Topamax for Weight Loss

Introduction

Topamax is a member of the anti-epileptic drug class. It is FDA-approved for the treatment of epileptic disorders and migraine avoidance. One typical negative effect that persons using Topamax for these diseases experience is weight loss.

As a result, the potential of Topamax as a weight reduction medication has been assessed in a number of trials of Topamax weight loss.

The mechanism through which Topamax induces weight loss is not fully understood, but several hypotheses have been proposed. It is believed to affect neurotransmitters in the brain, including gamma-aminobutyric acid (GABA) and glutamate, which play roles in appetite regulation and food intake. Additionally, Topamax may alter taste perception, leading to decreased appetite and reduced food cravings.

The FDA has only authorized Topamax in combination with phentermine for the purpose of weight reduction. Qsymi (phentermine/topiramate) is the brand name under which this combination is sold.

As previously indicated, using Topamax by itself to lose weight is regarded as an off-label usage. Healthcare providers still frequently advise using Topamax for weight reduction even though it is not approved for that purpose.

According to a 2012 poll, 63% of medical professionals said they have prescribed Topamax to reduce weight.

Uses of Topamax

Topamax was Authorized by the FDA for:

• therapy for persons two years of age and older with partial-onset or main generalized tonic-clonic seizures, either by itself or in conjunction with other medications.
• The Lennox-Gastaut condition
• Migraine prevention in individuals twelve years of age and above

Additionally, topiramate and phentermine can be purchased together as a single pharmaceutical medicine called Qsymia, which has FDA approval for the treatment of obesity.

People with a body mass index (BMI) of 30 kg/m² or above are recommended to take Qsymia; if a person additionally has an obesity-related disorder, such as type 2 diabetes, a BMI of at least 27 kg/m³, if they have high blood pressure or cholesterol.

The FDA has not authorized Topamax on its own to treat obesity. If a patient is unable to take phentermine or is having side effects, a doctor may nevertheless prescribe it in place of Qsymia in order to get the advantages of topiramate without the negative effects.

Moreover, topiramate could be sufficient for some people to help them lose weight and avoid taking unnecessary additional medications.

How effective is Topamax for weight loss?

Topamax appears to be useful for reducing body weight. Studies show that after taking Topamax for 24 weeks, individuals typically lose 5% to 7% of their body weight. Higher Topamax dosages and longer treatment times were associated with greater weight reduction.

The combination of Topamax and phentermine, known as Qsymia, appears to be the most potent FDA-approved weight-loss medication.

However, Wegovy (semaglutide) and Zepbound (tripeptide), two of the newest injectable weight-loss drugs, appear to be more successful than Topamax or Qsymia.

Research on Topamax’s Use for Weight Loss

Numerous studies have shown that when combined with a lower-calorie diet and regular exercise, Topamax can provide considerable weight reduction.

In one trial, 385 participants were divided into groups based on their body mass index (BMI) and randomly assigned to receive topiramate at varying doses or a placebo, which is a non-therapeutic drug.

• 60 milligrams (mg) per day,
• 96 mg per day,
• 192 mg per day
• 384 mg per day

Every participant shared comparable lifestyle regimens that included frequent exercise and dietary modifications.

The placebo group dropped 2.6% of their body weight on average after 24 weeks. Depending on the dose, the weight loss in the topiramate groups ranged from 4.8% to 6.3%. 854 subjects with a BMI of 27 to 50 who were between the ages of 18 and 75 made up the second trial.

For a full year, all patients were randomized to weight loss regimens that included changes to their food and exercise routines along with either a placebo or different dosages of Topamax.

The Topamax groups lost 7 to 9.7% of their baseline body weight after 60 weeks, compared to 1.7% for the placebo group. Additionally, the Topamax group had reduced insulin needs and blood pressure.

How Does Topamax Work for Weight Loss?

In order to reduce the seizure threshold, Topamax works on GABA receptors, calcium and sodium channels, and other receptors.

By altering how your body utilizes energy, these processes also help suppress your appetite, which leads to a reduced intake of calories and a more full feeling.

By altering the reward pathway linked to food, Topamax may also aid with binge eating habits by decreasing the allure of overindulging or cravings.

How Much to Take for Weight Loss

Topamax was administered at various dosages in clinical studies, ranging from 96 mg to 192 mg daily, which were linked to notable weight loss.

Depending on your tolerance and potential side effects, it could also be required to start with a lower dose of Topamax and gradually raise (or titrate) to a greater level.

Your doctor will collaborate with you to decide on the optimal Topamax beginning dosage and titration timeline, using their best judgment.

What Time of Day Is Ideal for Taking Topamax?

Whether you’re taking standard or extended-release (ER) Topamax will determine when and how often you take it. It can be necessary to take regular pills and capsules twice a day, once in the morning and once at night.

