Exploring personal stories and experiences can provide a real-world perspective on the use of Topiramate for weight loss. Some research suggests that Topiramate can improve insulin sensitivity, potentially leading to a reduced desire for high-sugar foods and assisting with weight management. As insulin plays a key role in regulating blood sugar levels and metabolism, changes in its function could influence body weight. And while promising, more extensive research is needed to fully understand Topiramate’s long-term effectiveness and safety profile in the context of weight loss. Topiramate The mean dose of topiramate was 195 mg/day (range, 100–375 mg/day). A detailed discussion was held with each of these patients regarding the use of topiramate to obtain consent for use. In the continuing outpatient program, the weight is recorded for all patients. One patient experienced mild paresthesia, and 2 patients experienced transient delirium at high doses (1600 and 2000 mg/day). Sixty percent of patients responded to topiramate. Table 4 lists AEs that occurred at a frequency of 5% or higher in any treatment group or occurred at a significantly higher frequency in the 15/92 group than placebo. We tested whether results differed by baseline BMI by repeating Analysis A after categorizing patients by baseline BMI and then testing for interaction between baseline BMI category and treatment. Subjects were able to discontinue study drug and study for different reason, however, reason was often the same. Overall discontinuations were lower in patients receiving active treatments. All AE-preferred terms (defined by MedDRA coding dictionary version 10.1) with a frequency of 5% or more in any treatment group or those that occurred significantly more often with active treatment than placebo (at a two-tailed nominal 0.05 α-level) are listed in Table 4. Clinical workflows and increased comfort in prescribing these agents must be supported by increased advocacy to enable patients to obtain these much-needed agents at a reasonable cost and inclusive of all payers. Even though the efficacy and safety data of the available pharmacotherapy for obesity is promising, clinicians still demonstrate reluctance to prescribe these agents. There is an urgent need to design and conduct robust controlled trials to further investigate the safety, efficacy, and mechanism of action(s) of these agents in pediatric populations, both as monotherapy and in combination. Continue to take topiramate even if you feel well. Ask your pharmacist for an measuring device if one is not included with your medication. It is especially important that you not take topiramate tablets that have been broken for any length of time because tablets that are broken may lose their effectiveness over time. Do not take any medication unless you are certain it is the medication that your doctor prescribed. Although weight loss medications can be an effective adjunct tolifestyle modifications in individuals with obesity, there is limitedevidence regarding their benefit with regard to blood pressure.Because there was no “blinding” of the patients or health care practitioners to the fact that topiramate was being utilized for the purpose of weight reduction, there is a potential for bias in the outcomes observed.It is important to understand how these substances interact with one another, both in the dynamic weight loss phase and in the weight-reduced phase.In 2021, members from the Pediatric Obesity Weight Evaluation Registry (POWER), in the United States published data regarding prescribing practice from 30 pediatric weight management programs.21 According to this data, in 2017, 53% of programs offered obesity pharmacotherapy, an increase of 19% when contrasted to the prescribing rates from the same programs in 2014.Studies have shown that individuals taking Topamax for weight loss typically experience a gradual reduction in weight over several weeks or months.The most frequently reported adverse events were paresthesia (75% of patients), dry mouth (46%), headache (36%), taste disturbance (34%), cognitive problems (32%), dizziness (30%), somnolence (25%), fatigue (25%), dyspepsia (25%), diarrhea (21%), confusion (18%), nausea (18%), and nervousness (16%). At 36 months, 41/64 (64%) maintained at least ≥ 5% of weight loss, 26/64 (40.6%) ≥ 10% and 17/64 (26.5%) ≥ 15%. The mean percentage of weight loss (Fig. 2A) at 3 months was 7.2 ± 6.5%, 10.3 ± 11.6% at 6 months, 10.4 ± 9.9% at 12 months, 10.9 ± 12.1% at 24 months and 10.9 ± 11.2% at 36 months, with no statistical difference between them. However, for comparison purpose, the weight used was the baseline before the initiation of any antiobesity drug. This study supported the findings from the earlier Bray et al69 study, including that there was not a great deal of weight loss seen by increasing the dose of topiramate to greater than 192 mg/day.72 Impaired glucose tolerance was normal by 60 weeks in 50% in the treated group versus 40% in the placebo group.Additionally, specific individuals may experience increased cravings for high-calorie, processed foods due to mood-related side effects.Discover how topiramate (Topamax) can aid in weight loss.The effective treatment of epilepsy with topiramate may take two to four weeks.In a separate longer term dose-ranging placebo-controlled trial, those receiving 92 mg topiramate plus lifestyle modification therapy experienced a mean 2.6 kg/m2 BMI reduction after approximately 1 year (18).Patients treated with topiramate lost an average of 5.34 kg (95% confidence interval 95%CI-6.12 to -4.56) of additional weight as compared with placebo.The choice depends on various factors, including weight loss goals, medical history, and how you respond to different medications.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. As a result, individuals with obesityoften require a greater number of antihypertensive medications to achieveadequate blood pressure control compared to normal-weight individuals, exposingthem to higher risk of adverse effects from medications. Futurestudies evaluating the effectiveness of weight loss medications shouldinclude careful assessment of their short- and long-term impact on bloodpressure in individuals with hypertension. Although weight loss medications can be an effective adjunct tolifestyle modifications in individuals with obesity, there is limitedevidence regarding their benefit with regard to blood pressure. Five drugs—orlistat, lorcaserin, liraglutide,phentermine/topiramate, and naltrexone/bupropion—are currentlyapproved for weight loss therapy in the United States. This is likely due to combining the weight loss effects of two medications. At Hormone Replacement Therapy LA Medication Clinic, we offer a comprehensive care approach to support you throughout your weight loss journey. The slower weight loss process requires patience but can lead to more sustained results. Topamax provides the advantage of long-term use and additional health benefits beyond weight loss. Phentermine offers rapid weight loss and strong appetite suppression, which can be very motivating. Check with your doctor right away if you or your child have changes