Qsymia: Phentermine and Topiramate in Weight Loss Formula

Qsymia is an innovative drug for weight loss, for the first time released for retail sales in 2012. In 2016, Qsymia is available only in the USA.

Qsymia used to be sold in the US only online, through mail order system. Today, anti-obesity drug Qsymia is available at over 40,000 U.S. independent pharmacies and national pharmacy chains.

The new anti-obesity drug contains two proven pharmaceutical ingredients, the Phentermine and Topiramate. Each of them was approved by FDA separately:

  • Phentermine – in 1959 (for obesity treatment)
  • Topiramate – in 1996 (for seizures control)

Topiramate and Phentermine combination was used for therapeutic purposes only after it has been proven. This combination therapy helps achieve significant weight loss.

Given that Qsymia drug contains two active ingredients, it is characterized by dual mode of action. Qsymia helps to lose weight because:

1. Phentermine – suppresses appetite
2. Topiramate – increases satiety feeling.

Qsymia is manufactured as extended-release (ER) capsules, which gradually release active ingredients Phentermine and Topiramate, and thereby provide a prolonged anorectic effect.

Dual mechanism of action, combined with long anorectic activity, provide effective appetite control from morning till evening, and fast weight loss by reducing calorie content of the daily diet.

Clinical research results have shown that using Qsymia for one year:

  • About 40% of patients have lost at least 10% of the initial weight
  • About 60% of patients have lost at least 5% of the initial weight

Uniqueness of Qsymia drug is the mutually complementary anorectic effect of active ingredients. Qsymia capsules contain low doses of Phentermine and low doses of Topiramate.

Therefore, Qsymia is characterized by high efficiency and relatively few side effects.

The list of the most common side effects of Qsymia includes:

  • dry mouth
  • distorted sense of taste
  • numbness and tingling
  • sleeping disorders
  • dizziness
  • indigestion

Other adverse reactions are observed in less than 5% of obese patients.

Qsymia does not cause serious side effects, so for most obese people benefits of its use outweigh its potential risks.

Particular attention should be paid to the fact that in addition to weight loss, patients taking Qsymia may experience:

  • drop in blood pressure
  • reduction in triglycerides
  • reduction of waist circumference
  • slowdown of type 2 diabetes progression
  • improved cardiometabolic risk factors.

Each of the additional benefits was demonstrated by the results of long-term clinical trials.

Qsymia drug is normally well tolerated by different groups of patients and can be used to treat obesity complicated by concomitant risk factors.

  • Patients diagnosed with excessive weight and diabetes, hypertension, dyslipidemia, or other chronic diseases, can start treatment with Qsymia if their BMI is 27 or more.
  • If no risk factors usually accompanying obesity are observed, Qsymia-therapy can only be indicated if the obese patient’s BMI equals or exceeds 30.

Qsymia is not approved for obesity treatment in children, but perspective clinical studies of Qsymia application for obesity treatment in children and adolescents are continuing.

Qsymia is not approved for obesity treatment in children, but perspective clinical studies of Qsymia application for obesity treatment in children and adolescents are continuing.

For obesity treatment in adults, Qsymia capsules containing a fixed dose of the active ingredients are used. Each Qsymia capsule may contain:

  • 3.75mg, 7.5mg, 11.25mg, or 15mg of Phentermine
  • 23mg, 46mg, 69mg, or 92 mg of Topiramate

In 2016, the US market is supplied with:

  • purple capsules of 3.75mg /23mg Qsymia
  • purple-yellow capsules of 7.5 mg /46mg Qsymia
  • yellow capsules of 11.25 mg /69mg Qsymia
  • yellow-white capsules of 15mg /92 mg Qsymia

Different concentration of the active components is required to gradually increase and adjust the optimal daily dose of Qsymia.

  • The minimum initial dose of 3.75mg /23mg Qsymia should be taken once daily, in the morning (one purple capsule), for the first two weeks of anti-obesity therapy.
  • On the fifteenth day of treatment, the morning dose of Qsymia should be increased to 7.5 mg /46 mg (one purple-yellow capsule).

The increased dose of Qsymia should be taken continuously for three months, and then the treatment effectiveness to be evaluated.
If in 3 months after the start of application of purple-yellow Qsymia capsules, the body weight is decreased by less than 3%, this drug should be canceled, or the daily dose of Qsymia should be increased.

