In some cases, weight management (bariatric) surgery may be helpful. If you do not have significant headaches or vision loss, no treatment may be necessary, although weight reduction is always a good idea to prevent the disease from worsening. It can help weight loss by making you less hungry. Sexual health The results of 2 multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trials established the effectiveness of topiramate in the preventive treatment of migraine. In five of the six studies, patients received active drug beginning at 100 mg per day; the dose was then increased by 100 mg or 200 mg/day increments weekly or every other week until the assigned dose was reached, unless intolerance prevented increases. No adverse effects on male or female fertility were observed in rats administered topiramate orally at doses up to 100 mg/kg/day (2.5 times the MRHD for epilepsy and 10 times the MRHD for migraine on a mg/m 2basis) prior to and during mating and early pregnancy. If communicating hydrocephalus is found without excessive atrophy and with transependymal absorption, then a large volume of cerebrospinal fluid is removed and the changes in the gait observed over several days. Patients with the clinical triad undergo FLAIR MRI. There was reduced clearance of the contrast agent from the subarachnoid space and accumulation in the Sylvian fissure (Ringstad et al., 2017). Drainage of CSF may involve the lymphatics of the brain, which are also called the glymphatics. Doctors determine the patient’s eligibility for the therapy based on their BMI, medical history, and the medications they take. Topiramate is primarily used for its anticonvulsant effects. Register for free today. Inflammatory lesions such as those that occur in acute attacks of MS respond well to high-dose methylprednisolone. High doses of corticosteroids have been shown to be effective in brain edema secondary to inflammation in MS; the steroids act by closing the BBB, which can be seen on contrast-enhanced MRI (Rosenberg et al., 1996). Hence, it is important to obtain contrast-enhanced MRI or CT scans before treatment with corticosteroids. More recently, hypertonic saline has been advocated for use in treatment of cerebral edema (Fink, 2012). Other effects are that mannitol reduces CSF and ISF secretion by 50%, which may contribute to its action. How does Topiramate compare to other weight loss medications? Besides dose, study design appears to impact the level of both subjective and objective cognitive AEs. When comparing patients on low versus high doses, Arroyo and colleagues found cognitive AEs in 15% and 24% of patients, respectively Arroyo et al. 2005. Despite adequate seizure control, discontinuation rates of up to 70% were found in one longitudinal study that followed 470 patients over 4 years, with 28% of patients reporting ‘mental slowing’ Bootsma et al. 2004. We review the literature describing the reversal of such negative effects upon medication discontinuation, and the use of TPM in special populations such as the elderly and developmentally delayed. When used in combination with phentermine, TPM is prescribed for the additional indication of obesity, one of seven known potentially controllable risk factors for Alzheimer’s disease Barnes and Yaffe, 2011. Associated Data Significant decreases were also observed in the topiramate group for leptin, glucose, cholesterol, trigylcerides, and blood pressure measurements.Cognitive impairment in hemodialysis patients is common.Although sensory complaints are typically inconspicuous, clinical examination shows sensory deficits.Siponimod targets the S1P1 and S1P5 receptors, similar to fingolimod, though notably it has less specificity for the S1P3 receptor, and thus bradycardia during first-day dosing is less of a concern.The brand nameQsymia (phentermine/topiramate) is used to sell this combination.The brain MRI is abnormal is almost two-thirds of the patients, showing unilateral or bilateral medial temporal lobe FLAIR/T2 signal, which is consistent with limbic encephalitis.This may limit the effectiveness of the medication in settings outside of scientific studies. More serious side effects can include kidney stones, glaucoma, and metabolic acidosis. Individual results vary based on dosage, diet, exercise, and other factors. Thinking about taking pills to lose weight? Body mass index (BMI), when adjusted for age and sex, is generally an excellent measure of percentage body fatness in the population.4,5 BMI is an accepted measure to screen for the health risks of obesity and provide cut-off points as indication for more intensive therapies. Because both agents are fairly well tolerated, the combination was studied as an approach to weight loss using lower doses than employed with either as monotherapy. Topiramate (toe pyre' a mate) was developed as an anticonvulsant, but studies of its efficacy in patients with seizures noted mild weight loss. Milnacipran is another SNRI; randomized double-blind placebo-controlled studies found that milnacipran is effective in controlling pain and improving global status, fatigue, and physical and mental function in patients with fibromyalgia (Arnold et al., 2010).It’s possible that your prescriber