in vision or pain around the eyes during and after treatment with this medicine. Birth control pills containing estrogen may not work properly if you take them with topiramate. Blood and urine tests may be needed to check for unwanted effects. For more information on Topamax side effects, refer to the product label and consult a healthcare provider. If you’re planning to take Topamax, it's helpful to be aware of the potential side effects you may experience. As part of your binge eating disorder treatment team, a registered dietitian who specializes in binge eating disorder can help you develop a healthier relationship with food. The terms used were “topiramate” and “obesity” and “children” and “adolescent.” There were 69 results which were reviewed and screened to include reviews, clinical trials, and case reports on individuals who were taking topiramate monotherapy. Importantly, topiramate has been safely used in children for other purposes such as neurological disorders,15,16 which is why its utilization for weight management in the pediatric population is of particular interest. A randomized controlled trial investigating the impact of topiramate for weight management in this age group is warranted. Results suggest that topiramate is well tolerated and may be utilized for weight management in younger children. This practice is legal and quite common, especially when a drug shows potential benefits for other conditions, and weight loss happens to be one such area where Topiramate has shown promise.In conjunction with lifestyle modification, topiramate was started in all five patients, at the first visit for cases 3 and 5.If you have not lost a certain amount of weight, your doctor may tell you to stop taking phentermine and topiramate or may increase your dose and then increase it again after 14 days.It is unique because very few drugs reduce cravings.Meta-analyses of olderrandomized controlled trials (RCTs) of lifestyle modifications (i.e. diet andexercise) demonstrate that every 1 kg of weight loss corresponds to a short-term(2–3 year) decline in systolic blood pressure of 1 mm Hg 34, 35.While the precise mechanism of Topiramate’s influence on weight loss is not entirely understood, several plausible theories have been proposed, largely based on the drug’s impact on the nervous system.People opting for the topiramate weight loss treatment can even choose sprinkle capsule formula (1).There was no significantly increased suicide risk, as defined and assessed by the C-SSRS, in patients treated with PHEN/TPM CR compared with placebo.FDA-approved for the treatment of seizures in youth 2–16 years of age, and for the prevention of migraine headaches in 12–17 year-old adolescents, in 1999 and 2014, respectively; however, has not been FDA or European Medicines Agency (EMA) approved for the treatment of obesity in either children or adults. This level of BMI reduction has been shown to elicit meaningful improvements in risk factors and co-morbidities among adolescents with severe obesity.22 Those patients who were taking other medications concurrently with topiramate, some of which were obesogenic, also reduced their BMI, albeit to a lesser extent. The duration and dose of topiramate treatment, documented side effects, other medications taken concurrently with topiramate, and special dietary interventions such as meal replacement plans were also abstracted from the medical records. The patients included in this study were those who, in addition to lifestyle modification therapy, were prescribed topiramate for weight loss for a minimum of three months. The objective of this study is to report the BMI outcomes of adolescent patients with severe obesity who were prescribed topiramate plus lifestyle modification therapy in the context of a pediatric medical weight management program. Because of weight loss observed in individuals treated with topiramate for epilepsy, this medication has been studied as an adjunct therapy to lifestyle modification for the treatment of obesity in adults. Topamax, or topiramate, is a medication that has been used off-label for weight management, and its dosage can vary based on individual factors. Qsymia is a combination medication that includes topiramate (Topamax) and phentermine. During clinical trials for its approved uses, some patients taking Topamax experienced weight loss. At present, metformin for weight loss should only be used in patients with carbohydrate metabolism disturbances. In contrast with our opinion, some specialists in the obesity field believe that concomitant use of drugs acting on the gastrointestinal tract with centrally acting drugs does not result in additional weight compared to the latter by itself . In summary, studies of combinations that are safe and widely used in clinical practice worldwide are still very scarce. A large clinical series done by our group was developed to evaluate the efficacy of the combination of sibutramine and orlistat in 446 individuals for six months, with concomitant dietary counseling . Medical history included Parkinson's disease, 2 seizures, obesity, and urinary incontinence. The slow titration may have been responsible for the lack of significant side effects. We started topiramate at 25 to 50 mg daily and conducted a gradual titration in increments of 25 mg. It’s not unusual to combine two medications to treat the same problem, such as in diabetes or hypertension. Some of the weight loss is due to reducing general impulsivity and altering the rewarding properties of some foods. As Topamax was used more widely in the 2000s, people began to notice weight loss as a side effect. And diet culture, which tells us that body shape and weight are more important than well-being, leads to anxiety about weight gain, body shape, body size, and more. 5. Safety It is noteworthy that this clinical trial, like many others in the obesity field, had a run-in phase which required weight loss of 2.5 kg, a method highly criticized by authors in the field . Placebo-subtracted weight loss of the combined therapy was 6.5% (13.4% combination vs. 6.9% placebo). In obese women who had already been using subutramine for one year, the combination of orlistat versus placebo for 16 weeks did not result in greater weight losses . The dosage range for Topamax for weight loss can vary depending on the individual’s response and tolerance. The exact mechanism by which Topamax promotes weight loss is still not fully understood. We’ll provide you with all the essential information you need to make an informed decision about using Topamax as part of your weight loss journey. The dosage of Topamax for weight loss can vary depending on the individual and the specific condition being treated. Given these safety concerns and the absence of data on clinically meaningful efficacy endpoints, clinicians should generally avoid use of topiramate alone for this indication. Content clinically reviewed and medically verified by licensed experts to meet California Prime Recovery’s highest standards of trust, transparency, and evidence-based care.The optimal dosage of Topamax for overall weight loss will vary from person to person.Studies with long-term