Qsymia vs Other Weight Loss Medications: Which one is Best?
Will Qsymia really help you lose an extra 25-30 pounds?
How does it compare to the newer weight loss medications such as Saxenda?
Is it really worth the price tag?
Learn the answers to all of these questions and more in this guide.
We will discuss how Qsymia works, what type of people should consider using it, other options available, side effects and more:
What is Qsymia?
Qsymia is a combination weight loss medication which is available via prescription only.
It’s actually a combination of two separate weight loss medications (thus the name combination medication): Phentermine and Topiramate (1).
While Qsymia isn’t the most popular weight loss medication, many people still consider using it, especially if other medications have failed.
But does it actually work?
Will it work in your body?
Should you try it?
How does it compare to other weight loss medications?
We are going to explore all of these questions to help you determine if Qsymia is actually right for you.
The pharmaceutical company which makes Qsymia claims that people (on average) may lose up to 15-19 pounds over the first 12 weeks, 22-29 pounds over 28 weeks and 24-32 pounds over 56 weeks.
They also claim that using this medication will enhance your weight loss efforts if combined with dietary changes, exercise and this medication (2).
While this may look tempting at first, especially if you suffer from obesity or extra weight, it’s important to look at how this medication works.
Only then can you determine if it’s actually worthwhile to use in your case.
How Does it Work?
Qsymia, like many weight loss medications, primarily affects your appetite and how much food you consume.
Basically, you can think about this medication as one that simply makes it easier to reduce the number of calories that you consume each day.
The problem with medications that fit into this class (those appetite suppressants) is that calorie restriction always leads to something known as metabolic adaptation when you lose weight.
This term, metabolic adaptation, refers to the fact that when you reduce the number of calories that you consume on a daily basis (for an extended period of time) your body “adapts” by reducing your resting metabolism (3).
And this is a big deal and not something that you want to have happened when you are trying to lose weight.
Your metabolism is perhaps the most important determinant of long-term weight management after weight loss.
If you damage your metabolism during weight loss therapies then you will almost always re-gain back any weight that you lost over 1-2 years.
This is why up to 99% of people fail to lose weight and keep it off after dieting.
But isn’t reducing your calories the only way to lose weight?
Not by a long shot.
In fact, we have FDA approved medications which are designed to help reduce hormone imbalances that lead to weight gain (imbalances such as leptin resistance, insulin resistance and so on).
So how does Qsymia actually work?
The combination of medications (Phentermine and Topiramate) work to help reduce the number of calories that you consume.
Phentermine is primarily a stimulant and it can be taken by itself as a stand-alone weight loss medication.
Phentermine works by increasing the number of calories that you burn and by reducing your appetite.
I’ve discussed how to use phentermine by itself for weight loss in this guide which you can read if you are interested (phentermine is cheaper if used by itself compared to Qsymia).
It does this by stimulating your sympathetic nervous system much the same way that ADD/ADHD medications do.
Topiramate, on the other hand, was originally created and used as an anticonvulsant drug (4) (medication used to treat seizures).
It works by blocking sodium pumps in the central nervous system which slows down the conduction of the brain (thus why it is helpful for seizures).
Since then it has also been used to treat alcoholism, PTSD, and binge eating disorder (5).
It’s not exactly known how Topiramate helps with weight loss but it most likely interferes with the appetite centers of the brain.
One of the biggest downsides to using Topiramate is that it can cause brain fog and slow down processing time (cause foggy thinking) and make you feel sluggish (6).
The idea behind combining it with phentermine is to combat these effects while attempting to benefit from the appetite suppression (but more on side effects below).
Dosages and How much Drug each Pill Contains
Qsymia comes in many preformulated dosages including:
+ 3.75mg Phentermine + 23mg Topiramate
+ 7.5mg Phentermine + 46mg Topiramate
+ 11.25mg Phentermine + 69mg Topiramate
+ 15mg Phentermine + 92mg Topiramate
This medication is generally started out at a low dose and then titrated (increased) slowly over several weeks.
To put this into perspective:
The highest dose of Qsymia contains only 15mg of Phentermine, but the average dose of Phentermine (for weight loss when used by itself) is 37.5mg.
While it may be nice to have a combination medication, it may actually be better to prescribe both medications individually so you have more control over the dosages of each medication.
This also helps reduce the price of the medication.
Does it Help with Weight Loss?
Whenever we talk about weight loss medications, therapies or supplements we always need to remember that each person is different.
What this means, in a practical sense, is that not all weight loss medications will work equally in all people (or any other weight loss therapy for that matter).
So even if the studies show that most people lose on average 15-20 pounds using this medication, that doesn’t mean it will help YOU lose 15-20 pounds.
