Phentermine/topiramate (Qsymia)

Approved as in addition to reduce calorie diet and exercise for long-term weight management.

A combination of an anorexiant phentermine and the anti-epileptic drug topiramate.

Associated with congenital malformations and infants exposed during the first trimester.

Schedule IV drug.

Phentermine is a shorter acting sympathomimetic amine approved as monotherapy as a weight management drug.

Topiramate is a longer acting neurostabilizer approved as monotherapy for seizure disorders and migraine headaches.

Starting dosage 3.75 mg/23 mg extended release.

After 14 days the recommended dose 7.5 mg/46 mg with the top dose of 15 mg/92 mg.

PHEN/TPM ER may alt exposure to oral contraceptives causing irregular menstrual bleeding.

May potentiate CNS depressants such as alcohol.

May potentiate hypokalemia of non-potassium sparing diuretics.

Phentermine is metabolized by the liver, with most excreted by the kidneys.

Topiramate is excreted mainly by the kidney.

Adverse reactions include paresthesias, dizziness, dysguesia, insomnia, constipation, and dry mouth.

Maybe associated with metabolic acidosis, elevated creatinine, and hypoglycemia.

Contraindicated in glaucoma, hyperthyroidism, within 14 days of monoamine oxidase inhibitors, and pregnancy.

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