follow-up were recommended to determine whether this drug was an effective weight loss agent in schizophrenia.1So, how does topiramate work for weight loss?A total of five patients met the inclusion criteria and were included in the case series (Table 2).This finding refutes a common notion that nonsurgical treatments are not efficacious among extremely obese persons.Our group conducted a small randomized controlled study of exenatide for weight reduction in youth with severe obesity and demonstrated a placebo subtracted percent BMI reduction of 2.7% at 3-months.This appears to represent a result between that of other available pharmacologic agents and that of lap-banding, although randomized head-to-head comparison studies would be required before any definitive statements about relative efficacy of treatments can be made.Ms. A was followed up as an outpatient for 2 months, and her symptoms and weight were monitored during visits. Phentermine/topiramate combination McElroy and colleagues13 investigated the safety and efficacy of topiramate in a 16-week, multicenter, randomized placebo-controlled trial. One patient never returned for an evaluation after taking topiramate; thus 43 patients were included in the final analysis. Topiramate was titrated from an initial dose of 25 mg/day to a maximum dose of 600 mg/day, as needed, to achieve a reduction in binge frequency and as tolerated. Using Topomax as a weight loss drug can put your health at risk Weight loss was noted as a side effect as topiramate was being investigated for other uses such as migraine prevention, seizures and bipolar disorder. 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.64–66 In addition to paresthesias, the carbonic anhydrase inhibitor activity of topiramate can contribute to a metabolic acidosis and type 3 renal tubular acidosis.62,64–66 However in the metabolic acidosis, plasma bicarbonate levels are seldom less than 18 mM. 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. 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. Topamax Weight Loss Side Effects However, the use of topiramate as adjuvant therapy was not recommended for patients starting SGA therapy. Adult patients with significant weight gain related to chronic antipsychotic therapy. Topiramate may be a stepping stone towards a healthier future, symbolizing hope in the ongoing endeavor of effective weight management. The future of Topiramate in weight management is promising, with ongoing research aiming to maximize its benefits while minimizing risks. However, while studies and personal testimonials point towards its effectiveness, it’s not without potential side effects, emphasizing the importance of medical guidance. For children, the recommended dosage varies based on age and body weight. When it comes to using Topamax for weight loss, the recommended dosage can vary depending on individual factors. Success stories of weight loss with Topamax vary from person to person and depend on factors such as individual response, adherence to a balanced diet, and lifestyle changes. While some individuals may experience weight loss with Topamax, it does not guarantee success for everyone. If this happens, you may experience poor taste that may affect your normal appetite and eventually lead to weight loss. Another theory studied about the effect of Topamax on weight loss is that it reduces saliva production (3). It is the state in which your body uses up the stored fat for energy and leads to losing weight. This drug may speed up your metabolism that may lead to losing weight In turn, many of thecardiometabolic consequences of obesity have a reciprocal relationship withhypertension. Based on pooled international data, there areapproximately 603.7 million adults with obesity worldwide, with accelerating ratesof obesity in many countries . Analyses from the most recent National Healthand Nutrition Examination Survey from 2015–2016 estimated that 39.6% of USadults are obese (body mass index BMI ≥30 kg/m2), compared to33.7% in 2007–2008 and 7.7% of adults are severely obese (BMI ≥40kg/m2), compared to 5.7% in 2007–2008 . Naltrexone/bupropionresults in an increase in in-office and ambulatory blood pressure comparedto placebo. In Storey et al’s paper from 2001,67 40 patients with migraine were randomized to placebo or topiramate in a double blind study and titrated up to 200 mg or the largest tolerated dose. Sixty-four patients completed the trial with a mean weight loss of 10.5 pounds (4.8 kg) for the placebo group, 27 pounds (12.2 kg) for the continuous phentermine group, and 28.7 pounds (13 kg) for the intermittent phentermine group. According to a pooled analysis of several placebo-controlled randomized controlled trials lasting 2 to 24 weeks, patients that were treated with phentermine had a 3.6 kg greater weight loss when compared to the placebo group.22 The authors of this analysis determined that the addition of phentermine to lifestyle modifications did result in a statistically significant increase in weight loss. Qsymia, a combination of topiramate and phentermine, is another option for weight loss. The findings of this small cases series seem to indicate that use of topiramate and metformin can achieve clinically significant weight loss prior to surgery in patients with a BMI ≥ 50 kg/m2. Pre-operative weight loss in patients with obesity may reduce the increased likelihood of hypoxemic complication due to reduction in apneic oxygenation reserve (19). As research continues to investigate TPM’s role in weight loss, current data are limited for the long-term therapy of TPM and its potential side effects on a patient’s overall health. TPM is an anti-epileptic drug mainly used to treat epilepsy and migraine but can also aid in weight loss. Around 80% of the enrolled patients lost over 8% of their initial body weight, and 293 were analyzed for efficacy. Concomitant medications included levothyroxine sodium, 75 µg/day; zolpidem, 10 mg at bedtime; and bupropion sustained release, 100 mg/day. Because of her numerous previous unsuccessful medication trials, the use of topiramate was discussed. Her weight was 180 lb (81 kg) before topiramate was added, and her DSM-IV diagnosis was schizoaffective disorder. She denied any side effects from the topiramate. Lithium carbonate was increased to 1200 mg at bedtime, and the other medications remained at the same dosages. Further research is required regarding the long-term effects and the optimal dosing in BED patients. Some authors have raised doubts about the tolerability of topiramate, drawing on data from the epilepsy literature; however, the dosages used in BED patients seem to lead to a somewhat milder adverse effect profile. The presence of moderate to severe depressive symptoms might be an indication for antidepressant treatment for binge eating patients. The drug should probably be started at 25 mg/day and increased by 25 mg/day every 1 to 2 weeks, until reaching a dose of 150 to 200 mg/day. About 6% of people on the lower 50 mg/day dose of topiramate lost weight, while 17% of people taking the higher 200 mg/day dose lost weight.Despite its efficacy in reducing seizures, the exact mechanisms