It is recommended that ER formulations be taken once a day, preferably at the same time every day. If you have difficulties falling asleep at night, your doctor could advise you to take Topamax first thing in the morning.

It might be preferable to take the medication at night before bed, though, as it tends to make some individuals drowsy. With or without meals, you can take Topamax.

According to studies, eating when taking Topamax may delay the medication’s blood concentration peak, but it has no effect on the amount of the medicine that is absorbed by the body. You can thus take it without thinking about meals or snacks.

Side Effects

There are several possible negative effects of Topamax. A crucial point to remember is that before starting you on Topamax, your doctor should measure your baseline blood bicarbonate level because the medication might alter your acid-base balance.

This measurement can be obtained as a component of a metabolic or electrolyte lab panel. Your doctor should also obtain a baseline glomerular filtration rate (GFR) if you have kidney disease or are at risk for developing it.

This is a measurement of kidney function that they may use to compare subsequent readings and determine if Topamax is having an impact on your kidneys.

Additional possible adverse outcomes include:

• Paresthesia, sometimes known as “pins and needles”
• Weary
• lightheadedness
• Tiredness
• Mood swings
• Suicidal thoughts
• A change in taste or a decrease in appetite
• impaired focus or memory, as seen by slowing mental processes or having trouble identifying certain words

These negative effects might only last a few days or weeks. If the side effects worsen, last longer than anticipated, or cause you concern, don’t hesitate to get in touch with your physician or pharmacist.

The Food and Drug Administration (FDA) monitors a drug’s adverse effects after approving it. Visit MedWatch to report an adverse effect you experience while taking Topamax to the FDA.

Serious Side Effects Of Topamax

There might be major negative effects of Topamax. The list below does not contain all of the medication’s potentially harmful side effects.

See the prescription instructions for Topamax for further details. Contact your doctor as soon as possible if you have any severe adverse effects after taking Topamax.

As soon as possible if you think you may be having a medical emergency or if the side effects seem potentially fatal.

There have been reports of the following severe side effects and their corresponding symptoms:

Hyperthermia, or elevated body temperature and reduced perspiration. Among the symptoms are:

• abnormally high body temperature
• heat intolerance,
• especially in hot temperatures, resulting in abnormally low sweat production

Elevated blood acid levels, or metabolic acidosis. Among the symptoms are:

• variation in your heart rate
• difficulty focusing
• feeling more exhausted than normal
• appetite decline

Severe skin responses, such as toxic epidermal necrolysis and Stevens-Johnson syndrome. Among the symptoms are:

• bodily pain
• difficulty gulping
• fever
• aching skin
• skin peeling, blisters present or absent

Elevated blood ammonia levels, a waste product produced by the body, can lead to brain swelling. Among the symptoms are:

• issue with coordination
• headache
• agitation
• seizures
• vomiting

kidney-shaped stones. Among the symptoms are:

• pee with blood
• unpleasant urination,
• nausea, and vomiting
• stinging aches in your lower abdomen or back
• vision issues.
• Mood swings, including thoughts of suicide.
• Adverse cognitive effects.
• An allergic response.

Who Should Not Take Topamax?

Not all demographics should use topiramate. If you have: You might need to abstain from taking it.

• Chronic electrolyte imbalances such as metabolic acidosis
• There is an uncommon correlation between taking Topamax and glaucoma, particularly angle closure glaucoma.
• Alcoholism or heavy alcohol consumption, since these factors can greatly raise your chance of experiencing topiramate adverse effects. Additionally, extended-release topiramate (Trokendi XR) must be taken within six hours after taking it because doing so would change the levels of the medicine in your body.
• Overactive thyroid

Other Options For Obesity Treatment

For those who are obese, lifestyle changes that don’t include medicine should usually be the initial step toward weight loss.

Although many of these intervention programs are offered in a range of treatment environments by a range of providers and according to different protocols, their overall goals are as follows:

• Include physical exercise in your life in methods that are easy, enjoyable, and have been proven to help you lose weight.
• Provide instruction on good coping mechanisms for stress
• Overcome obstacles that may ruin your hard work, such as figuring out how to order healthful meals when dining out.
• Find out how to incorporate healthy eating into your lifestyle by learning about it.

While individual reactions and success rates may differ significantly, these programs have been demonstrated to be effective overall.

For those with a BMI of 30 or higher, or a BMI of 27 or higher with weight-related comorbidities, pharmacotherapy—the use of medicine to treat obesity—is recommended if lifestyle approaches have not sufficiently resulted in weight loss.

However, be aware that anti-obesity drugs should be used in conjunction with healthy lifestyle choices rather than as a substitute.

