Phentermine / Topiramate SR COMBO

  • Qsymia™ is a brand name pharmaceutical COMBO medication that was FDA approved in July 2012 with varying prescriptions including phentermine 3.75 mg/topiramate 23 mg extended-release – up to phentermine 15 mg/topiramate 92 mg extended-release use to aid in weight loss and appetite control. Indian Lake Medical Weight Loss & Wellness & Wellness does not offer these exact dosages or prescriptions for these exact dosages.
  • Since July 2012 Indian Lake Medical Weight Loss & Wellness & Wellness has offered the extended release phentermine capsules and topiramate as a duel therapy. We call this SR COMBO. Adding the
  • Topamax to the phentermine is a more aggressive approach.

TOPAMAX…also used in Night Time Eating Syndrome 

Curbing the Appetite

For unknown causes of Sleep related eating disorders, trials from 2 academic institutions suggest that off-label use of topiramate, 25 to 150 mg at bedtime, may be the treatment of choice.

Start topiramate at 25 mg, and increase in 25-mg increments every 5 to 7 days until the night eating
episodes are eliminated. Paresthesias, visual symptoms, and (rarely) renal calculus are reported side

Topiramate is the generic name for Topamax. It was initially approved by the FDA to treat seizure disorder and is now used to treat many other problems such as migraines, depression, chronic pain, binge-eating disorder, and obesity. For weight loss discussion purposes, the patient that considers Topiramate as a form of treatment is considered to have reached therapeutic therapy when they show a decrease in carbohydrate cravings, a curb in binge-eating desires, and overall reduction in caloric intake.

Topiramate works by a different mechanism than phentermine, so the two drugs can be used in combination. In July 2012, the FDA approved a brand name drug that is a combination of phentermine and topiramate called Qsymia. Qsymia is dosed at 15mg of phentermine. This dose is much lower than the 37.5mg dose that is traditionally used for weight loss. Team INDIAN LAKE doses the phentermine & topamax separately and by taking the phentermine and topiramate separately, a patient can customize the dose of phentermine to their needs, and save money by paying generic versus brand name prices. 



  • Extreme agitation
  • Advanced age
  • Drug abuse       
  • Hyper (FAST)thyroid
  • Alcohol abuse
  • Seizures disoder
  • Blood Pressure >140/90
  • Glaucoma (increased eyepressure)
  • History of stroke
  • Under age 18
  • Breastfeeding
  • Heart disease
  • Taking Suboxone
  • Tourettes (Tics)
  • Pregnant
  • History of Heart Attack
  • HISTORY OF KIDNEY STONES – please tell the practitioner 


FETAL TOXICITY: Females of reproductive potential: use effective contraception.

OTHER CONTRAINDICATIONS: Hypersensitivity to the drug; MAO inhibitor used within 14 days (hypertensive crisis); Advanced Arteriosclerosis; unstable heart disease; Severe Hypertension; Pulmonary Hypertension;

Anorexiants/Stimulants – OTHER DIET PILLS OR ADD/ADHD medications.

SIDE EFFECTS (Phentermine): These include but are not limited to nausea, headaches, dry mouth, insomnia, tingling, altered taste, constipation, diarrhea, fatigue, respiratory infection. For those who may have experienced any of these, they were generally considered mild to moderate.    

CAUTIONS: Avoid abrupt withdrawal; Caution if diabetes mellitus; while taking Phentermine avoid taking the following Decongestants (Sudafed/Pseudoephedrine, Tylenol Sinus, Claritin D, Zyrtec D and Allegra D), stimulant medications, high doses of caffeine, other weight loss medication, ephedrine, MAO inhibitors in the past 14 days and alcohol use, depression and those with a history of drug dependency (or addiction prone personalities).

Combo TOPAMAX and PHENTERMINE (incidence greater than or equal to 5%) are: paraesthesia, dizziness, dysgeusia, insomnia, constipation, and dry mouth.

 If you take Phentermine/Topiramate SR COMBO during pregnancy, your baby has a higher risk for birth defects called cleft lip and cleft palate. These defects can begin early in pregnancy, even before you know you are pregnant.  .

‚óŹ Fetal Toxicity:  Females must disclose birth control method before being considered for the Phentermine/Topiramate

Topiramate is prescribed at a maximum dose of 75mg daily at Indian Lake Medical when used for weight loss, starting at 25mg.The most frequent side effect is the sensation of tingling (called paresthesia) that can occur randomly on the face or fingers/toes. This is seen most often after a dosage change, particularly if the dose is changed too rapidly.This side effect can be eliminated with Tums or a similar type of calcium carbonate (3-4 per day). Dividing up the Topamax doses during the day may also be helpful. Another frequent “side effect” is that carbonated beverages taste metallic.

Also – a very rare but concerning side effect that a small percentage of patients report (usually in much higher doses) is that of possible cognitive difficulties while taking topiramate. Although the numbers are quite low in percentages, the idea of having difficulty remembering words (word-finding difficulties) bothers anyone on any medication. If this happens and it affects the patient’s normal, daily functions, the drug will have to be discontinued.  The forgetfulness immediately resolves.  

There is a rare anatomic disorder of the eye that is present in the general population.  It makes these people prone to a condition called acute angle closure glaucoma.  If you had this anatomic disorder and did not know it, you could develop this version of acute glaucoma when you take topiramate.  The symptoms are sudden one sided eye pain with headache.  If this were to happen to you, you would need to go an ophthalmologist or ER promptly to have the pressure in your eye checked.  If the pressure is elevated, it can easily be treated and topiramate will have to be discontinued.  

If you form kidney stones several times a year or more, this drug may make this worse, and in that scenario you should not take it.  

Topiramate may make you more susceptible to heat exhaustion and heat stroke.  If you are doing strenuous activity in the heat, make sure you take frequent breaks and drink plenty of water.  Finally, if you are pregnant, or actively trying to get pregnant, you should not take this drug. 

Some patients may find that topiramate makes them sleepy; hence an evening dose may be necessary for the Topiramate.  If the patient remains on Topiramate for several months, they should undergo a similar taper down. Do not stop this medication without a healthcare provider’s supervision.Studies report that Topiramate is has been shown to be effective when taken alone in the treatment of NES (nighttime eating syndrome) and BED (binge eating disorder) – without the drug Phentermine.

Of note – women of child-bearing age should know that becoming pregnant while taking Topiramate exposes the unborn fetus to a rick of cleft lip – cleft palate. 

$95.00 (30) day supply