underlying its weight loss effects remain unclear.All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.However, children are more likely to have unwanted effects (eg, rickets, slow growth, and increased risk of kidney stones) to this medicine.Phentermine is in a class of medications called anorectics.Side effects depend on the medication prescribed and individual tolerance.We also conducted the baseline observation carried forward analyses (27), and although point estimates changed, conclusions about statistical significance and direction of effects remained unchanged (data not shown).Simply said, you might feel fuller and less hungry, which would make you eat fewer calories, suppress your appetite, and lose weight. Activation of mania in bipolar patients (Over half of participants who underwent bariatric surgery hadcomplete remission of hypertension as measured by office blood pressure (46% byambulatory blood pressure), in contrast to zero participants randomized tomedical management.Some studies have also shown that combining oral administration of GLP-1, 2 mg, and PYY 3-36, 1 mg, may lead to a reduction of food intake .Topamax dose recommendations for weight loss are nonexistent.Interestingly, all five children in the case series had a degree of developmental delay, and all received genetic testing given the coexistence of early-onset obesity and behavioral concerns.The studies were conducted in accordance with the local legislation and institutional requirements.These findings suggest that topiramate with lifestyle modification may be an effective option among youth treated in a pediatric weight management clinical setting.Vivus (Mountain View, CA, USA) have spearheaded the clinical development of a combination of phentermine and topiramate for the clinical management of obesity.74–79 Initially called Qnexa this proprietary fixed drug combination which obtained FDA approval for use in the clinical management of obesity in July 2012 now bears the proprietary name Qsymia.74–79 This preparation is a once daily combination of extended release topiramate (topiramate ER) and phentermine. They reported remission of binge eating and displayed significant weight loss (31.7kg, 14.5 kg, and 2 kg in 17, 9, and 4 months, respectively). Other anecdotal observations on the use of topiramate in three patients who underwent bariatric surgery were reported by Guerdjikova and colleagues.21 These patients gained weight and showed recurrent binge eating after initially successful bariatric surgery. The authors reported a mean increase in weight loss from 20.4% to 34.1% in 14 patients after 90 days, without the need for band readjustment. Topiramate is a medication that helps with weight management by reducing appetite and promoting a feeling of fullness. In conjunction with Phentermine, the CONQUER and SEQUEL Trials Showed as high as 10.7% weight loss in low-dose and 14% in high-dose groups maintained over 2 years. Tirzepatide is the newest form of weight loss medication. Additionally, it may assist in weight management for some patients. How Does Topiramate Work? Patients in this study who were noted to have higher BMIs at the study start had slightly more weight loss than their thinner counterparts.67,68 They also noted that three of five patients with diabetes achieved “good glycemic control” without altering any of their current diabetes medications. 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.7,19,61–64 One study did find that patients were more tolerant of these side effects when rivastigmine, a cholinesterase inhibitor was added to the treatment regimen.64–66 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 2002 and 2003, and then later was found to have diabetes-fighting qualities independent of the amount of weight that patients lost.61–64 This may be in part from sensitization of previously insulin-desensitized adipocytes, skeletal muscle, and pancreatic B-cells.61–64 While the two prime examples of combination pharmacotherapy for obesity are no longer available for clinical prescription because of long term safety concerns, the combinations of ephedrine and caffeine as well as of phentermine and fenfluramine did provide important historical examples of the clinical potential of combination therapy in long term obesity management.35–40 Currently there are two fixed drug combination formulations either approved or undergoing review for potential approval for the chronic pharmaceutical adjunctive management of obesity. This review details the history and clinical trial basis for the use of both phentermine and topiramate in obesity therapeutics as well as the results of clinical trials of their combination for obesity treatment in humans. Topamax helps prevent fat gain by altering body composition. The drug may also improve glycemic control and metabolic parameters. This can benefit obese type 2 diabetic patients and those with cardiovascular disease. This results in a reduced-calorie diet and an overall decrease in body mass. Understanding these differences is essential for safe and effective use of Topamax for weight loss. The dosing of Topamax differs between its use in epilepsy and weight loss. The initial starting dosage of Topamax for weight loss is typically low, around 25 mg per day. Given this literature, clinical research sought to investigate topiramate as a pharmacotherapeutic agent in pediatric obesity. Although the quality of this evidence is low due to the retrospective nature of these study designs, the data do add to our appreciation of the benefits possible when phentermine monotherapy is implemented in cohorts of youth with obesity. Six participants (20%) developed side effects, including agitation, sleep disturbances, increased blood pressure, anxiety, photophobia, abdominal pain, and dehydration.45 Although there clearly exists a paucity of studies investigating the use of phentermine monotherapy in youth cohorts, these two retrospective studies provide support for its use as adjunct to lifestyle modification. In a 12-week, open-label extension, eight of the patients assigned to the chlorphentermine group remained on the study agent and lost an additional 14.5 kg at week 24, when compared to baseline. Topamax, or topiramate, has emerged as a potential solution for weight loss, although its primary FDA-approved uses are for treating epilepsy and migraines. When using Topamax for weight loss, medical supervision is crucial to ensure safe and effective treatment. If significant weight loss is not observed, your healthcare provider may consider adjusting the dosage or discontinuing treatment. “study found that participants who combined Topamax with lifestyle modifications experienced greater weight loss compared to those taking Topamax alone” Topamax, or topiramate, is often prescribed off-label for weight management, and its effectiveness can vary from person to person. Our virtual medical weight loss clinic in Virginia reaches residents throughout the Commonwealth. A licensed pharmacy will ship any prescribed medications right to your door. Our online weight loss clinic in Virginia makes connecting with specialized care straightforward and stress-free. We