Qsymia for weight loss - equivalent, alternative & less expensive medications available

DR. STUART WASSER   ROCKVILLE CENTRE- LONG ISLAND    516 594-2514


Qsymia is a medication approved by the FDA for weight loss 6-9 months ago.  The pill in a combination of two other medications- each has been available for years.  The first is phentermine and has long been used for weight loss. It is thought to be a stimulant medication and is currently a controlled medicine; however, in the formulation used, relatively low dosages of the medication is prescribed.  Therefore, most persons will not have a stimulant feeling.  They will, however, benefit from the appetite suppressing effects of the drug.  The second medication is topiramate, a medication that calms the central nervous system and reduces food cravings.  The side effects of topiramate include sedation, nausea and tingling .  For this reason, the medication has to be begun at low doses and increased in small steps.

I cannot say enough about how useful this medication combination is.  The combination of the two medications produces a result far greater than that which can be obtained by either alone.  I have treated about 40-50 persons so far and have found that about 70% of my patient seem to obtain a weight loss of 10-15% (of their starting weight) within the first three months.  Some patients reach 30-35% weight loss.   

The FDA's concern is whether the risk of heart attack is increased with long term use.  However, studies of phentermine show no increase in blood pressure and minimal increase in pulse.  Perhaps, the weight loss obtained more than made up for any stimulation provided by the medication.  Certainly, we need to be concerned about heart issues, but there is no clear cut increase in heart disease in available studies.  Of course, I would not treat a person at high risk of heart attack and have sent a few of my patients for stress tests before beginning treatment.  We need to be careful.   That still leaves plenty of other patients including those whose risks of heart attack is years away and can be lowered by significant weight loss. 

The concern over topiramate is birth defects in pregnant woman.  Of course this is a concern; however, topiramate has been used in young women for years for other reasons such as seizures and migraine headaches.  Birth defects should not be more of an issue for the overweight population.  We also have to worry about kidney stones in patients using this medication.

These medication will not be tolerated by everyone.  5% cannot tolerate phentermine. (If you can't tolerate decongestants, you will not be able to tolerate phentermine) About 10% of persons cannot tolerate the topiramate.  Other medications can be substituted for these and are also effective.  see Weight Loss Medications

The cost is about $150 for Qsymia without insurance or a brand name copay with insurance.   Many commercial insurance companies have been paying for the generic medication, some of the medicare part D companies do not.   Luckily, phentermine costs only about $30-35/month.  Topiramate costs range from $15. to over $200 depending on the pharmavy you go to (in Rite Aid,  50 mg two times daily costs $232)

The drugs only suppress appetite; they need to be used with a structured diet.  Most popular diets are fine and I recommend any.  Weight Watchers, South Beach, Jenny Craig or any other, will all be beneficial.  Excercise is also neccessary for optimal results.

Treatment with these medications may become chronic.  Some patients may learn new eating habits and maintain their weight without medication. Unfortunately, most others require help indefinately.  I compare obesity to hypertension or diabetes(especially since these problems improve with weight loss).  We often use combinations of medications to treat these other problems.  We don't stop medication once a target pressure, cholesterol level or diabetes result has been achieved.  Rather, we continue medication as long as the benefits outweigh the risks and monitor for side effects.  That is my job.

The office is open 5 days/week  See link below for more detailed office information.  Insurance may cover treatment if your BMI is greater than 28.  Patients are seen on a monthly basis.

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