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Qsymia (phentermine-topiramate) and Belviq (lorcaserin)

In 2012, the United States Food and Drug Administration (FDA) approved two new medical weight loss pills. Belviq (lorcaserin) and Qsymmia ( Phentermine-topiramate ) as an addition to a reduced-calorie diet and exercise for patients who are obese (BMI ≥30   adults with a body mass index ≥30 kg/m2 or with a BMI ≥27 kg/m2 with at least one weight-related comorbidity (eg, hypertension, diabetes, dyslipidemia.

Dr. Ghayouri, an experienced medical weight loss doctor in San Diego, after a careful evaluation of risks and benefits for each individual patient, will decide whether to prescribe anti-obesity diet pills or another treatment such as HCG.

The first step in evaluation of the patient will include a medical history and physical examination. Determination of the body mass index (BMI), the distribution of fat based upon the waist circumference, and investigations for comorbid conditions such as diabetes mellitus, dyslipidemia, hypertension, and heart disease.

When overweight patients have diabetes, depression, behavioral problems, or cardiovascular disease, Dr Ghayouri tries to select drugs for these diseases which produce weight loss, rather than weight gain. Several drugs are well known to produce weight gain and should be avoided if good alternatives are available.  Although weight loss is always desirable, it must be balanced against other factors (ability to achieve desired glycemic control, other side effects and risks of meds, and expense Dr. Ghayouri’s decision to use anti obesity drugs is based on available clinical trial evidence and her clinical expertise. It is individualized, weighing the potential benefits with the risks of the drugs for each patient.

Lorcaserin (Belviq) — Serotonin reduces food intake in animals and human beings. Lorcaserin increases serotonin level, reduces appetite and decreases body weight in men and women. (Lorcaserin) used in conjunction with behavioral modification caused significantly greater weight loss and improved maintenance of weight loss compared to placebo(%11) Lorcaserin also improved values for biomarkers that may be predictive of future cardiovascular events, including lipid levels, insulin resistance, levels of inflammatory markers and blood pressure.

Adverse effects — Adverse effects of lorcaserin include headache, upper respiratory infections, nasopharyngitis, dizziness, and nausea, occurring in 18, 14.8, 13.4, 8, and 7.5 percent of patients, respectively.

Qsymmia (Phentermine-topiramate)

  • Combination phentermine-topiramate is an option for obese men or women without hypertension or coronary heart disease. The efficacy of phentermine-topiramate appears to be greater than orlistat or lorcaserin, but it may have more side effects (eg, increased heart rate, dose-related increase in the incidence of  depression, anxiety and disturbance in attention. It may be an acceptable option for a patient with an obesity-related comorbidity such as sleep apnea, who does not have any cardiovascular disease. dyslipidemia. Qsymmia has been shown to enhance weight loss in the first year of use.

This combination drug is contraindicated during pregnancy because of an increased risk of orofacial clefts in infants exposed to the combination drug during the first trimester of pregnancy. Women of child-bearing age should have a pregnancy test before starting this drug and monthly thereafter. It is also contraindicated in patients with hyperthyroidism, glaucoma, and in patients who have taken monoamine oxidase inhibitors within 14 days. Because topiramate can produce renal stones, this combination preparation should be used cautiously in patients with a history of renal stones.

We do not recommend phentermine-topiramate for patients with cardiovascular disease (hypertension or coronary heart disease) or in pregnant women. Phenterminetopiramate may be considered for obese postmenopausal women and men without cardiovascular disease, particularly those who do not tolerate orlistat or lorcaserin.

Possible side effects of Qsymia include mood changes and trouble sleeping; concentration, memory, and speech difficulties; increases of acid in bloodstream (metabolic acidosis); low blood sugar (hypoglycemia) in people with type 2 diabetes mellitus who also take medicines used to treat type 2 diabetes mellitus.  Central nervous system (CNS) symptoms when used with prescription sleep aids, anxiety medicine, or when drinking alcohol; possible seizures if you stop taking Qsymia too fast; kidney stones.