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Phentermine suppresses appetite via norepinephrine (central stimulant effect) Topiramate reduces appetite via GABA receptor modulation and glutamate antagonism The combination creates complementary, additive appetite suppression from two distinct neurological pathways Lower doses of each drug can be used, reducing side effects from both Clinical trial data for phentermine and topamax for weight loss (the EQUIP and CONQUER trials) showed: Average weight loss of 10.9% total body weight at 1 year (top dose Qsymia) 67.7% of patients achieved 5% weight loss at 1 year 47.2% of patients achieved 10% weight loss at 1 year Phentermine and Topiramate Dosage for Weight Loss: The Titration Schedule Important: topamax with phentermine for weight loss carries a significant pregnancy risk topiramate is teratogenic and women of childbearing age require a negative pregnancy test before starting and monthly monitoring

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Agarwal R, Filippatos G, Pitt B, et al

Some common side effects, such as nausea, vomiting, and diarrhea, were reported in higher numbers in the group taking a 1 mg dose compared to those on a lower dose