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Fact Checked

Qsymia: What is it and How Much Does it Cost?

The Centers for Disease Prevention and Control, or CDC, estimates that approximately 42.2 percent of the United States adult population is obese as of 2017-2018, representing an increase of nearly 12 percent since 1999-2000.  The obesity epidemic, as the situation is often described, costs an estimated 147 billion dollars a year in annual medical costs, with people who are obese paying approximately 1,429 dollars per year in medical costs compared to people who are at a normal body weight. Unfortunately, being obese or even overweight is associated with a wide range of different weight related comorbidities including heart disease, heart attacks, and general heart problems, type 2 diabetes mellitus, chronic back pain, stroke, high blood pressure, high cholesterol, and even some types of cancer. More and more Americans need to get their weight under control before they experience significant health issues, but many people have tried to lose weight for years with little to no success. Qsymia is a prescription medication that can help people who are obese or who are overweight and have a weight-related medical condition lose weight when used in conjunction with a reduced-calorie diet, exercise plan, and behavioral changes. Many people would benefit from a medication like Qsymia, but how much does it cost?

What is Qsymia?

Qsymia is a prescription chronic weight management medication that contains two drugs: phentermine/topiramate extended-release. The medication was approved by the U.S. Food and Drug Administration (FDA)  in 2012 for use in obese adults and some overweight adults who are struggling to lose weight. The medication is designed to be used in conjunction with a physician-approved diet, physical activity, and behavioral changes plan in order to help patients lose weight and keep it off. Phentermine is an appetite suppressant medication that belongs to a class of drugs called sympathomimetic amines, and it can be highly addictive. Topiramate belongs to a class of drugs known as anticonvulsants. Due to the potential for addiction and abuse of phentermine, Qsymia is a Schedule IV controlled substance by the U.S. Drug Enforcement Agency.

What Conditions is Qsymia Used to Treat?

Qsymia is a weight loss drug by Vivus, Inc. that is designed to help obese adults and some overweight adults lose weight and keep it off. The majority of patients who use Qsymia are classified as obese, meaning they have a body mass index (BMI) of 30 kg/m2 or greater. However, the medication can also be used in adults whose BMI classifies them as overweight (27 kg/m2 or greater) if they have a coexisting medical condition that is related to their weight. Weight-related medical conditions include high blood pressure, dyslipidemia, high cholesterol, and type 2 diabetes. Qsymia is not a weight loss product intended for patients who only have a small amount of weight to lose, as it has the potential to be addictive and should only be used when the benefits outweigh the risks.

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How Does Qsymia Help People Lose Weight?

Qsymia is an oral medication, and the recommended dose of Qsymia is just once per day. It should be stored at room temperature. Made up of phentermine and topiramate in an extended-release form, Qsymia helps people control their hunger and resist food cravings for 24 hours. Phentermine is a fast acting drug that begins to work immediately to reduce your appetite, helping to control hunger. Topiramate is an extended-release drug that provides a feeling of fullness throughout the day and can alter the taste of some foods, which makes eating less enjoyable. As a result, patients are more likely to lose weight when taking Qsymia combined with diet and exercise. The medication is intended only for use in adults with a BMI of 30 kg/m2 or greater, putting them in the obese category, or in adults with a BMI of 27 kg/m2 or greater when combined with at least one medical condition resulting from being overweight, such as high cholesterol, high blood pressure, or type 2 diabetes. Qsymia must be used in conjunction with a doctor-approved program that includes exercise, behavioral changes, and a reduced-calorie diet.

How Much Does Qsymia Cost?

Qsymia is still manufactured under the original patent issued to the manufacturer, which means that no generic version of the drug is currently available. The manufacturer offers a flat 98 dollar purchase price across all doses when Qsymia is purchased from their website through a program called Qsymia Engage with a prescription. However, it is possible to save even more on the cost of the medication by using a pharmacy discount card. Pharmacy discount cards offer savings on all FDA-approved medications, including both brand name and generic prescriptions. When purchased using a pharmacy discount card, Qsymia can be purchased for less than 70 dollars per month, saving patients nearly 30 dollars per month. Qsymia is not covered by most commercial insurance programs, and it is not covered by Medicare and Medicaid plans. The two primary ways of saving on the drug include purchasing through the manufacturer’s website and using a pharmacy discount card at local pharmacies that carry the medication. Because of the risk of serious birth defects, only doctors and pharmacies trained in Qsymia’s distribution program, Qsymia REMS, should prescribe or dispense the medication.