may still decide that a smaller dose is more appropriate for you.If you’re having trouble with cost, side effects, or dose adjustments, don’t try to microdose on your own.In summary, data shows lower doses of TPM, when used as monotherapy for the treatment of epilepsy in the older patient, may be effective, with 50 to 75 mg, sufficient for seizure control.28Favorable experience with jugular bulb oximetry has been reported in patients with SAH and ICH Descargado para Oscar Dussan (email protected) en Pontifical Xavierian University de ClinicalKey.es por Elsevier en marzo 20, 2021.Surrounding yourself with a supportive network of friends, family, or a weight loss support group can significantly enhance your chances of success.Evaluation of reports is hampered by incomplete documentation and the variety of agents to which exposure has often occurred.Each response was provided a score and the total RWL score corresponded to the aggressiveness of weight management methods.Clinically affected patients present with subacute or insidious onset of upper motor neuron signs and gait instability. In many patients, the prognosis becomes clear within a relatively short time, as with stroke and coma. The patient with a tracheostomy may still be able to talk using a valved tracheostomy tube or a partially inflated cuff, but many such patients lose bulbar functions and must use communication devices such as computers or letter boards. Although the availability of insurance to cover the cost of ventilator care is paramount in the United States, in Japan the health insurance system pays for the cost of 24-hour home ventilatory care for all ALS patients. For patients who decide to request ventilator support, health insurance and economic matters must be considered. Even if patients have prepared living wills, they will be taken by emergency services to a hospital emergency department and be intubated unless proper arrangements are in place for end-of-life care at home, usually through hospice services. Before taking any medication to treat obesity, talk with your health care professional about the possible risks and benefits. Some weight management medications that curb appetite, such as phentermine, are approved by the FDA only for use for a few weeks. You can keep taking these medications as long as you are benefiting from treatment and not experiencing serious side effects. The table below lists prescription drugs approved by the FDA for chronic weight management. Some, but not all, insurance plans cover medications that treat overweight and obesity. Another 2014 systematic review of 22 RCTs involving 4,531 participants reported a mean weight loss of 7.4 kg (16.3 lbs) with Topiramate treatment. In this in-depth article, we’ll delve into the evidence, examining the effectiveness of Topiramate for weight loss and what you need to know before considering this medication. The quest for an effective weight loss solution has led many individuals to explore various options, including prescription medications. Since the market approvals of rimonabant and sibutramine have been withdrawn since 2009 and 2010, respectively, these two drugs were no longer considered as relevant for long‐term weight management and were therefore excluded from the 2020 version of this review. Long‐term trials assessing the effects of sibutramine and rimonabant on mortality and morbidity have confirmed concerns about the potentially severe side effects that led to marketing withdrawal of these two drugs throughout the world. Signs and Symptoms of Tuberculosis Indeed, we have a responsibility to provide appropriate care for these common complications of obesity. By itself, topiramate has not been linked to severe hepatic injury. Clinically apparent liver injury due to this combination has not been reported, but several instances of acute liver injury have been linked to topiramate monotherapy of other conditions. Retrieved studies showed conflicting data concerning physiological parameters and biomarkers, while psychological well-being parameters were more consiste... Out of 52 studies initially found, 14 studies met our eligibility criteria and were included in the review. Body water is stored in and shifted between different sites throughout the body complicating hydration assessment. Gradual dieting, sauna use and skipping meals were the most dominant methods used to reduce weight prior to competition while more extreme methods of RWL such as the use of laxatives, diuret... Each participant received RWL questionnaire that was available in multiple languages, and every participant was instructed how to fill it out. It’s also critical to taper off the medication slowly under a doctor’s supervision to avoid withdrawal symptoms. This combination is designed to be more effective than either drug alone. Mood changes, including nervousness, anxiety, and in some cases, depression, are potential side effects. The most frequently reported side effects include tingling in the hands and feet (paresthesia), cognitive fog or ‘brain fog,’ fatigue, and changes in taste. When topiramate is used on its own for weight loss, it’s started at a low dose and then slowly increased over time. Are you curious about how topiramate, a medication primarily used to treat seizures and migraines, can also lead to weight loss? Clinical trials confirm its weight loss effects, but potential risks should be considered. There may be other side effects of phentermine that are not listed here. The most common side effects of phentermine are listed below. Common side effects include fast heartbeat, high blood pressure, and restlessness. The majority of them resolved spontaneously without resolution and did not spur stopping the medication. The following paragraphs discuss the major findings from these studies while Table 3 details the major features of these studies. 