New Diet Drug Update

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.