combine medical expertise with personalized support to create sustainable weight loss solutions that fit your lifestyle. While the precise mechanism of Topiramate’s influence on weight loss is not entirely understood, several plausible theories have been proposed, largely based on the drug’s impact on the nervous system. This combination, marketed as Qsymia, is approved by the FDA specifically for weight loss. For instance, a 2024 study published in Obesity Reviews reported that participants taking Topiramate lost more weight than those given a placebo. Scientific research exploring Topiramate’s effects on weight loss has yielded encouraging results. This practice is legal and quite common, especially when a drug shows potential benefits for other conditions, and weight loss happens to be one such area where Topiramate has shown promise. The program involved a 120-minute visit monthly for 6 months followed by 30-minute maintenance visits every 3 months. AOMs are also considered as an adjunct to lifestyle interventions, particularly in young children with severe obesity. A subsequent report of an 11-year-old male with PWS showed no impact on BMI but did report reduced “demand for food” following topiramate therapy.27 A total of five patients met the inclusion criteria and were included in the case series (Table 2). – Demographic, clinical and laboratory characteristics of the patients The dose escalation regimen was done within the first 3 months of combined therapy. Regarding the prescribed dose, sibutramine was always started with 10 mg/d and topiramate with 25 mg/d. The potency of achieving a weight loss greater than 10–15% is also noticeable 6–8. Subjects were enrolled beginning in November 2007 at 91 US sites, consisting of clinical practices, clinical trial sites, and academic centers. Each of the individual components has published dose-related efficacy, tolerability, and AE data (15,16,17). Randomized controlled trials (RCTs) show that topiramate monotherapy produces WL among obese individuals of ~6–8 kg at 24 weeks and improvements in lipids, glycemic control, and blood pressure (BP) (5,6,7). Topiramate, a fructose monosaccharide derivative with sulphamate functionality, was approved for the treatment of epilepsy in 1996 and the prevention of migraine in 2004. Many clinicians opt to start at lower doses of 8 or 15 mg daily and monitor response to determine need for titration to a higher dose.19,91 Monitoring frequency differs by program. Currently, there are no universal dosing and monitoring guidelines for obesity pharmacotherapy in pediatric populations.21 Many institutions utilize single center protocols that incorporate consistent themes with regards to dosing and monitoring for these agents (Table 2).19 Phentermine monotherapy is available in 8 mg, 15 mg, 30 mg, and 37.5 mg tablets or capsules. Although the combination product has recently obtained FDA approval, many payers have not yet included it on their formularies. Topiramate is a prescription medication used to treat various medical conditions, including epilepsy, migraine headaches, and, more recently, weight management. Explore the weight loss benefits of Topiramate and its potential side effects. Under doctor watch, yes; topamax weight loss reviews stress pairing with healthy habits. Rather, medications reinforce lifestyle management and play a useful role in long-term management of obesity. Whenever possible, medications chosen should promote weight loss or be weight neutral. In the absence of contraindications, metformin should be used as first-line therapy for T2DM as it is safe, effective, inexpensive, and may reduce cardiovascular events and death.28 If combination therapy is needed, or if metformin is contraindicated, the weight profile of second-line medications should be carefully considered. Combining Topamax with a healthy diet and regular exercise can enhance weight loss results. Several factors can influence an individual’s response to Topamax for weight loss, including starting weight, diet, exercise habits, and overall health. When taking Topamax for weight loss, understanding the expected results and timeline is crucial for managing expectations. Topamax can interact with various drugs and supplements, potentially altering its effectiveness or increasing the risk of side effects. Topamax (topiramate) used by 50% of weight loss doctors surveyed In many patients the side effects of Topamax(lethargy) and those of phentermine(brain stimulation, excitement) seem to cancel out each other. Topamax can be taken as a single drug for weight loss. Eating more nutritious foods and exercising can enhance the positive effects of Topamax and improve your overall well-being. Based on their assessment, they may recommend medication that better addresses insulin resistance. While this is helpful, it may not always be enough to keep the weight off long-term. Topamax appears to help certain parts of the body—muscles, fat cells, and heart tissue—respond better to insulin. If you think this may be why you’re not losing weight on Topamax, talk to your doctor about potential alternatives. The weight may stay there after the body’s appetite and metabolism return to normal. Stopping Topamax suddenly could lead to weight gain if the person wasn’t making healthy lifestyle adjustments while on the drug. Seventeen percent of kids using the maximum dose (400 mg daily) lost weight. In some cases, healthcare providers may prescribe Topamax “off-label” for weight loss in individuals who are obese and have not been able to lose weight through diet and exercise alone. If you are taking Topamax and experience a significant decrease in appetite or unintended weight loss, it is important to inform your healthcare provider. No adverse events were reported among participants receiving the study drug.48 Similar to the previous study, there was a significant weight reduction in the chlorphentermine group compared to placebo, most notable by week 24, further illustrating the sustained effect of phentermine-based treatments with prolonged use, as compared to the natural history of weight among patients with obesity.19,20 Of note, chlorphentermine is an agent more akin to fenfluramine with respect to its mechanism of action and acts primarily as a serotonin releasing agent, perhaps suggesting an explanation for the greater weight reduction observed with this agent than with other agents in the previous studies, similar to the robust effects of fenfluramine seen in adult studies.22,25,26 One patient in the phentermine arm withdrew from the study due to insomnia.46 Of note, pediatric obesity studies from that time frame (1959 and on) utilized only changes in absolute body weight to assess efficacy of obesity treatment.47 However, this metric fails to take into account either height velocity or BMI.47 Nevertheless, at week 4, there was no statistically significant reduction in weight when comparing phentermine monotherapy to placebo, whereas by week 12, continued weight reduction in the phentermine group was observed, whereas the placebo group had begun to regain weight. To date, the combination phentermine-topiramate is one of the most