Present FDA-approved medications for obesity include:

• Alli or Xenical (orlistat)
• Lorcaserin, also known as Belviq
• Liraglutide, or Saxenda
• Semaglutide, or Wegovy
• Qsymia (topiramate/phentermine)
• Contrave (bupropion/naltrexone)
• Tirzepatide, or Zepbound.

With these medications, patients might lose between 3% and 9% of their starting body weight. Bariatric surgery is an additional therapeutic option for patients with a BMI of 40 or higher, or 35 or higher with weight-related comorbidities.

Who has attempted pharmacological therapy and lifestyle measures without achieving enough weight loss? The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are the two most popular varieties.

For many, both might result in rapid and sustained weight loss. Nonetheless, even after a successful procedure, some patients are still unable to reach their weight loss targets.

Some patients experience a plateau in their weight reduction after a year or two, partly because of changes in their activity and eating habits after surgery.

The greatest preparation for a successful bariatric surgery involves realistic expectations, being ready to modify one’s behavior, being aware of the food and activity needed to maintain weight loss, and planning to use a team of healthcare professionals for postoperative follow-up.

The Science Behind Topamax Weight Loss

Research indicates that Topamax may help people who are overweight or obese lose weight. Participants on Topamax significantly reduced their body weight in a randomized controlled experiment when compared to those on a placebo.

These results imply that Topamax could be a useful choice for those who have trouble controlling their weight. In one study, the benefits of Topamax on weight reduction in a group of obese people were examined and the results were published in the journal Obesity Research.

Two groups of volunteers were formed; one group was given Topamax and the other was given a placebo. The group receiving Topamax lost an average of 10% of their starting body weight after six months, compared to the placebo group’s 2% reduction.

Another investigation into the long-term effects of Topamax on maintaining weight loss was published in the Journal of Clinical Psychopharmacology.

Researchers discovered that although those who stopped using Topamax saw weight gain, those who used the drug for up to two years were able to maintain their weight reduction.

It’s crucial to remember that Topamax is not a miracle medication, even though it could help some people lose weight.

For best effects, it should be used with a balanced diet and frequent exercise. Additionally, before beginning the medicine, it is advisable to address any potential adverse effects of Topamax with a healthcare provider.

Can Topamax Side Effects Result from Missing a Dosage?

No, Topamax side effects shouldn’t result from missing a dosage. Nevertheless, if you skip a dosage, you can experience the side effects of the illness you’re taking Topamax for. For example, not taking your prescribed dosage of Topamax might give you a migraine.

Furthermore, skipping too many Topamax doses or quitting the medication abruptly may make seizures more likely.

Consider setting a medication reminder to ensure that you don’t forget to take your prescription. This can involve using a timer or setting an alarm. You may also download an app for reminders on your phone.

Summary

Topamax is just one choice among many drugs and various therapies for the obesity pandemic. It reduces hunger, which lowers the amount of calories you consume. By altering how your body utilizes energy, it can also help you feel fuller for longer.

Taking Topamax may be limited by side effects. Paresthesias, drowsiness, mood swings, and memory or concentration problems are a few possible ones.

Several clinical trials including Topamax showed weight reduction ranging from 4.8% to 9.7% as a percentage of baseline body weight.

Therefore, in addition to dietary and exercise lifestyle modifications, it could be a useful alternative for many people who are attempting to lose weight as a pharmacological therapy option.

When Is the Right Time to Discuss Topamax with Your Medical Team?

Speak with a healthcare provider if you’re interested in using medication to help you control your weight. They can assist you in deciding if Topamax is the best choice for you.

To assist you in making an educated decision, they can also go over the advantages and disadvantages of various possible treatment alternatives. Inform your prescriber if any of the negative effects of taking Topamax are interfering with your regular activities.

They might have to modify how you are treated. Remember that sudden, sharp changes in weight over a short period of time may also be a sign of a medical issue.

In the event that you see noticeable changes in your weight without a clear cause, you must seek medical assistance immediately.

When using Topamax and not seeing weight loss, what should you do?

There are several factors to take into consideration if you’re taking Topamax and you’re not losing weight:

Give it time: It’s likely that you haven’t given Topamax enough time to take effect. It’s advisable to give it at least four weeks before concluding that it’s not effective for you.

Make sure to adjust your lifestyle: Eating a balanced diet and engaging in regular exercise will improve the way Topamax functions. If you would like assistance in making long-lasting adjustments, speak with your healthcare team.

Modify your dose (with permission from your prescriber): See if you qualify for a higher dosage of Topamax by speaking with your doctor.

Try a different drug: If Topamax isn’t helping you lose weight, ask your doctor about other weight-loss options. To identify the optimal solution for your unique health needs, some trial and error may be necessary.

FAQ

Author: Arjun Sharma