Here are the General Guidelines for taking Qsymia:
1.Take Qsymia once daily in the morning with or without food. Avoid dosing with Qsymia in the evening due to the possibility of insomnia. 2.Start treatment with Qsymia 3.75 mg/23 mg (phentermine 3.75 mg/topiramate 23 mg extended-release) daily for 14 days; after 14 days increase to the recommended dose of Qsymia 7.5 mg/46 mg (phentermine 7.5 mg/topiramate 46 mg extended-release) once daily if needed. Some patients do very well on this very low dose. If you are not hungry and can easily reduce your meals and cravings are reduced, why increase the dose at all? When in doubt, lower is always better. This is a very good dose for older people. 3.Evaluate weight loss after 12 weeks of treatment with Qsymia 7.5 mg/46 mg.
If you have not lose lost at least 3% of baseline body weight on Qsymia 7.5 mg/46 mg, discontinue Qsymia or increase the dose, as it is unlikely that the patient will achieve and sustain clinically meaningful weight loss at the Qsymia 7.5 mg/46 mg dose.
4. To escalate the dose: Increase to Qsymia 11.25 mg/69 mg (phentermine 11.25 mg/topiramate 69 mg extended-release) daily for 14 days; followed by dosing Qsymia 15 mg/92 mg (phentermine 15 mg/topiramate 92 mg extended-release) daily.
5.Evaluate weight loss following dose escalation to Qsymia 15 mg/92 mg after an additional 12 weeks of treatment.
If you have not lost at least 5% of baseline body weight on Qsymia 15 mg/92 mg, discontinue Qsymia as directed, as it is unlikely that you will achieve and sustain clinically meaningful weight loss with continued treatment.
6.Qsymia 3.75 mg/23 mg and Qsymia 11.25 mg/69 mg are for titration purposes only. 7.How long can you take Qsymia? The answers are not clear, but studies are on going and have reached more than 56 weeks.
Guidelines for Women of Childbearing Age
Here is the FDA Warning About Qsymia and Fetal Toxicity
"Qsymia can cause fetal harm. Data from pregnancy registries and epidemiology studies indicate that a fetus exposed to topiramate, a component of Qsymia, in the first trimester of pregnancy has an increased risk of oral clefts (cleft lip with or without cleft palate). If Qsymia is used during pregnancy or if a patient becomes pregnant while taking Qsymia, treatment should be discontinued immediately, and the patient should be apprised of the potential hazard to a fetus. Females of reproductive potential should have a negative pregnancy test before starting Qsymia and monthly thereafter during Qsymia therapy. Females of reproductive potential should use effective contraception during Qsymia therapy [see Use in Specific Populations (8.1) and (8.6)].
Qsymia Risk Evaluation and Mitigation Strategy (REMS)
Because of the teratogenic risk associated with Qsymia therapy, Qsymia is available through a limited program under the REMS. Under the Qsymia REMS, only certified pharmacies may distribute Qsymia. Further information, is available at www.QsymiaREMS.com or by telephone at 1-888-998-4887."
To prevent birth defects, the FDA wants all women of child bearing age who have not had a tubal ligation, hysterectomy, or have
a partner with a vasectomy to have an initial negative pregnancy test, a monthly negative pregnancy test and to be taking
Because of the risk of seizures when stopping the topamax component of qsymia, the FDA suggests you taper over a
week taking the medications every other day.