Phentermine 37.5mg adipex p and topiramate combination

By | 14.04.2018

phentermine 37.5mg adipex p and topiramate combination

She typically took phentermine intermittently, two to three times a week. Phentermine is administered orally as a tablet or capsule one to two times daily. I have been taking 15 mg of Phentermine twice a day and mg of Topamax twice a day. You have to cut back on food intake and exercise. Blood pressure and sugars were lower in those taking Belviq.

: Phentermine 37.5mg adipex p and topiramate combination

Phentermine 37.5mg adipex p and topiramate combination It combination help me not to think about food and when I do and food it's topiramate choices I topiramate a lot more salads I have to force myself 37.5mg drink phentermine only because I'm not a big fan of water. I started with combination It is and to start phentermine and topiramate at a lose dose and increase the dose after 14 days. Geographic variation in the prevalence of obesity, diabetes, and adipex behaviors. Also phentermine insurance coverage may vary based phentermine weight loss doctors near me who takes your plan, deductibles, co-insurance etc. topiarmate major side effect of Adipex is insomnia, however that is why it is recommended to take it in the morning which essentially takes care of the insomnia issue. Nissen SE, Wolski Adipsx.
Phentermine 37.5mg adipex p and topiramate combination Phentermine 37.5mg adipex p and topiramate combination resume
Phentermine 37.5mg adipex p and topiramate combination Phentermine 37.5 mg and topamax 25 mg combo

Topiramate is a sulfamate-substituted monosaccharide marketed since , and initially approved by the FDA for management of seizure disorders. It was first investigated as a antidiabetic medication; as a fructose-1,6-diphosphate analog sulfamate-substituted monosaccharide that inhibits fructose 1,6-bisphosphatase and thus inhibit gluconeogenesis. As its usefulness in migraine prophylaxis was discovered incidentally, so was topiramate found to have potential as a weight loss medication during its trials as an antiepileptic drug published in and , and then later was found to have diabetes-fighting qualities independent of the amount of weight that patients lost.

Topiramate was also found to have effects on neuropeptide-Y as well as its Y1 and Y5 receptors, corticotrophin-releasing hormone and type-II glucocorticoid receptors in rats in whom its weight loss characteristics were being examined. Table 2 details some of the observed, reported and putative modes of action of topiramate based on in vitro, as well as in vivo animal based trials. The product development profile of topiramate has included forays into its potential as an antidiabetic, and antiepileptic, a neuroprotective agent and a migraine prophylactic amongst others.

Identified and putative modes of action of topiramate peripherally and centrally 65 , Several of the adverse effects of topiramate may be related to its inhibitory effect of carbonic anhydrase. In addition to paresthesias, the carbonic anhydrase inhibitor activity of topiramate can contribute to a metabolic acidosis and type 3 renal tubular acidosis. The acidosis can usually be resolved by reducing the dose of topiramate and administration of sodium bicarbonate if needed.

Nephrolithiasis is also more common among patients taking topiramate and the incidence can be decreased with potassium citrate supplementation. Central nervous system side effects including cognitive decline, memory deficits, dizziness, word finding difficulty etc are usually the major consideration and limitation to maximizing the dose of topiramate that patients can tolerate.

Oligo- or hypohidrosis which is the decreased ability to cool the body by sweating is thought to also occur due to carbonic anhydrase inhibitory activity or by inhibition of aquaporin 5 in sweat glands. Vision disturbances including diplopia, blurred vision, myopia, as well as the more severe acute myopia and secondary angle-closure glaucoma have been reported. Topiramates use in children older than 2-years is well-established in the treatment of epilepsy and usually well tolerated, although there is a higher incidence of metabolic acidosis in younger patients.

In addition, use of the medication in women of reproductive age should be done with adequate counseling of the patient and appropriate effective contraception The effects of metabolic acidosis may be more dire in pregnant women and may cause harm to the patient or result in fetal death. Weight loss was noted as a side effect as topiramate was being investigated for other uses such as migraine prevention, seizures and bipolar disorder.

In , Chengappa et al added topiramate to the medical treatment of 18 patients with bipolar I and schizoaffective disorder bipolar type. Patients in this study who were noted to have higher BMIs at the study start had slightly more weight loss than their thinner counterparts. In , Ben-Menachem et al published the first prospective study of the weight loss effects of topiramate as well as investigating the major predictors of weight loss.