It really all depends on why you have extra weight on your body, to begin with.
This means that there will always be certain people who will benefit more from medications when compared to others.
So the question really becomes:
Will Qsymia help ME to lose weight or is there some better option for my body?
In general, those who stand to benefit the most from medications like Qsymia include those people who have trouble with appetite regulation or with consuming an appropriate amount of food during meals.
These conditions are primarily hormone related, but they may actually cause you to inadvertently consume more food than necessary.
People who struggle with the over-consumption of food probably tend to do best on Qsymia.
Who will Qsymia NOT work well for?
Qsymia will likely NOT work well for you if you have weight gain related to some other cause, especially hormone related weight gain.
Weight gain at menopause, weight gain from estrogen/progesterone imbalances, weight gain from thyroid related disorders all fall into this category.
If you have weight gain from these causes then using Qsymia may actually be counter-productive and lead to more weight gain long-term due to the metabolic adaptation we discussed earlier.
Treatment for weight loss for individuals with hormone imbalances should focus on hormone replacement therapy (if necessary) or other therapies designed to reduce or eliminate excess hormone.
Qsymia vs Other Weight Loss Medications (Saxenda, HCG & Phentermine)
While Qysmia may be effective as a weight loss tool for some people, I don’t believe it is as “strong” when compared to other medications.
There are other, more powerful, weight loss medications and hormones such as HCG (the hormone, not the diet), Saxenda or even phentermine by itself.
All of these medications have studies which show that they are efficacious, but it seems that these medications tend to be more “well rounded” in that they have fewer side effects and still help with weight loss.
I’ve written about these medications in the past and you can read more about each one below.
These medications and hormones tend to treat the “root cause” of obesity in many people (hormone imbalance) and tend to be better tolerated.
As always, however, you should consult with your physician because each person will require a different approach.
Is it Worth the Price?
It’s always important to discuss price whenever we discuss any weight loss therapy.
You can have the best weight loss medication in the world, but if it’s over $1000 per month then it simply will not be accessible to very many people.
While Qsymia is not as expensive as Saxenda (which is over $1000 per month) it still runs around $200 per month at the cash price.
Most insurance companies do NOT cover weight loss medications (which is crazy but it’s the truth) which mean that most people who decide to use this medication will need to pay that price.
The good news is that you have a couple of options if you aren’t able to afford the cash price.
The first is a coupon program that is put on by the makers of Qsymia.
The second option is to combine the medications each individually because each medication (Phentermine + Topiramate) is cheaper when purchased by itself.
The cash price for 37.5mg of Phentermine is only around $10 for a 30 day supply:
And the cash price for Topiramate is only around $10 for a 30 day supply as well.
This means you can combine the medications each individually for around $20 per month instead of the $200 per month.
If you choose to go this route you will need to play around with the dosing because you can’t get the “exact” Qsymia dosing if you buy them individually.
But this may be worth it if the cost is prohibiting you from using it at all.
It’s also important to note that if you can lose weight and keep it off you will most likely save thousands of dollars on your health over the years.
Obesity is one of the leading causes of type II diabetes, heart disease and stroke.
So if you can reduce your risk of developing these conditions, even if it costs more up front, you will be doing your body a service over time.
Qsymia contains medications which can be at odds with each other in terms of how it impacts your brain.
Phentermine can help “stimulate” your body and brain while topiramate may cause the exact opposite effect.
This can lead to some strange symptoms that may be associated with this medication.
Because these medications are combined together you may be subject to any of the side effects associated with either medication if taken on their own.
More common side effects of Qsymia include:
- Dry mouth
- Sluggish thinking
- Brain fog
- Trouble sleeping
- Mood changes
- Heart palpitations
- *This is not a complete list of side effects but you get the picture (9)
People who should absolutely not use Qsymia include:
- Women who are pregnant
- People with Glaucoma
- Those with hyperthyroidism
- Those who are also taking a class of medication known as monoamine oxidase inhibitors
- Those with a known hypersensitivity to sympathetic mimetic drugs (drugs that are used to treat ADD/ADHD)
Compared to other weight loss medications Qsymia definitely has a less favorable side effect profile (meaning there are other medications that are safer to use).
The only way to determine if you will experience these side effects is to try the medication with a trial run.
If you experience any symptoms which affect your quality of life, or if you don’t lose weight while using it, then that would be an indication to discontinue the medicine.
Qsymia is a combination weight loss medication that may help some people.
The potential side effect profile and the fact that it suppresses your appetite as a means to help with weight loss means that there are likely other medications that are more effective.
Qsymia may be best for people who have appetite regulation issues or in those with leptin resistance.
If you have a hormonal reason for weight gain then it’s probably best to avoid this medication.