efficacious oral medications approved on label for the treatment of obesity, with a mean weight loss surpassing the combination of bupropion plus naltrexone and as potent as 3 mg subcutaneous liraglutide . Yanovski et al showed that the proportion of individuals achieving at least 5% weight loss with high dose PHEN/TMP was much greater than that for alternative oral obesity pharmacotherapies such as lorcaserin and orlistat.88 Shi et al conducted a systematic review and network meta-analysis of randomized controlled pharmacotherapy for adults with obesity and determined that the evidence supported phentermine-topiramate as the most effective agent for weight loss, followed by GLP-1 receptor agonists.87 However, further post-hoc analysis revealed that semaglutide is the most effective in achieving more than 5% weight reduction, when considering adverse events.87 In conclusion, topiramate appears to be a relatively safe and effective treatment for obese subjects with BED. These results should be replicated by other independent studies to provide further evidence for the use of topiramate in BED. On the other hand, comorbidity can also provide indications that are valuable for targeting the pharmacological treatment to the needs of the individual patient (eg, treating a patient having bipolar symptoms with a mood stabilizer instead of an antidepressant) and should therefore be addressed in clinical research. Two patients were reported to have intolerance to topiramate; no further details were provided about the kinds of symptoms experienced. 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 women with similar clinical profiles who, however had no history of topiramate exposure had oral cleft prevalence rates of ~0.07%. Five of the six cases resolved with cessation of topiramate and one patient continued to have depressed mood after stopping the drug. Many times the dosage prescribed of topamax by doctors is considered based on the age and weight of a person. Doctors prescribe a lowest possible dosage which is topiramate 25mg to begin the treatments. For this many doctors prescribe topamax to people with suffering from obesity. People who do not prefer the bitter taste of the drug can opt for topamax oral capsule. Eliasson et al. noted that in obese patients diagnosed with Type 2 diabetes, treatment of topiramate for 11 months as an adjunctive showed significantly reduced body weight and improved glycemia control .Fifteen of the 27 patients showed significant improvement, and only 4 patients discontinued because of adverse events.The treatment of these illnesses with antidepressants many times results in weight variation, depending on the drug class that is used 15,34,64,65.The authors concluded that subjects with BED continued to experience a reduction in binge eating and had further weight loss with topiramate treatment during the open-label extension of the study.Yes, switching medications can be an option if one isn’t effective or causes undesirable side effects.Our case series demonstrates that 16 weeks of topiramate, at 100 mg nightly, is effective in decreasing BMI as well as in promoting weight loss.Additionally, consistency is key—taking it at the same time daily helps maintain stable drug levels in your system.Medical management of hypertension, Schiavon et al. found that 84% ofparticipants who underwent bariatric surgery experienced a ≥30% reductionin the total number of antihypertensive medications, compared to 13% ofparticipants randomized to medical management . This study received no specific grant from any funding agency. The results underscore its potential utility, particularly for patients in resource-limited scenarios, where cost-effective options are essential. However, the development of newer pharmacotherapies targeting diverse pathways is likely to redefine treatment paradigms. The majority of side effects presented are well-reported in the literature. Symptoms of overdose may include the following: Twenty-eight patients (71.4% girls, mean age 15.2±2.5 years old) were identified for inclusion in this study, 11 of which were in the topiramate only group, i.e. not taking other medications or specialized diets.Second, WL induced by PHEN/TPM CR was accompanied by improvements in many cardiovascular and metabolic risk factors, such as WC, systolic BP, and total cholesterol/HDL cholesterol ratio in both doses.The inclusion of patients who used at least 3 months of the combination could also incur bias, potentially excluding non-compliant participants and possible early non-responders, although reflecting real life.Recently, as an example, the European Society of Cardiology released a new guideline for hypertension treatment and stated that all patients should receive as first-line therapy a combination of two antihypertensive drugs.Lithium carbonate was increased to 1200 mg at bedtime, and the other medications remained at the same dosages.The drug was well tolerated in this study, with fatigue being the only side effect reported with a higher incidence in the active group than in the placebo. In recent years, it has gained attention for its potential off-label use in aiding weight loss. Topamax (topiramate) is a prescription medication primarily used to treat epilepsy and prevent migraines. Chandana Balasubramanian is a science writer who loves to translate complex science into clear insights on metabolism, weight management, nutrition, and much more. Topamax has shown potential for weight loss due to its appetite-suppressing effects. Like all medications, Topamax carries the potential for side effects. Longer treatment durations and appropriate dosing are correlated with more substantial weight loss. On average, a weight reduction of approximately 5% to 10% of baseline body weight can be anticipated. Personalized treatment plans, regular monitoring, and adjustments based on your progress and side effects are essential. Medical supervision is critical to a successful weight loss journey. Our patients have experienced a range of outcomes with both phentermine and Topamax. While there isn’t an FDA-approved dosage for weight loss, studies have explored a range between 64 mg to 400 mg daily. Studies indicate that individuals taking Topamax can experience a weight reduction of approximately 5% to 7% of their body weight over 24 weeks. However, its off-label use for weight loss has garnered significant attention due to its potential to aid in weight management. Among patients completing intake surveys, presence of baseline binge eating tendencies, nighttime eating, and meeting criteria for depressive and/or anxiety symptoms were present in 19%–34%, while general hunger was present in 69% (see Table 2). For missing values within the specific date windows due to inconsistent follow-up occurring in the clinical setting, linear interpolation using the most recent measure(s) prior to or closest after a target time point were utilized to compute an imputed BMI. Associations between baseline characteristics and weight-related outcomes were determined via separate univariate analyses, regressing percentage point change in %BMIp95 to a given time point on the baseline characteristic. 