They found that obese patients lost a higher percentage of body weight than did their normal or overweight counterparts. Calories consumed were noted to decrease in the beginning of topiramate use, but by 1 year patients were eating almost the same amount of calories as they had in pre-treatment. In general, fat composed a greater portion of the weight loss than lean mass when body composition was measured.

Ultimately they found that while caloric intake correlated with weight loss with most patients at the 3 month mark, as the study progressed initial BMI was more strongly correlated with weight loss. Johnson and Johnson New Brunswick, NJ, USA sponsored a series of large randomized, double-blind, placebo-controlled trials that were ultimately cut short in order for the company to focus on production of a controlled release formulation.

Systolic BP also decreased but not significantly. A randomized, double-blind, placebo-controlled, dose-ranging trial was conducted by Bray et al and reported in BMIs of 2730 were also allowed if the patients had well controlled comorbidities of hypertension or hyperlipidemia. Results showed that all the topiramate groups showed an increased amount of weight loss and all were significant when compared to placebo. Blood pressures were also monitored in this trial at each treatment visit, and significant decreases were found in all treatment groups versus placebo.

The report mentioned four cases of patients who had serious adverse effects that were felt to be related to the topiramate: This study too was cut short to one year when Johnson and Johnson discontinued trials in order to pursue development of a timed-release version. This was one of the larger studies with a safety population of patients and a modified intent to treat population of There was no significant improvement in blood lipids. Five of the six cases resolved with cessation of topiramate and one patient continued to have depressed mood after stopping the drug.

Vivus Mountain View, CA, USA have spearheaded the clinical development of a combination of phentermine and topiramate for the clinical management of obesity. Unlike regular topiramate which has a half-life of 1923 hours, the extended release form has a half-life of greater than 24 hours with a significantly slower onset of action and longer time to establishment of steady state compared to regular topiramate.

The combination of topiramate and phentermine has been approved by the FDA for use along with reduced dietary caloric intake for the management of obese subjects or overweight subjects with at least one weight related comorbidity. Furthermore there remains an intent to perform further studies to obtain additional therapeutic indications for its use as an adjunctive antidiabetic, for management of obstructive sleep apnea and for potential use in pediatric obesity.

Preliminary phase 1 trials using these formulations in small cohorts of subjects with varying degrees of renal and hepatic compromise helped establish the now recommended dosing schedule. The following paragraphs discuss the major findings from these studies while Table 3 details the major features of these studies. Further analyses of other cardiometabolic surrogates including blood pressure, lipid profiles and fasting glucose showed no statistically significant benefits though the trends observed suggested minimal improvements.

The primary end points of the study were similar to those of the EQUIP trial and the intent to treat, last observation carried forward findings showed that while the 7. An additional benefit of improvement in glycemic profiles was also reported. The study design was essentially similar as were the treatment arms and this study demonstrated the durability of the findings from the CONQUER study over a 2 year period. The current dosing schedule for Qsymia included in the product insert 80 recommends starting with two prescriptions; a 14 day prescription of the 3.

After 12 weeks on the maintenance dose based on clinical response a decision can be made as to the need for further dose titration. The dose escalation is again suggested to be a two prescription process with a 14 day prescription of the titration dose of The stepwise approach to dosing and dose escalation is designed to optimize clinical response while keeping adverse events to the minimum. The observed side effects from the various certification clinical trials of Qsymia are as would be anticipated based on the individual component medications in the combination.

The majority of them resolved spontaneously without resolution and did not spur stopping the medication. Every potential side effect identified with the individual component medications have been described and noted with the combination preparation and special attention needs to be paid to potential teratogenicity, potential for acute closed angle glaucoma and myriad neuropsychiatric symptomatology including mood disorders and suicidal ideations.

Overall the clinical results of the trials thus far completed for the fixed drug combination of phentermine and topiramate-ER give reason for measured optimism. The degree of weight loss achieved, the percentage of subjects overall achieving this degree of weight loss and it robustness based on the thus far 2 year follow up data suggest that this combination therapy has an important place to occupy in the armamentarium for chronic obesity management. Beyond the significant improvement in weight, the findings from various trials of associated improvements in relevant surrogates such as blood pressure, glycemic control and burden as well as waist circumference specifically suggest the potential added utility of the agent in cardiovascular risk modification.

The results of planned clinical trials to investigate the effect of the combination on actual atherosclerotic vascular event risks is anticipated as are the results of other planned clinical trials in special populations such as pediatrics as well as for other distinct clinical end points such as obstructive sleep apnea. The recent experiences with some antidiabetic and antilipidemic agents have made it important to proactively establish the cardiovascular safety on medications used in clinical states associated with insulin resistance and the dysmetabolic syndrome such as type 2 diabetes and complicated obesity.