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.80 Unlike regular topiramate which has a half-life of 19–23 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.70,80 This formulation is suggested to thus have a longer duration of action and better tolerability profile compared to regular topiramate. Weight loss with both combinations seemed to be greater than that observed previously for the oral drugs in monotherapy, although the absence of such groups in this trial does not allow a direct comparison. Treatment was single-blind for subjects receiving sc medication only and open-label for subjects in the combination arms. Other side effects were much less frequent, occurring in up to 5% of the cases, and included nasopharyngitis, headache, constipation, and diarrhea. There are some crucial things to consider before your doctor recommends Topamax for weight loss. Topamax aids in preventing or reducing weight gain, which is frequently observed with this family of drugs. Additionally, Topamax has been demonstrated to enhance insulin sensitivity in patients on antipsychotic drugs such as olanzapine (Zyprexa). The precise mechanism of action of Topamax for weight loss is uncertain. The prices for a single month supply of weight loss medications with and without coupons were acquired through online query of GoodRx®, a website which compiles medication costs at various pharmacies throughout the United States (9). For each case, body weights recorded at clinic visits were plotted versus time, with medication changes noted on the timeline. Bariatric surgery is considered a safe and effective treatment for most patients with obesity. In 2008, a study was done on 12 children between the ages of 2-12 year, who were on topiramate for seizures . There was a case series on two patients, reported by Stella et al. where they reported reversible psychotic side effects with topiramate . No prospective dose-ranging studies of TPM's effect on cognition, however, have been performed, making it difficult to determine specific dose-related risk to neuropsychological function. Overall numbers of foetal malformations in mice were increased for all drug-treated groups (20, 100 and 500 mg/kg/day). As a result, higher steady-state topiramate plasma concentrations are expected for a given dose in renal-impaired patients as compared to those with normal renal function. Concomitant multiple-dose administration of topiramate, 100 to 400 -mg twice a day, with phenytoin or carbamazepine shows dose proportional increases in plasma concentrations of topiramate. Following administration of multiple doses of 50- mg and 100- mg of topiramate twice a day, the mean plasma elimination half-life was approximately 21 hours. Motor strength is intact, reflexes are usually normal or slightly increased, and Babinski signs are absent. When gait is the presenting factor, the prognosis for treatment is better. D, Echo-planar T2 axial image shows enlargement of the ventricles prior to surgery for hydrocephalus. B, Initial axial T2-weighted magnetic resonance imaging shows normal ventricular size. Subsequently, several randomized clinical trials examined the efficacy of TPM for weight reduction in obese patients with and without obesity-related comorbidities.24–31 Diet and lifestyle modifications remain the cornerstones of weight loss therapy, but are limited by a lack of long-term success for most obese patients.5,6 Furthermore, the type of intensive lifestyle interventions that have been shown to be effective in randomized controlled trials are challenging to implement in clinical settings, especially primary care practices, due to limited time, resources, and a lack of reimbursement by health insurance carriers. However, as your body adapts to the medication, hormone levels may shift, leading to a decrease in the medication’s weight loss effects. In fact, many studies have shown that combining topiramate with other weight loss medications, such as phentermine, can lead to even greater weight loss and improvements in metabolic parameters. The maximum dose in adults is 360 units. This condition is easily confused with migraine attacks, but physical examination may reveal positive tenderness over the greater occipital nerve. These patients may have continuous headaches in the occipital, parietal, and sometimes the frontal region. Patients are often misdiagnosed as having tension headache or migraine. Table 52.5 lists commonly used interventional pain management techniques and their indications (Dinakar and Ross, 2013b). The study adequately described the method of