Topamax Produces Weight Loss, Controls Cravings & Reduces Impulsive Eating
Topamax is a weight loss drug by acting on the brain to reduce appetite, cravings, binge eating as it promotes fullness. Its a prescription drug that has been used for seizures and migraine headaches. The FDA first approved Topamax for the treatment of seizures in 1996 and migraine headaches prevention in 2004. As Topamax was used more widely in the 2000’s, people began to notice weight loss as a side effect. Topamax was noted to reduce cravings and control binging and purging as well as promote fullness.
How Topamax Produces Weight Loss
The medication reduces compulsive behavior and stabilizes mood. Some of the weight loss may be due to reducing general impulsivity and altering rewarding properties of some foods. Other studies have shown that Topamax may reduce food intake by its interaction in the hypothalamus in the brain appetite center as well as stimulating energy expenditure directly. Since the weight loss was noted to be modest, researches often combine Topamax with other weight loss medications such as phentermine. This produces both appetite suppression and reduction in cravings thus increasing the overall weight loss.
Topiramate, the active ingredient in Topamax, is the main ingredient in the weight-loss drug Qsymia, along with phentermine. The FDA approved Qsymia in 2012 after vigorous testing for 5 years for both safety and effectiveness. Numerous studies over the past 15 years have proved the effectiveness and safety of Topamax alone or in combination with other drugs such as phentermine and Wellbutrin.
It’s not unusual to combine two medications to treat the same problem such as in diabetes or hypertension. Each medication acts differently and the weight loss may be 2 or 3 times the effect of each individual medication.
Weight Loss Results with Topamax Alone
In the largest controlled study, at 24 weeks, weight loss in Topamax treated subjects was −2.6% for placebo and −5.0%, −4.8%, −6.3%, and −6.3%, respectively, for groups treated with 64, 96, 192, and 384 mg/day in this study from Dr Bray. in 2003:.
Side Effects of Topamax
The most frequent adverse events were related to the central or peripheral nervous system, including paresthesia,(numbness in hands) somnolence, and difficulty with memory, concentration, and attention. Fatigue was the most common side effect noted. Most events were dose‐related, occurred early in treatment, and usually resolved spontaneously; only 21% receiving topamax withdrew due to adverse events compared with 11% on placebo.
Topamax comes in 25, 50, 100 and 200 mg doses. There is a large variation in dosage because of individual variations and side effects. The average dose is 50 mg twice a day. Studies with bulimia note average doses 200 mg/day. (range 50 to 600 mg/day).
How to Take Topamax
It can be taken as a single drug for weight loss. This is especially useful when the patient wants to avoid the brain stimulation often seen in most appetite suppressors. It safe for diabetics, patients with heart disease and hypertension. It can also be added to any other weight loss program. It is especially useful to control evening and night eating and cravings as well as impulsive eating patterns. The best use of Topamax is to increase the dose in weekly intervals starting at 25 mg in the late afternoon. The effective dose is usually between 50 and 200 mg/day with most patients doing well on 100 mg/day. The starting dose is usually 25 mg/day. Here is a suggested titration schedule:
Titration Dosing of Topamax (25mg dose)
Weight Loss When Combining Phentermine and Topamax
Topmax combined with phentermine produces more weight loss then either medication along. This is true at all dose levels. In many patients the side effects of Topamax(lethargy) and those of phentermine(brain stimulation, excitement) seem to cancel out each other.
Surveys and Observations of Topamax-Phentermine Combinations
“Qnexa” is an older term for the current combination marketed as QSYMIA.