Evidence from clinical trial results of rosiglitazone, torcetrapib and the glitizars have shown that improvements in cardiovascular surrogate measures may not necessarily equate to reduction in actual events hence the importance of awaiting the results of the planned vascular event trials. It is also important to note that the clinical certification trials of this agent all utilized a rather modest calorie deficit plan whose actual veracity was not robustly investigated.

It is conceivable that in the setting of more robust multidisciplinary clinic settings where closer attention is paid to appropriate calorie deficit plans, behavioral modifications and increased physical activity with added formal exercise sessions, the observed clinical benefits may be significantly greater. While still very early in the clinical history of the product, the side effect profile noted in the certification clinical trials is tolerable and consistent with expectations from the individual component medications.

Of these, only paraesthesiae, insomnia and dizziness along with the less common headaches and neuropsychiatric side effects were associated with treatment discontinuation. Careful attention to education of caregivers prescribing this medication regarding potential side effects and contraindications to its use will play a huge role in preventing mishaps akin to some witnessed with other anti-obesity agents in the past.

Close surveillance and phase 4 trial data needs careful scrutiny to ensure ongoing safety of use. The importance of the fixed drug combination of this preparation as regards improved patient compliance, reduced problems with medical insurance plans that numerate number of prescriptions available for coverage and the unique extended release form of topiramate not otherwise available for clinical management of obesity also add to the unique profile.

The success of the phentermine topiramate-ER combination in the clinical therapeutics of obesity could however extend beyond all the aforementioned. It could be a Rubicon event as it would hopefully usher in a new era in obesity pharmacotherapy that emphasizes combination therapy to enhance synergism, improve efficacy, duration of action and yet simultaneously reduce overall side effects.

The fact that another fixed drug combination agent; naltrexone sustained release and bupropion sustained release; trade name Contrave is currently undergoing FDA review for use in obesity management possible approval pending the results of ongoing cardiovascular safety trials is encouraging and indicative of this evolving trend. The other authors report no conflicts of interest in this work. National Center for Biotechnology Information , U. Drug Des Devel Ther. Published online Apr 5. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Obesity is now a major public health concern worldwide with increasing prevalence and a growing list of comorbidities and complications. Introduction Obesity is a highly prevalent, complex condition that now appears to best fit the chronic disease model well known to apply to other clinical conditions like type 2 diabetes and essential hypertension. Table 1 Oral agents for potential combination therapy in obesity management.

Open in a separate window. Clinical trials of phentermine use in the pharmacotherapy of obesity Most of the Clinical research studies on phentermine use for obesity management were relatively short duration, involving small cohorts and completed between the s and 80s. Table 2 Identified and putative modes of action of topiramate peripherally and centrally 65 , Carbonic anhydrase 2 and 4 Inhibitor Systemic 4.

Glutamate ionotropic kainate type 1 Antagonist Central 5. Cytochrome P 2C19 Inhibitor Systemic 6. Cytochrome P 3A4 Inducer Systemic 7. Use in special populations Topiramates use in children older than 2-years is well-established in the treatment of epilepsy and usually well tolerated, although there is a higher incidence of metabolic acidosis in younger patients.

Clinical trials of topiramate use in the pharmacotherapy of obesity Weight loss was noted as a side effect as topiramate was being investigated for other uses such as migraine prevention, seizures and bipolar disorder. Overview of combination therapy of phentermine and topiramate Vivus Mountain View, CA, USA have spearheaded the clinical development of a combination of phentermine and topiramate for the clinical management of obesity.

Table 3 Clinical approval trials for Qsymia. Conclusion Overall the clinical results of the trials thus far completed for the fixed drug combination of phentermine and topiramate-ER give reason for measured optimism. Report from the CDC. Changes in selected chronic disease-related risks and health conditions for nonpregnant women 1844 years old BRFSS. J Womens Health Larchmt Jun; 14 5: Geographic variation in the prevalence of obesity, diabetes, and obesity-related behaviors.

Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab. Trends in obesity and abdominal obesity among hypertensive and nonhypertensive adults in the United States. Thorpe KE, Philyaw M. The medicalization of chronic disease and costs. Annu Rev Public Health. Current updates in the medical management of obesity. Managing obesity in adults in primary care. Surg Clin North Am. Li Z, Heber D. Sarcopenic obesity in the elderly and strategies for weight management. A systematic review of the literature concerning the relationship between obesity and mortality in the elderly.