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. 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. The majority of them resolved spontaneously without resolution and did not spur stopping the medication. Exposed women had nearly a 2× greater risk for having children with oral clefts with estimated prevalence rates amongst those actively using topiramate of ~0.29%, compared to ~0.16% among previously exposed women and prevalence ratio of 1.88 (0.7–5.03 95% confidence interval) between continuous pregnancy exposed to previously exposed groups. The following paragraphs discuss the major findings from these studies while Table 3 details the major features of these studies. Graphic representations of responses shown in the most comprehensive studies revealed that clinically significant changes in binge eating days per week and binge eating episodes per week should be expected after about 4 weeks of treatment, whereas effects on weight might be expected after approximately 6 to 8 weeks. The authors highlight the efficacy of the combination of topiramate and CBT in producing weight reduction and significant remission in bingeing in obese patients with BED. Claudino and colleagues16 evaluated the efficacy of adjunctive treatment with topiramate compared to that with placebo in reducing weight gain and binge eating in obese patients receiving cognitive behavior therapy (CBT). Baseline binge frequency was defined as the frequency of bingeing at the beginning of treatment with topiramate for patients who received placebos in the double-blind period of the study. We included both kinds of studies in the belief that the effects of topiramate both under ideal conditions (efficacy studies such as RCTs) and routine clinical situations (effectiveness trials such as those reporting on the effects of topiramate as an add-on to other psychopharmacologic treatments) can contribute to treatment of this disorder. Many healthcare professionals prescribe it off-label for weight loss, particularly for obese patients and those with metabolic disorders. Common side effects include dizziness, drowsiness, cognitive issues (like memory problems), weight loss, and tingling in the hands or feet. While topiramate’s specific mechanism of action regarding weight loss remains uncertain, various hypotheses suggest it may help by reducing calorie intake and impacting food reward pathways. No serious adverse effects were reported on cognitive function, depression, suicidal ideation or anxiety. The most common side effects shown were headache (13–15%), insomnia (12–15%) and nausea (8–12%). This evidence highlights previous reports of taste alteration with other carbonic anhydrase inhibitors (e.g., topiramate, acetazolamide), thus possibly leading to an anorectic effect. In vitro evidence has also shown that this drug leads to an increase in serotonergic and dopaminergic activity. The mechanism of action for the antiepileptic activity of this medication is not totally clear, but it is believed that it is linked of sodium and calcium channels blockage. Topiramate extended release capsules, is sometimes used for topiramate weight loss, but its effectiveness remains uncertain compared to alternative weight loss methods. Individual responses to the medication can vary, and it should be taken as part of a broader weight management plan under the supervision of a healthcare provider. Clinical studies support the use of Topamax in sustaining weight loss over time, showing that it outperforms alternative weight loss methods in terms of both efficacy and tolerability. In terms of weight loss, Topamax has been studied for its off-label use, and it is sometimes prescribed for obesity or binge-eating disorders. Of note, the patients receiving intermittent therapy experienced some weight regain or lost weight more slowly during the 4 weeks on placebo. None of these patients exhibited cravings for phentermine or typical withdrawal symptoms that would be expected in a patient abruptly stopping therapy with an amphetamine related medication. The potential for abuse with phentermine is a major concern among providers which may preclude prescribing this agent for weight loss. Other contraindications for phentermine therapy include use with monoamine oxidase inhibitors, hyperthyroidism, glaucoma, agitation states, pregnancy, and use in patients with known history of drug abuse.55 Obesity pharmacotherapy is new to using fixed drug combinations but promises significant potential.32,33 While the number of available molecular targets for obesity pharmacotherapy increase as well as the number of potential injectable adjuncts for obesity and its comorbidities,6,17,18,20,34 the number of oral agents available for potential fixed drug combinations is significantly more limited. It also raises the question of whether withdrawal of chlorpromazine contributed to the weight loss. This case report suggests the usefulness of topiramate as an adjuvant in reversing the weight gain caused by antipsychotics. She showed a gradual decline in weight at a rate of kg every 2 months. She was continuously monitored for weight and body mass index measurements. After 2 weeks of starting topiramate, her parents noticed reduction in her appetite. 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. 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. 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. 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.47 Beyond weight loss however the treatment groups of the cohort also demonstrated significant improvements in waist circumference measures suggesting possible diminution in visceral fat depots. The study group using Topamax had a higher degree of weight loss compared to placebo-treated patients. A randomized double-blind placebo-controlled study showed that overweight patients who took Topamax experienced absolute weight reduction. However, it has also shown weight loss effects in clinical studies. Yes, the combination of phentermine and topiramate is FDA-approved and commonly used for weight loss, although some individuals may still experience weight gain as a possible side effect. The time it takes to lose weight with Topamax (topiramate) varies by individual, but most people begin to notice weight loss within a few weeks to a few months of starting the medication. Qsymia is FDA-approved for weight loss and has shown significant results in clinical trials. Topamax is often combined with Phentermine in a prescription weight loss medication called Qsymia. A comprehensive approach that integrates medication with lifestyle changes is recommended for sustainable weight loss. Track weight loss, energy levels, and any side effects to assess how well Topamax works for you. A combination of cardio and strength training can enhance weight loss. Wellbutrin (bupropion) and Topamax (topiramate) are prescription medications that are sometimes used off-label to aid in weight loss. Analysis B was a prespecified secondary per protocol–based analysis that was included to facilitate assessment of the experience in patients who reported using the study drug or placebo for the full intended treatment course. A 56-week