At the second stage of obesity treatment, the morning dose should be increased to one yellow capsule of 11.25mg /69mg Qsymia. This dose should be taken daily for two weeks. Then, a single dose should be increased to one yellow-white capsule of 15 mg /92 mg Qsymia.

  • If in 3 months after the start of application of the maximum Qsymia dose of 15mg /92mg, the body weight decreased by less than 5%, Qsymia drug should be canceled.
  • If achieved results demonstrate weight loss by more than 5%, application of yellow-white capsules of Qsymia can be continued.

The clinical research results show that most obese patients using Qsymia managed to achieve significant weight loss in just 5-6 months.

If Qsymia provides stable weight loss, but the desired result failed to be achieved for six months, Qsymia can be used for long-term anti-obesity therapy, for up to 1 year.

Qsymia is the only Phentermine-containing drug approved by FDA for long-term treatment of obesity. Other weight loss drugs containing Phentermine (including Adipex-P, Suprenza) are approved for short-term anti-obesity therapy lasting up to three months.

Today, Catalent Pharma is the exclusive manufacturer of Qsymia, but its capacities are not ready to expand the marketing of diet pills. So if Qsymia (Qsiva) is approved in Europe, Vivus will have to enter into partnership with other manufacturers of pharmaceutical products.

Another company involved in Qsymia commercialization in the USA is Cardinal Health. The company provides Vivus with logistics services.

From 2015, Vivus promotes Qsymia in USA in collaboration with:

  • Privately held biopharmaceutical company – Kadmon Corporation
  • Nonprofit medical practice and medical research group – Mayo Clinic

Despite that Qsymia is available in USA only for few years, two pharmaceutical companies (Actavis and Teva) are trying to challenge patent exclusivity for the drug.

In the second quarter of 2016, Vivus is an owner of 12 patents for Qsymia in the USA, and 4 patents are pending so far. Actavis and Teva challenged the most patents for Qsymia, in order to obtain approval to manufacture and sell generics of Qsymia in the USA.

If Teva and Actavis successfully challenge the patent exclusivity for Qsymia, the first generics of Qsymia may appear on sale already in 2017-2018 years.
If Vivus proves its exclusive patent rights for Qsymia, it will remain the sole rightholder for Phentermine/Topiramate-containing drug till 2020 as minimum.
Qsymia investigations are continuing and Vivus hopes that this combination drug may be useful in treatment of not only obesity, but also of concomitant diseases of obesity, including:

  • Hypertension
  • Hyperlipidemia
  • Nonalcoholic steatohepatitis
  • Nonalcoholic fatty liver disease

Despite its high efficiency, proven safety and other advantages of Qsymia, this drug has one disadvantage – its high price.

The cost of diet pills that contain only Phentermine is lower than the cost of combination drug Qsymia (Phentermine and Topiramate). Therefore, between Qsymia and Phentermine, many Americans with overweight select cheap Phentermine pills.

In order to successfully compete with other manufacturers of weight loss products, the US provider of Qsymia provides:

  1. To get first 14 capsules of Qsymia for free
  2. To get a monthly discount of 75$ for every 30 capsules of Qsymia

Popularity of Qsymia in USA is growing and the number of prescriptions for this drug increases annually.

  • In 2013, more than 370,000 prescriptions for Qsymia were issued
  • In 2014, more than 530,000 prescriptions for Qsymia were issued
  • In 2015, more than 560,000 prescriptions for Qsymia were issued

Since the launch of sales to mid-2015, about 1.3 million prescriptions for Qsymia were given to more than 300,000 obese men and women.

Considering that about 110 million people with overweight or obesity live in the USA, the number of Americans using Qsymia will be growing.

The first sales of Qsymia started in 2012, but the drug history began much earlier.

The first patent for a combination product containing Phentermine and Topiramate was issued to Dr. Najarian, in 1999.

Dr. Najarian proved that benefits of combination of Phentermine and Topiramate for weight loss are higher than in application of each of these pharmaceutical agents individually.

In 2001, Dr. Najarian and drug-development company Vivus signed an agreement on transfer to Vivus of all rights for further development, investigation, and commercialization of the combination product containing fixed doses of Phentermine and Topiramate.

After years of laboratory researches and clinical observations, Vivus proved that benefits of the combination of Phentermine and Topiramate for obese patients outweighed the potential risks.

