Anticonvulsant drug, topiramate, is used to treat epilepsy, generalized or focal seizures, migraine prevention, and alcohol addiction. When used to manage seizures and prevent migraine, it has also been demonstrated to produce weight loss. Although the Food and Drug Administration (FDA) has not yet approved this as a weight-loss drug, some doctors give it to patients who are suffering from seizures or migraines and need to lose weight. However, Qysmia, a combination of Phentermine and Topiramate, is an FDA-approved weight-loss medication for obese or overweight adults with type 2 diabetes, high cholesterol, or high blood pressure who also need to exercise.
Weight-loss happens in 6% to 17% of individuals in clinical studies using topiramate in both adolescents and adults. Weight-loss and loss of appetite are common adverse effects in persons 16 years and older who are taking 50 mg or 400 mg of topiramate per 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. Patients who get topiramate as an additional medication lose significantly more weight than those who receive a placebo.
About 7% of children aged 6 to 15 years old who were receiving 50mg/day for seizure management lost weight, and when increased to 400mg/day, weight loss was observed in 17% of children of the same age group. There was no loss of appetite in any dose group for children. Patients aged 12 to 17 years old who took 50mg/day for migraine prevention lost 7% of their weight, whereas those who took 100mg/day lost 4%. Patients on topiramate experienced a loss of appetite in 9% to 10% of cases, compared to 4% of those taking placebo.
While topiramate is beneficial for weight loss, it is not for everyone. Disorders such as glaucoma, osteoporosis, metabolic ketoacidosis, depression, and suicidal thoughts and behaviors may be made worse by taking topiramate. Let your provider know of any existing conditions like those above as well as kidney disease, liver disease, lung disease, or breathing problems.
Topiramate should not be recommended for the purpose of weight loss in pregnant women. Both the mother and the baby in her womb may suffer fatal damage as a result of this. Although topiramate may be safe for pregnant women if it helps with a medical issue, it is always best to talk with a doctor.
Patients stopped usually stop using topiramate because of other adverse effects, not because of weight reduction. Adults 16 and older who were using 400mg/day quit taking the medication because of memory problems, weariness, weakness, insomnia, excessive sleepiness, and tingling in the extremities. Fever, flushing, disorientation, and difficulties concentrating were reported in children aged 6 to 15 who were taking 400mg per day. Although common side effects of topiramate are diarrhea, loss of appetite, loss of coordination, dizziness, sleepiness, and numbness, topiramate can be taken safely by people who do not have any of the disorders listed in the above section and are not pregnant.
Sources: Clinical utility of phentermine/topiramate (Qsymia™) combination for the treatment of obesity