What Risks are Associated With Qsymia?

There are numerous risks associated with Qsymia, but two of the most significant are the risk of serious birth defects and the risk of dependence or abuse when taking the medication. Qsymia should never be taken by women who are pregnant or planning to become pregnant, as the medication greatly increases the risk of birth defects even when taken very early in a pregnancy, such as before a woman knows she is pregnant. The most common birth defects associated with Qsymia use during pregnancy include cleft lip and cleft palate. Women who are capable of becoming pregnant should receive a negative pregnancy test result prior to taking Qsymia and should test monthly while taking the medication to ensure that they have not become pregnant. They also must use effective birth control consistently while taking Qsymia. If a woman becomes pregnant while taking Qsymia, she should stop taking the medication immediately and notify her healthcare provider.

Another major risk associated with Qsymia is the risk of dependence on or abuse of the medication. Phentermine is a Schedule IV controlled substance classified by the DEA due to its potential for abuse or addiction, and as a result, Qsymia can be habit forming. Qsymia should only be taken by the person for whom it was prescribed, and it should only be used for weight loss when the benefits of the medication outweigh the risks. Patients who have a history of alcohol or drug abuse may be more likely to abuse Qsymia. Qsymia should not be stopped suddenly, as patients can suffer from a seizure. Instead, the medication should be slowly tapered down under a doctor’s advice in order to avoid withdrawal symptoms.

What Side Effects are Associated With Qsymia?

There are both serious and common adverse events seen in clinical trials for Qsymia. 

Common side effects of Qsymia include:

  • Numbness or tingling in the hands, feet, arms, or face (paraesthesia)
  • Changes in the way foods taste or loss of taste (dysgeusia)
  • Constipation
  • Dizziness
  • Trouble sleeping
  • Dry mouth

Possible side effects of Qsymia that can be serious include:

  • Mood changes, such as depression or mood problems
  • Trouble sleeping
  • Difficulties concentrating, remembering, or speaking
  • Metabolic acidosis, or increases of acid in the bloodstream, which may be indicated by:
    • Feeling tired
    • Loss of appetite
    • Changes in the heartbeat that are noticeable
    • Difficulty thinking clearly
  • Hypoglycemia, or low blood sugar, in people with type 2 diabetes who take medications to treat their condition
  • Possible seizures when stopping use of the medication too quickly
  • Kidney stones 
  • Decreased sweating and increased body temperature or fever

Serious side effects of Qsymia that require immediate medical attention include:

  • Birth defects in pregnant women. If you become pregnant while taking Qsymia, stop taking the medication immediately and notify your healthcare provider.
  • Increases in heart rate while at rest that last more than a minute
  • Suicidal thoughts or actions
  • Serious eye problems and unusual changes that can result in permanent loss of vision, including:
    • Angle closure glaucoma 
    • Sudden decrease in vision with or without eye pain
    • Redness or blockage of fluid in the eye causing increased pressure in the eye

Who Should Not Take Qsymia?

Qsymia can be a helpful weight loss tool for some people, but it is not right for everyone. People who should not take Qsymia include:

  • Women who are pregnant, planning to become pregnant, or who become pregnant while taking Qsymia
  • People with glaucoma
  • People with thyroid problems, including hyperthyroidism
  • People taking medications called monoamine oxidase inhibitors (MAOIs) or people who have taken MAOIs in the past 14 days
  • People who are allergic to topiramate, sympathomimetic amines like phentermine, or any of Qsymia’s ingredients

There are also potential drug interactions, and you should seek prescribing information and medical advice if you take zonisamide, valproic acid and other antiepileptic drugs, or if you take any type of amphetamine. 

References: 

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/022580Orig1s000_qsymia_toc.cfm 

https://qsymia.com/patient/how-qsymia-works/ 

https://qsymiaengage.com/?_ga=2.73025111.570988043.1600006470-1950015547.1600006470 

https://www.webmd.com/drugs/2/drug-162311/qsymia-oral/details 

https://www.drugs.com/qsymia.html 

https://www.fda.gov/media/83651/download 

https://www.dea.gov/drug-scheduling

Published September 30th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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