After studying these research results, the FDA approved Phentermine and Topiramate for long-term weight control, and in 2012 for the first time this combination drug was launched for sale under brand name Qsymia.

In 2015, more than 60% of Qsymia consumers used the money-saving program, bought Qsymia at a discount and (or) got free Qsymia for 14 day course.
In 2016 money-saving program is continuing, so you can still get a free trial of Qsymia, or buy Qsymia monthly at a discounted price.

It should be noted that Vivus was trying to get the central marketing authorization for Phentermine /Topiramate pills in Europe, but in 2013 the application was rejected. In the EU, Vivus planned to sell a new drug under brand name Qsiva.

After studying the research results, the European Medicines Agency concluded that Qsiva could create potential risks to the central nervous system and the cardiovascular system.

Therefore Qsiva (Qsymia) sales in Europe were not launched, although attempts to obtain a European license for this product are still ongoing.
It should be noted that all rights for Qsymia belong to Vivus, but the company has not its own pharmaceutical factory. Therefore Vivus is manufacturing Qsymia in partnership with Catalent Pharma Solutions.

Qsymia is an anorexiant (appetite suppressant) used to treat severe cases of obesity that can potentially cause weight-related health problems like diabetes, high cholesterol, hypertension and heart diseases.

Two basic components are used in the drug’s capsules – Phentermine and Topiramate. The former is a well-known appetite suppressant many weight loss medications are based on.

The latter is an anticonvulsant, the drug often referred to as a seizure medication. Combined in the formula of Qsymia these work for the weight loss objective.

Recommendations for Use

Qsymia is never recommended as the only solution to the problem of excess weight; it is always an additional component used in the overall weight loss program. The other two are regular exercises and healthy (low-calorie) food.

Qsymia capsule is taken once a day, in the morning preferably. The strength is based on the weight-height correlation, your medical condition and overall response to the treatment. Capsules are to be taken whole (no chewing, crushing, opening), with or without food.

Therapy with Qsymia: Precautions

Therapy with Qsymia requires responsible attitude. On the one hand, you must follow all the recommendations given. On the other, understand all potential risks the drug can involve before you get a prescription.
Thus, Qsymia is contraindicated for patients with:

  • glaucoma and overactive thyroid;
  • pregnant women come into this category as well.

Patients with such concomitant conditions as:

  • hypertension,
  • heart problems,
  • diabetes,
  • kidney and liver diseases,
  • metabolic acidosis,
  • seizures or epilepsy,
  • mental illness
  • history of depression

also require monitoring if and when on therapy with Qsymia.

Qsymia Side Effects: How to Avoid

Potential side effects may include the following symptoms: change in or loss of taste, stuffy or runny nose, sneezing, ear congestion, back pain, rash, itching, sweating, headache, dizziness, nervousness, fear, memory problems, etc.

More serious reactions that require immediate medical aid can be the following: chest discomfort, irregular or racing heartbeat and pulse, nausea, vomiting, shortness of breath, convulsions and some others.

To prevent any you must:

  1. Strictly follow your prescription label and inform your physician about anything that may bother you.
  2. Never combine Qsymia with alcohol or any other substance that may cause harm.
  3. Never take any other drugs without prior consultation with your physician.
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42 Comments on "Qsymia: Phentermine and Topiramate in Weight Loss Formula"

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I am one of people who were trying to lose weight by various diets, exercising, medications, and always failed to maintain a consistent weight loss, and was getting weight gain. When I decided I want to start using such a strong drug, like Qsymia, I know it was the last chance I had. So I developed a comprehensive approach. I literally wrote down everything I must do and must NOT do, including the diet, exercises and water consumption. It did take me a couple of days to adjust everything, but I think I managed to cope with the task perfectly… Read more »
Lisa Blake

Owen, hello! This is so impressive! You really did take enough time to get ready for your weight loss blow. This is such a great advice to every overweight person out there! Hope you will manage to maintain your weight and will never have to fight your cravings. Best wishes!


