a “taper up” over the period
of a few weeks. Should you decide to add
this drug to your regimen, you will receive two pill bottles.
The
First Bottle - The first bottle will have 25mg
tablets. During week number one, the
patient takes one 25mg tablet before bed.
Some patients find that topiramate makes them sleepy, hence the evening
dosing. During week two, the patient
takes one 25mg tablet in the morning and one in the evening. If this produces daytime sleepiness, then the
entire dose can be taken in the evening.
The
Second Bottle - At the start of week number three, the
patient will switch to the second pill bottle which has 50mg tablets. They will take one tablet twice daily. If there is daytime sleepiness, the entire
dose can be taken in the evening. This dose, is the dose the patient takes
until they have reached their goal and decide to stop taking it. If the patient
remains on topiramate for several months or more, they should undergo a similar
taper down. The staff can guide you at
that time.
SIDE EFFECTS
Side
effects of topiramate at these low doses are generally mild and in most cases
non-existent.
Some people experience a sensation of tingling during the first two
weeks. It does not affect your function
at all, and it goes away in 1-2 weeks.
The other side effect that is sometimes seen is mild weakness and sleepiness. This requires taking the drug in the evening
before bed time. Patients will often ask, if I have any of these side effects,
is there anything I can do about it?
Yes, there is. The side effects
will resolve if you take a Tums tablet
in the morning and evening and if you take 500mg of vitamin C once daily.
A very small percentage of patients will report
forgetfulness (usually at much higher doses).
If this happens and it affects the patient’s normal, daily functions,
the drug will have to be discontinued.
The forgetfulness immediately resolves.
There is a rare anatomic disorder of the eye that is present in the
general population. It makes these
people prone to a condition called acute angle
closure glaucoma. If you had this
anatomic disorder and did not know it, you could develop this version of acute
glaucoma when you take topiramate. The
symptoms are sudden one sided eye pain with headache. If this were to happen to you, you would need
to go an ophthalmologist or ER promptly to have the pressure in your eye
checked. If the pressure is elevated, it
can easily be treated and topiramate will have to be discontinued. If you form kidney stones several times a
year or more, this drug may make this worse, and in that scenario you should
not take it. Topiramate may make you
more susceptible to heat exhaustion and heat stroke. If you are doing strenuous activity in the
heat, make sure you take frequent breaks and drink plenty of water. Finally, if you are pregnant, or actively trying
to get pregnant, you should not take this drug.
AGAIN,
IF YOU ARE INTERESTED IN ADDING THIS DRUG TO YOUR CURRENT REGIMEN, JUST LET THE
STAFF KNOW.