randomisation and concealment (Nissen 2016).Symptoms typically occur within 1 month of initiating topiramate therapy.Talk to your doctor about the risks of taking topiramate.Despite use of intracranial monitoring in patients with severe brain injury, clinical utility has not been shown.The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025.A gene for autosomal dominant sacral agenesis maps to the holoprosencephaly region at 7q36.This side effect usually resolves once your body adjusts to the medication.It does this by helping your body use insulin better. Current evidence suggests a positive, durable effect of phentermine/topiramate ER on the cardiometabolic sequelae of obesity, including improving glycemia and blood pressure, and ameliorating obstructive sleep apnea. The weight loss achieved by pharmacotherapy is in between that commonly achieved by lifestyle intervention and bariatric surgery. It seems reasonable that pharmacotherapy be offered as an alternative intermediate option to lifestyle or bariatric surgery, expanding the current armamentarium of obesity management. Accordingly, successful obesity management requires escalation of intervention in many individuals, and adjunctive pharmacotherapy appears to be increasingly effective in this regard. Heroin users are at risk for ischemic stroke in the absence of systemic disease or other stroke risk factors; an immunological mechanism has been proposed (Brust, 2011). Heroin nephropathy carries risk for stroke. A case-control study found that marijuana use was protective against the development of incident seizures (Ng et al., 1990). In addition to a healthy, balanced diet and lifestyle modifications like increasing physical exercise, medical practitioners may advise these drugs. In general, a person with a BMI between 25 and 29.9 is overweight. To assess a person’s weight for health, medical experts employ certain instruments and measurements. Partial-onset seizures, primary generalized tonic-clonic seizures, and seizures linked to Lennox-Gas taut Syndrome are all treated with topiramate. Topiramate is a prescription medicine used either alone or in combination with other medications to treat specific epileptic seizure types. 7 Patients Undergoing Hemodialysis Second-generation Japanese in the United States retain their parents’ low risk of MS. The White population of South Africa, with medium prevalence of MS, is surrounded by a Black population in whom the disease is very uncommon. Japan, situated at the same latitude as areas of high prevalence in Europe, is a low-risk area. However, this risk is clearly modulated genetics, as notable exceptions exist. Be careful to warn patients about cognitive effects such as mental slowing, difficulty calculating or finding words, dulled thinking, and blunted mental reactions.It is essential for today’s clinical neurologists to recognize that their scope of practice involves much more than diagnosis.In some patients, attempts to elicit a Babinski sign will result in a grasp response of the toes, suggestive of frontal lobe damage.If it is recommended that a topiramate capsule become accessible and scattered on light food, do not chew the meal and swallow it right away.Induced ketosis can be gained through the use of topiramate, which then facilitates weight loss.By the end of the study, a decline in phonemic fluency was seen, similar to findings in studies of patients with epilepsy taking higher doses.Yes, there are several alternatives to Topamax for weight loss, including other medications, dietary approaches, and lifestyle changes. We could include all four studies in the meta‐analysis investigating the effects of orlistat on diastolic BP. We could include all four studies in the meta‐analysis investigating the effects of orlistat on systolic BP. For details on secondary outcome data see Table 9 (body weight), Table 10 (systolic blood pressure), and Table 11 (diastolic blood pressure). The dose was titrated by 25–50 mg increments per week to a maximum of 400 mg/day. The trial lasted for 10 weeks and the median dose was 100 mg/day (range 25–400). This was confirmed by significant reduction in scores on the Bulimic Intensity Scale, 37% for topiramate vs. 14% for placebo. Medical Disclaimer Understanding how it works, its potential side effects, and the individual variability in responses are crucial for making an informed decision. One critical aspect of using Topamax is the individual variability in response to the medication. Topiramate operates within the central nervous system and targets various neurotransmitters that are involved in controlling seizures and migraine pain. Case-control study of the association between malignant brain tumours diagnosed between 2007 and 2009 and mobile and cordless phone use. Solvent exposures and Parkinson disease risk in twins. The effects of toluene on the central nervous system. Topiramate and cognitive impairment: evidence and clinical implications Sigma (σ) receptors as potential therapeutic targets to mitigate psychostimulant effects. Salvinorin A analogs and other kappa-opioid receptor compounds as treatments for cocaine abuse. Recreational cannabis—minimizing the health risks from legalization. Phenylpropanolamine