So Owen, did you manage to maintain your weight up till now. Was it hard without the drug?


hi Emily. Yes, I am still working on my body and I am not planning to stop. Once you get there, you have to do everything to maintain it. I don’t want to go back to the way I was. If it is hard without Qsymia… yes, it is. However, I know for sure that it would have been 10 thousand times worse, is I didn’t use it. Gave me the kick start I needed, helped me build new habits, regime. Now I know how to cope with hunger attacks and definitely try having healthy snacks, if I need.

started taking Qsymia 1 month ago. Lucky to have the only side effect, which is the increased energy levels, and I can’t complain on that! I have to admit that I notice how I feel less hungry, and I definitely am safe from hunger attacks, as well as cravings for sweet foods. My water consumption is up to 2 – 2.5 liter per day. I used to drink not more than 1 – 1.2 liter a day. I even notice that my skin benefited from the water intake. Looks a lot smoother and lighter, which is another huge advantage of… Read more »

hey Char, how’s your weight loss? Still on Qsymia?


In 1.5 month managed to lose 10 kg. That’s huge for me. Plan on taking it another month and then continue losing weight on my own. Been struggling to lose at least 1 kg for 5 years, and now that Qsymia gave me a good kick and a good weight loss, I am not going to stop. I will get to my best weight. Miracles do happen!

Lisa Blake

Hello, Rocket. Thank you very much for your feedback. Congratulations with your weight loss. It’s a huge success. Could you please describe the side effects you had, as well. Thanks in advance and good luck!


Hi Lisa. Name is Roxanne. The side effect I had, which was quite troublesome for me, was constipation. It is better now. No other side effects so far. Hope, nothing will manifest in the nearest month.

I have started using Qsymia last October. I managed to lose almost 12 kilos. It helps me with fighting my cravings for sweets and junk food. I did try several weight loss drugs before, but, unfortunately, non of them worked so well. I did have some slight side effects at the beginning of the course. However, these were minor. I was having some sleep troubles and felt a bit dizzy. Now everything’s just fine and I am working on getting used to eating in a healthier way. In my opinion, this drug will work for people who need to lose… Read more »
Lisa Blake

Hello Tina. Thanks for dropping in and giving a good insight of your Qsymia journey! Glad the drug helped you reduce your appetite well enough to help you lose so much excess weight. I am also very happy that you are working on learning to eat healthy. This will help you maintain your weight after you stop taking Qsymia. Good luck!


If I have low blood pressure, can I take Qsymia?

Lisa Blake

Hello Max. The contraindications to Qsymia do include high BP, and not the low one. However, you should find out the reason of your low BP and consult with a competent healthcare professional. Low BP often is a symptom to various conditions. Before you start using Qsymia for weight loss, you have to make sure that you have no contraindications to it. Best of luck!


Hi Lisa. Followed your advice. Doc said it’s ok to take it. SO I am on Qsymia from Monday. Thank you!


does everyone manage to lose weight with Qsymia? I am worried that I won’t lose anything. Have been trying everything to lose these 15 kilos. Nothing works!


do not count that Qsymia will do everything for you! WORK WORK WORK! Then you will lose weight. A miracle won’t happen if you lie on the couch and eat donuts. Good luck!

Lisa Blake

Hi. Qsymia already helped a very considerable amount of people lose weight. Of course, we are different, and some people find it more effective, while the others wish higher results. However, you shouldn’t expect you will lose 15 kilos in a week. It does take time and you should work on losing weight in a healthy weight, i.e. through healthy eating and exercise. You should stay committed to your goals and plan, and you will do it!


starting Qsymia today. Wish me luck!

Lisa Blake

Good luck to you! And I hope your nick will switch its meaning from “someone who fails to lose weight” into “someone who managed to lose a lot of weight”! =)) If you need any advice, feel free to write.


hello, Lisa. So it’s my day 2 on Qsymia. I have a very bad taste in my mouth and occasional ear congestion. will these side effects go away with time? anything I can do about them?

Lisa Blake

hi, yes, these are among the common side effects of Qsymia. There is not much you can do about these, but to follow the recommendations of your doctor. Plus, I would advise you to inform him about the issues. Take care!


hello Lisa. Doctor also said I should continue. I think. It’s getting better and the side effects are getting milder. I eat right and I exercise. Weigh in is in less than 2 weeks. That’s when I will switch to the higher Qsymia dose.


