QSYMIA
Combination product
Pronunciation: FEN-ter-meen and toe-PIRE-a-mayt
Combination of Phentermine and Topiramate.
Each component keeps its own pharmacology page; the combination itself adds no new mechanism.
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Components (2)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Chronic weight management (obesity, or overweight with a comorbidity) | adults and pediatric ≥12 years | 3.75 mg/23 mg QD × 14 days, then 7.5 mg/46 mg QD | 7.5 mg/46 mg QD; may escalate to 11.25 mg/69 mg × 14 days then 15 mg/92 mg QD | 15 mg/92 mg QD |
Titration Evaluate response after 12 weeks at 7.5/46 before escalating; escalate via 11.25/69 for 14 days before 15/92.
Renal Moderate or severe impairment (CrCl <50): max 7.5 mg/46 mg QD; avoid in ESRD on dialysis.
Hepatic Moderate impairment (Child-Pugh 7–9): max 7.5 mg/46 mg QD; avoid in severe impairment.
Discontinue if weight/BMI loss targets are not met at each dose step.
Instructions
- Take orally once daily in the morning; avoid evening dosing (insomnia).
- Gradually discontinue the 15 mg/92 mg dosage to prevent possible seizure.
- Obtain negative pregnancy test before and monthly during therapy; available only through a REMS.
Available strengths
- ER cap 3.75/23, 7.5/46, 11.25/69, 15/92 mg
- cap 3.75/23, 7.5/46, 11.25/69, 15/92 mg
Contraindications
- Pregnancy
- Glaucoma
- Hyperthyroidism
- Taking or within 14 days of stopping a monoamine oxidase inhibitor
Cautions
- Embryo-fetal toxicity (REMS)
- Suicidal behavior and ideation
- Acute myopia / secondary angle-closure glaucoma
- Mood and sleep disorders
- Cognitive impairment
- Slowing of linear growth (pediatric)
- Metabolic acidosis
- Decrease in renal function
- DRESS/multiorgan hypersensitivity
- Increased heart rate
- Hypoglycemia in patients on antidiabetics
- Hypokalemia
- Oligohidrosis/hyperthermia
Adverse reactions
- Paresthesia
- Dizziness
- Dysgeusia
- Insomnia
- Constipation
- Dry mouth
Pregnancy Contraindicated in pregnancy; increased risk of oral clefts and small-for-gestational-age infants with topiramate exposure.
Lactation Topiramate and phentermine present in human milk; breastfeeding not recommended during therapy.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 3.75/23 mg | ER cap | 30 qd | $89.58 | not offered |
| 7.5/46 mg | ER cap | 30 qd | $91.69 | not offered |
| 11.25/69 mg | ER cap | 30 qd | $92.72 | not offered |
| 15/92 mg | ER cap | 30 qd | $85.42 | not offered |
Part D rank #421.