and the risk of hemorrhagic stroke. Nerve conduction studies may show slowing of both sensory and motor conduction velocities, with prolongation of the absolute refractory, relative refractory, and supernormal periods. Some patients have findings of a mild sensory neuropathy. Some patients are referred to psychiatrists by clinicians unfamiliar with the disease. Symptoms are typically dose-dependent, with more severe poisonings occurring after consumption of the toxin-rich head, liver, and viscera of contaminated fish. It is a water-soluble compound that increases Ca2+ influx through voltage-independent Na+ channels. How long you take a weight-loss drug depends on whether the drug helps you lose weight. Many people gain back some of the weight they lost when they stop taking weight-loss drugs. And ask about the possible benefits and risks of each drug. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone. There is no standard topiramate dosage for weight loss because the medication is not approved for this indication. So if life gets busy, it may be easier for you to remember to take that one dose daily instead of two times a day for topiramate weight loss. A review of other studies found that topiramate appears to be more likely to cause weight loss among people with a high body mass index (BMI). In 2012, after years of clinical trials, the FDA approved Qsymia®—a controlled-release combo of phentermine/topiramate—for weight management. While Topamax may result in weight loss, its primary use for neurological conditions sets it apart from these dedicated weight management medications, which often have more robust studies supporting their efficacy for weight loss. Other conditions include purine and pyrimidine abnormalities, Smith-Lemli-Opitz syndrome, and lysosomal storage disorders. Dysmorphology examination should be performed to facilitate the diagnosis of genetic syndromes (e.g., FXS, velocardiofacial syndrome, and Smith-Magenis syndrome). CHAPTER 90 Autism and Other Neurodevelopmental Disabilities Macrocephaly occurs in about one-third of children with autism and generally becomes apparent around the age of 1–3 years. Probably the most commonly used is the Modified Checklist for Autism in Toddlers–Revised (M-CHAT-R), which is a parent-completed questionnaire designed to identify children at risk for autism in the general population. The American Academy of Pediatrics recommends screening all children at well-child visits at 18 months and at 24 months of age (Johnson et al., 2007). Termed “crocodile” for the green-black skin lesions found on parenteral users, the drug is made by cooking crushed codeine pills with household hydrocarbons such as gasoline or paint thinner. In 2016, a national epidemiological survey of American adults reported a 9.9% lifetime prevalence of DSM-5 drug use disorder (not including ethanol or tobacco) (Grant, 2016). Worldwide, numerous drugs, licit and illicit, are used recreationally, resulting in different patterns of intoxication and withdrawal. Additional interventions, such as bariatric surgery or pharmacotherapy, may be needed to achieve adequate sustained weight loss and cardiovascular risk reduction. Modest weight loss of 5–10% in obese individuals improves cardiovascular risk markers, including blood pressure (BP) 9–11. Obesity poses significant cardiovascular health risks, such as increased risk of hypertension and cardiovascular disease, and can cause or exacerbate arterial hypertension; it is an important cause of treatment-resistant arterial hypertension 2,3. In addition, all participants received a standardised counselling for diet (to reduce caloric intake by 500 kcal/day) and lifestyle modification. The assigned dosages were maintained for 52 weeks. The treatment duration was 56 weeks. About 90% of the included participants were taking antihypertensive medication. The hypertensive subgroup included 1305 participants with a mean age of 53 years, a mean baseline systolic BP of 134 mm Hg and a mean baseline diastolic BP of 84 mm Hg. Many of these patients have hypertensive vascular disease with lacunar infarcts. Diagnosis of adult-onset hydrocephalus and selection of patients for placement of a ventriculoperitoneal shunt has been difficult. Incontinence of urine may occur, particularly in patients with prominent gait disturbance. The dementia is of the subcortical type and involves slowing of verbal and motor responses, with preservation of cortical functions such as language and spatial resolution. Because many of these patients also have hypertension, and some have small or large strokes, such patients may have other neurological findings including spasticity and hyperreflexia with Babinski signs. Measurement of these metabolites is especially useful when the serum cobalamin concentration is in the low range of normal, between 200 and 350 pg/mL, and in patients with suspected nitrous oxide abuse who may have normal serum cobalamin levels. Mental slowing, depression, confusion, delusions, and hallucinations are common, and occasionally patients present with only cognitive or psychiatric symptoms. Clinical Features The onset of symptoms is insidious, with paresthesias in the hands or feet experienced by