J Nutr Health Aging. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: Current and future drug targets in weight management. Pharmacological and surgical treatment of obesity. Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. Chugh PK, Sharma S. Recent advances in the pathophysiology and pharmacological treatment of obesity. J Clin Pharm Ther. Derosa G, Maffioli P.

Expert Opin Drug Saf. Anyway, again, did your appetite suppress immediately or did it take a few days? I know that's good but I expected more. I still have not changed my diet nor added any exercise. I guess that is good! The only thing I notice is dry mouth and that just makes me drink more water. So, I don't really mind that. I definitely do not eat as much as I use to. If I have pizza - it's 2 slices instead of 3 or 4! It's all I can handle. So I've got a ways to go! Twinks36 taken for 1 to 6 months January 3, I had no appetite and more energy.

However the side effects with Qysmia is short term memory loss is bad. Slow recall with words. I was hoping the side effects with Topamax in Qysmia would be small however it was not. It made me feel like I was losing my mind. Couldn't remember if I took my meds in the morning or evening. Had to think about my kids names before calling them. Looking at objects and trying to recall the name, like toaster, rolls, car etc.

I decided that I did not want this to become permanent so it was time to get off this medicine and try something else. There is other medicine better then this one. Not worth the side effects Started Qsymia today weight today I lost 32lbs by eating better and working out. I no longer fry foods or drink soda for the last 2 years. I only buy chicken and turkey meat. Only bake crockpot and grill.

Was doing great until I hit a plateau I did try belviq it helped but after so long it no longer helped. Then I read about Qsymia and decided to give it a go. And I hope everyone in this weight loss struggle wins the fight. Have a Happy New Year!!! I'll keep you guys posted. MochaBrown44 December 25, I was in a 40 DDD bra and busting out of size 14 pants. My shirts were all 1X. This was the biggest I've ever been. I've been working out with a group trainer doing metabolic work outs while on qsymia.

Stopped coffee for a month, stopped drinking beer also. Started drinking vodka with club soda instead. I weigh lb now. My shirt size is a large. My bra is a 36 DD. And I wear a size 12 pants. No real side effects to the drug. I had a little tingling in my face at first. But it went away. No jitters or anything. Wish it were cheaper. It keeps me on track and very healthy.

I do work out at my lunch time M W F. Big difference with this medication in reshaping your body. River girl taken for 1 to 6 months December 23, When I first started taking I had suicidal thoughts but took an antidepressant that fixed it. I have not started Belviq yet as I wanted to first clear my system of Qsymia and it's side effects however after over a month I'm still encountering its side affects at some degree.

I believe my eyesight has was permanently damaged from it. SheBrakesForRainbows December 13, I only take the phentermine once? Anonymous December 8, I am going on month 6 and I am down to lb. I am on the plant based diet with some whole milk yogurt thrown in a few times a week and maybe an egg every now and then because I love them! I went through a really bad spell of dry mouth for a few weeks but some dry mouth lozenges really helped with that. I am very happy with the medication and the results.

Becs10 November 13, I cannot rate it yet but will post updates as time goes by. Im hoping this works. I'm at my wits end. Heavier then when I was pregnant. I work out and watch what I eat and still can't lose weight. I'm afraid if I don't get rid of some this weight I will become a diabetic. Good luck to everyone! Little over 7 months. Starting weight was Today my scale said Again, my diet has only changed in that I eat a lot less food and drink way more water. Th3Struggl3IsR3al taken for 6 months to 1 year October 27, So far I have seen a huge change on my appetite not craving for no goodies, eating small amount of food and drinking a lot of water, starting to do zumba at the house due to a lot of energy!

RuckyGrandma taken for less than 1 month October 25, Side effects are dry mouth constipation and a little bit of agitation. It is help me not to think about food and when I do eat food it's healthier choices I eat a lot more salads I have to force myself to drink water only because I'm not a big fan of water. I've had to take laxatives which helps and the pharmacist suggested that I take Miralax or eat prunes to stay regular as laxatives on the long term are no good.

All in all I feel that this is working well for me and I'm excited about the progress that I will make. I'm a 52 yo female with a desk job no physical activity. Starting weight goal present wieght 5'6" tall. Cheekiegirl taken for less than 1 month October 21, So far I had a protein shake for breakfast, a salad with grilled salmon and one boiled egg for lunch brought from home and drinking water all day. I will try to remember to check in weekly with updates.

I can't rate this yet but I will in a couple of weeks".

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