randomized controlled trial was conducted to evaluate safety and efficacy of a controlled-release combination of phentermine and topiramate (PHEN/TPM CR) for weight loss (WL) and metabolic improvements. The lack of high-quality evidence results in ongoing lower rates of utilization, despite additional agents obtaining pediatric FDA approval and clinical practice guidelines recommending their use as first-line treatment.21 This discrepancy appears to be related to the combination of limited medical training in (pediatric) obesity management, lack of clinical comfort with prescribing these agents, particularly in pediatrics and without satisfactory long-term safety and efficacy data, and both high costs and inadequate insurance coverage. Several clinical studies have observed a correlation between the use of Topiramate and a significant decrease in body weight. Topiramate use as monotherapy for obesity treatment is not recommended as its usual side effects greatly reduce the tolerability and safety of the medication. The combination of orlistat with noradrenergic drugs is frequently used in clinical practice, albeit the safety and efficacy of this combination has not been assessed in randomized controlled studies. 5-Hydroxytryptophan (5-HTP) is the precursor of serotonin and is known, in high doses (900 mg/d), to induce weight loss, although with a high rate of side effects (mainly nausea, due to conversion to serotonin). However, in obese patients without leptin deficiency, the administration of this substance alone in monotherapy, even in high pharmacological doses, failed to produce substantial weight loss . Patients may notice weight loss within four weeks of initiating Topamax therapy. Clinical evidence indicates that individuals on Topamax may begin to notice weight loss within four weeks of initiation. Consistency in medication timing can enhance its effectiveness and minimize potential side effects. Therefore, while sibutramine acts mainly on the homeostatic control of food intake, topiramate acts on hedonic and reward centers, making this a synergic combination. Big cohort trials later on also provided cardiovascular security in those with no cardiovascular disease , demonstrating that sibutramine’s marketing authorization may have been inappropriately withdrawn for healthy young patients with obesity. This was highly expected, since although sibutramine is not a catecholaminergic drug as phentermine, it acts centrally, inhibiting the reuptake of both serotonin and norepinephrine, reducing the appetite and enhancing indirectly caloric expenditure . A 2004 randomized, double-blind, placebo-controlled study investigated the efficacy of topiramate at 50 mg/day, 100 mg/day, or 200 mg/day doses. The study found a 50% or more reduction of primarily generalized tonic-clonic seizures in 73% of patients compared to 18% in the placebo group. One study observed significant blood glucose reductions in overweight patients undergoing TPM therapy and more profound blood glucose reductions in obese patients . To combat the obesity epidemic, various weight loss management techniques have been developed, ranging from lifestyle changes such as dietary modification and exercise to pharmaceutical interventions. Notably, the medication demonstrates effectiveness in reducing body weight across different dosages and sustaining weight loss over time, outperforming alternative weight loss methods. They mimic the effects of the naturally produced hormone, GLP-1, released from cells in the gut to regulate blood sugar and slow food movement through the gut. Topiramate may not benefit people with depression, so Bupropion or Contrave may be more appropriate for these patients. They found that people taking topiramate lost an average of 5.3 kg (~11 lbs) after 16 weeks. Topiramate is an anti-seizure medication that works on the inhibitory centers of the brain to prevent or reverse seizures caused by overactivation of the brain. Qudexy XR and Trokendi XR are the “extended-release” forms, which means it stays in your system longer than Topamax, an immediate-release form of topiramate. According to sources, the usual starting dose of Topamax for weight loss in adults is between 25 and 50 mg once a day. Like any medication, Topamax can cause side effects, and it’s important to be aware of the potential risks before starting treatment. If you’re interested in learning more about how Topamax works for weight loss, its potential side effects, and the recommended dosage, keep reading. Controlled-release phentermine/topiramate (PHEN/TPM CR) is an investigational WL therapy combining immediate-release phentermine and controlled-release topiramate given in a single daily morning dose. Phentermine hydrochloride is a sympathomimetic amine approved by the US Food and Drug Administration (FDA) in 1959 with a dose range of up to 37.5 mg/day for short-term obesity treatment. While there are no standard discontinuation rules for obesity pharmacotherapy, if the BMI continues to increase, or the patient experiences adverse side effects, most clinicians will transition to an alternative treatment modality.21 Frequently, the patient is started on 25 mg nightly, increasing by 25 mg nightly each week, until reaching a target dose of 75 to 100 mg nightly, while being serially assessed for tolerability and efficacy.42,72 Typically, a maximum dose of 200 mg daily is set for pediatric obesity treatment. In 24 weeks the weight loss by intent-to-treat analysis (ITT) was 5.4%, 5.4% and 4.3% for the combination of bupropion with naltrexone, 16 mg (NB16), 32 mg (NB32) and 48 mg (NB48) respectively, against 2.7% for bupropion, 1.2% for naltrexone and 0.8% for placebo. Although an open-label study, we consider not only the number of patients enrolled to be expressive but also the proportion of patients with significant weight loss. After six months, 88.7% of the patients that finished the study had lost more than 5% of baseline weight and 66% had lost more than 10%. Topiramate was added to a drug regimen consisting of methylphenidate (20mg/day) and venlafaxine (150 mg/day), and was titrated upward until a dose of 300 mg/day was reached. Schmidt do Prado-Lima and Bacaltchuck18 described the topiramate treatment of a patient with refractory unipolar depression and comorbid BED. Appolinario and colleagues17 described the effects of topiramate on a woman diagnosed with BED in the absence of neuropsychiatric comorbidity. The adverse events most commonly reported by patients receiving topiramate were paresthesia (48.6%), taste disturbance (24.3%), dysuria (13.5%), and leg pain (10,8%). The most frequent cause for withdrawing from treatment was nonadherence to the study protocol. Mood-related (depression, anxiety, and irritability) and cognition-related (disturbance in attention) AEs occurred at higher frequencies among patients receiving 15/92. Second, WL induced by PHEN/TPM CR was accompanied by improvements in many cardiovascular and metabolic risk factors, such as WC, systolic BP, and total cholesterol/HDL cholesterol ratio in both doses. Among patients who completed the course of 15/92, 48.1% lost ≥15% of BW, 67.7% lost ≥10%, and 83.5% lost ≥5%.