most patients. Symptoms appear subacutely after surgery and resolve quickly with cobalamin treatment (Singer et al., 2008). Motor nerve conduction velocities, sensory nerve conduction studies, and repetitive nerve stimulation are typically normal. The clinical presentation of tick paralysis often mimics Guillain–Barré syndrome. Other areas where a tick may go undetected for days are the ear and nose canals and the genital areas. At Spark Healthcare, we understand the importance of personalized treatment approaches.Especially notable are syphilis and tuberculosis, including drug-resistant forms.At the same time, rapidly losing weight can also affect your body image and, hence, your mental health.Cell injury that occurs in cerebral ischemia, hypoglycemia, and some metabolic disorders causes tissue damage via cell swelling or breakdown of the BBB.Paresthesia was the most common side effect observed in most of the included studies (Ko et al., 2005; Afshar et al., 2009; Narula et al., 2010).After 8 weeks of titration, the participants used the treatment or placebo for 52 weeks.At this time, it is not possible to predict which patients are most vulnerable to such cognitive effects.Trichomegaly can be congenital or acquired secondary to medications or chronic illnesses.The quest for effective and safe weight loss solutions has driven a significant amount of research and development in the medical field. The latter method first fits an inconsistency model and then conduct a Wald test to check whether there is significant inconsistency among the included studies (White, 2015). The connecting line between two nodes meant a direct comparison existed and its thickness was determined by the number of studies included. Each node represented an add-on and its size was weighted by the number of subjects of each add-on. Each domain would be assigned a judgment of ‘Low risk’ of bias, ‘High risk’ of bias, or ‘Unclear risk’ of bias. The Achilles reflex is typically lost, and other tendon reflexes may be depressed also; however, in some instances, evidence of central involvement is manifested by brisk tendon reflexes. Although sensory complaints are typically inconspicuous, clinical examination shows sensory deficits. Tremor, convulsions, and coma may follow acute high-level exposure, but the effects of chronic low-level exposure are uncertain. Chelating agents are of uncertain utility. Electrodiagnostic study results reveal both sensory and motor involvement. Thus, unlike natalizumab, the treatment is not limited by a patient’s JC antibody status. These trials were both 96-week randomized, placebo-controlled trials of ocrelizumab (300 mg IV once, repeated in 2 weeks and then 600 mg IV q24 weeks) against an active comparator, IFN-β-1a (44 μg SC, three times a week). OPERA I and OPERA II were identical trials that were carried out in over 1650 RRMS patients (Hauser et al., 2017). Based on these results, phase III trials in RRMS and PPMS were conducted with ocrelizumab, an analogous but humanized antibody. The FDA has okayed a few meds for weight loss. Our services do not include medical advice, diagnosis, treatment, or prescription management and are not a substitute for care from a licensed healthcare provider. Learn how ValleyForgeWMC can help you with your weight loss goals. Topiramate was administered at a dose of 100 to 600mg/day depending on response to treatment. Topiramate is an anticonvulsant drug used for the treatment of epilepsy and prophylaxis of migraine. It indicated that topiramate, as an adjunct to standardised medication, is more efficacious in reducing alcohol consumption than placebo. McElroy et al. , reported efficacy of topiramate in reducing binge eating episodes by 93% in the treatment arm compared to 46% in the placebo group. Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest.The decrease in BMD at 12 months was correlated with decreased serum bicarbonate, suggesting that metabolic acidosis was at least a partial factor contributing to this adverse effect on BMD.In the higher dosage group (400 mg/day) weight loss occurred in 17% of children.Ten patients (18%) discontinued topiramate because of side effects.Topiramate Notably, topiramate may help people lose weight by lowering their triglyceride and cholesterol levels, calorie consumption, and fat gain.Doctors now prescribe it to overweight people who can benefit from the medication because of it curbs appetite and prolongs satiety.The impact of migraine medications on weight varies between individuals. However, four large unpublished placebo-controlled monotherapy trials failed to confirm the efficacy of topiramate in the treatment of acute mania (cited in ), indicating a poor antimanic effect, at least in monotherapy. Several studies, including this one, show that topiramate has a strong potential to induce weight loss which is sustained for at least one year. Psychiatrists should have a responsibility in managing obesity in their patients by choosing more appropriate drugs in patients prone to weight gain. One patient (N 10) complained of paraesthesia, sore tongue and bad taste in her mouth and stopped topiramate during an earlier treatment (on Figure 1 this coincides with an earlier short period