My sister used Qsymia and lost a lot of weight. She recently confessed that she used it and offered me the remaining stock. It’s 22 capsules of Qsymia 15 mg/93 mg. how should I take it? I have about 20 extra kilos. Please help

Lisa Blake
Hello Nick. I am very happy for your sister’s weight loss. However, if you want to start using Qsymia, you should consult a doctor, even if you don’t need a prescription. The doctor will check your overall health condition and will make you pass though some certain tests and examinations to make sure it will be ok for you to take this drug. I strongly advise you to NOT take the drug without consulting a doctor. It is a very potent medicine and you have to be sure you don’t have any condition that is a contraindication to its use.… Read more »

doc told me I need to lose weight to get pregnant. I need to drop 20 kilos. Can Qsymia help me do this? My main problem is snacking.

Lisa Blake

Hello Tasha. Yes, Qsymia can help you lose weight, if you comply with healthy eating regime and exercise every day at least 30 minutes. However, if you are trying to conceive, you should be very careful. You’d better stop trying to conceive until you get to the goal weight and use a reliable birth control method. Discuss this with your doctor and good luck to you!




1.5 years since I gave birth and I can’t lose the weight, just accumulate more. Any certain intervals between giving birth and using Qsymia?

Lisa Blake

Hello. There are no certain restrictions for this period. Yet, I do have a question for you. Are you still breastfeeding? If you are, you can not take Qsymia. If you’re not, it’s ok and good luck for your weight loss!


Hi Lisa, yes I am breastfeeding, but I am planning to quit soon. Got an apt with my doc in a week. Will try to quit breastfeeding by then. Thanks for warning me!

Lisa Blake

Ok, that’s a good thing to talk to your doctor first, and make sure he checks your overall health condition. And, of course, don’t start Qsymia until you stop breastfeeding!!!


any suggestions on eating and exercising while on Qsymia? Anyone?

Lisa Blake
Sure, ringabell! Hi! In fact. I can give you only general recommendations to have at least 30 minutes a day of physical activity (you can start from simple brisk walking and increase the load with time) and to comply with healthy eating principles. So, you should avoid any processed foods and ready-made meals from stores, as well as ordering food. You have to cook yourself to know for sure what is inside your meal. And your meal should contain lean meat/cottage cheese/eggs/fish, i.e. proteins with vegetables. Preferable cooking methods are boiling, steaming, oven-baking and grilling without oil. Of course, sweets… Read more »
work your … off

My experience of using Qsymia shows that it works in waves. You get a new dose for a certain period, and the effect slowly wears off. Then you get a higher dose, and again get a huge appetite suppression, then it wears off again, and so it goes. However, the important thing is to work on your body improvement, and not just wait that Qsymia melts all the fat you gained during your life. WORK!

Lisa Blake

Hello! Yes, you are quite right. Many people report exactly the same scheme, as you described. And you are so right about the necessity to work as much as you can, and eat healthy. Otherwise, you won’t lose any considerable amounts of weight. did you manage to lose any weight with Qsymia? Take care


is it enough if I go to the gym 3 times a week and walk for 30 minutes n days when I am off gym? Should I up the exercises. I am on Qsymia for around a month now. So far, so good. I just want to have the best results for my next weigh in, which is in 1 week.

Lisa Blake

Hello IIE! I think it is quite enough, especially if you spend your gym time on strength trainings. Thus, you will alternate strength and cardio loads. I would also advise you to complement your physical activity with stretching. Best of luck to you with your next weigh in and the entire weight loss progress in general!


When I was for two weeks on Qsymia 3.75, I was feeling great. Lots of energy and losing weight as well… now my doc upped me to Qsymia 7.5 mg, and I don’t feel so well… should I get back to 3.75 mg. Is it ok to do so? Will it work for me?

Lisa Blake

Hello LFA. I think you should discuss this issue with your doctor. He is the only person, who can monitor your condition and give a qualified advice, when it comes to your health and overall wellbeing. Best of luck on your weight loss journey!


I need to lose 30lbs for health reasons but i can not find a local doctor who is willing to prescribe any weight loss medicine. Is there an online doctor any of you used to get it WITH a prescription? Because of my job, I do not want to take it without a prescription.

Lisa Blake

Hello Kris. I am sorry your excess weight creates health problems for you, and I wish you to find the right way out of this situation and lose weight. There might be a particular reason why your doctors won’t prescribe any slimming pills to you. They might be contraindicated to you. Be careful!


It says that you shouldn’t drink alcohol and take the medication , but what are the potential problems if you do?