of weight loss). In a study focusing on topiramate-related weight loss, 15 patients who had gained weight after using selective serotonin reuptake inhibitors for anxiety disorder received topiramate, starting at a dose of 50 mg and titrating up to a target daily dose of 100 mg to a maximum dose of 250 mg daily. Eight patients (4.5%) discontinued the drug, and average weight loss oscillated ranged between 2.3 and 54.5 kg, during a nonspecific study period. The aim of this study was to evaluate adherence, weight loss, tolerability, and response to topiramate in adult migraineurs receiving treatment in a tertiary care center. Topiramate is a new anticonvulsant with proven efficacy in migraine and other conditions, which reportedly confers weight loss in patients receiving doses up to 300 mg/day. Patients using a 50mg/day dose lost 6% of their body weight, and weight loss was found in 17% of patients using 400mg/day. Phentermine is in a class of medications called anorectics. Phentermine and topiramate must be used along with a reduced calorie diet and exercise plan. Discuss your full medical history to assess if topiramate is appropriate for you, and if prescribed, commit to the protocol and scheduled follow-ups. Crucially, this medication is not a magic solution; it must be combined with the sustainable lifestyle pillars of a calorie-conscious, nutrient-dense diet and regular physical activity. A thorough 2026 medical evaluation is required to assess suitability and minimize risks. Presence of weight loss (preferably expressed as ≥5% reduction in baseline weight) was also considered. There was no restriction on the identification of studies in terms of publication status, language and design type. The putative efficacy of topiramate in the treatment of alcohol dependence is based on reversing chronic changes induced by alcohol resulting in dopamine-facilitated neurotransmission in the midbrain. Never stop taking this drug without the prescription of your doctor as it can lead to adverse side effects. A person’s daily routine, diet, exercise, genetics, medication intake and sleep habits have a greater impact on weight loss. In addition to dosage, there are several other factors that influence weight loss more deeply. The dosage of topiramate varies from person to person depending on his physiological condition and other medications he is taking. Children with GDD and ID are at risk for physical disabilities. Macrocephaly also occurs secondary to increased brain volume or hydrocephalus. A valid determination of ID (intellectual and adaptive abilities) also considers differences in language and culture, as well as in communication, motor, sensory, and behavioral factors. The prevalence of ID varies due to differences in diagnostic approach, population characteristics, and study design. In almost all cases, medications will not disqualify you as a blood donor. If you have traveled or lived in a malaria-risk country, a waiting period is required before you can donate blood. Malaria is transmitted by mosquito bite in certain countries and may be transmitted to patients through blood transfusion. Wait 3 months after using needles to inject drugs that were not prescribed by a physician. Wait 10 days after the last antibiotic injection for an infection. All topiramate immediate-release doses elicited greater weight loss than placebo . Furthermore, clinical studies using short-term (12 weeks) phentermine monotherapy have shown either reductions in heart rate and BP with phentermine treatment, perhaps linked to weight loss , or no significant changes in BP with phentermine treatment 53,54. Phentermine is the most widely used weight-loss pharmacotherapy in the US ; phentermine HCl, an immediate-release formulation that undergoes rapid dissolution and absorption in the gastrointestinal tract, is currently approved for use at a dose of 15.0–37.5 mg/day (adjusted to the patient's need) for the short-term (up to 12 weeks) treatment of obesity (Table 2) 19,20. Here’s some more information about how the dose of Qsymia® is managed based on your weight loss pace and side effects. Body weight reduction (BWR) is a common practice in combat sports. In addition, a high percentage of athletes uses unapproved or prohibited methods such as diuretics, saunas, and plastic clothing. The authors conclude that a high percentage of athletes uses RWL methods. An exploratory methodology was employed through descriptive research, using a standardized questionnaire with objective questions self-administered to 580 athletes (25.0 ± 3.7 yr, 74.5 ± 9.7 kg, and 16.4% ± 5.1% body fat). Aside from accidental ingestion, mushrooms such as Psilocybe spp., Panaeolus, Amanita muscaria, and Amanita pantherina are popular among drug users for their psychoactive effects. Acute clinical effects may also include mydriasis, nausea, vomiting, and diarrhea. Initial treatment is usually empirical, consisting of gastric lavage or catharsis and supportive measures. Another category arises with intentional consumption by those seeking drug-induced mood effects from plants such as Jimson weed. The tick can then be removed, leading to clinical improvement that may start within a few hours and complete in 1–2 days.