From the Guidelines
Yes, phentermine-topiramate ER is a medication that can help with weight loss and is also beneficial for patients with migraines, as topiramate is a component of this medication and is used for migraine prevention. According to the American Gastroenterological Association (AGA) clinical practice guideline on pharmacological interventions for adults with obesity 1, phentermine-topiramate ER is suggested for use in adults with obesity or overweight with weight-related complications, particularly in those with comorbid migraines. The recommended dosage of phentermine-topiramate ER is to initiate treatment with the starter dose of 3.75 mg/23 mg taken once daily for 14 days, followed by a maintenance dose of 7.5 mg/46 mg daily, with the option to escalate to 15 mg/92 mg daily if necessary 1.
The weight loss effect of phentermine-topiramate ER is moderate to large, with an average weight loss of 3-5% of body weight over several months. This occurs because topiramate reduces appetite, alters taste, and may slightly increase metabolism. However, it is essential to note that phentermine-topiramate ER should be avoided in patients with a history of cardiovascular disease or uncontrolled hypertension, and female patients with child-bearing potential should be counseled on the risks of teratogenicity and consistent use of reliable contraception while using phentermine-topiramate ER 1.
Some key points to consider when prescribing phentermine-topiramate ER include:
- Monitoring blood pressure and heart rate periodically while taking the medication
- Avoiding use in patients with a history of cardiovascular disease or uncontrolled hypertension
- Counseling female patients with child-bearing potential on the risks of teratogenicity and consistent use of reliable contraception
- Gradually titrating the dose to minimize risks and adverse events
- Discontinuing the medication if 3% weight loss is not achieved after 12 weeks at 7.5/46 mg daily or if 5% weight loss is not achieved after 12 weeks at 15/92 mg daily 1.
Overall, phentermine-topiramate ER can be a useful medication for patients with migraines who are also concerned about weight management, but the decision to use it should be based primarily on its effectiveness for migraine prevention and weight loss, as well as careful consideration of the potential risks and benefits.
From the FDA Drug Label
Metabolic and Nutritional Disorders: Weight Decrease 48 Weight Decrease 34913
Topiramate is a migraine medication that can also aid in weight loss. According to the drug label, weight decrease was reported in 48% of patients taking topiramate, and it is listed as a dose-related adverse event. However, it is essential to note that this medication should only be used under the guidance of a healthcare professional, as it can have other side effects and interactions. 2 2 2
From the Research
Migraine Medications and Weight Loss
- There are several migraine medications that have been associated with weight loss, including Topiramate 3, 4, 5, 6.
- Topiramate is an anticonvulsant agent that is effective in the prophylaxis of migraine and has been shown to induce weight reduction by an unknown mechanism 4.
- Studies have found that Topiramate treatment is associated with increased insulin sensitivity, increased adiponectin concentration, and a reduction of body fat in all treated patients 4.
- Other migraine medications, such as atogepant, have also been associated with weight loss, particularly in patients with episodic migraine 7.
- Atogepant was found to be associated with modest dose- and duration-dependent weight loss in a pooled analysis of five clinical trials 7.
Comparison of Migraine Medications and Weight Loss
- Topiramate has been shown to be more effective in inducing weight loss compared to other migraine medications, such as amitriptyline and divalproex sodium 5.
- Atogepant has been found to be associated with weight loss, but the magnitude of weight loss is generally smaller compared to Topiramate 7.
- The exact mechanisms by which these medications induce weight loss are not fully understood and require further research.
Clinical Implications
- Migraine medications that are associated with weight loss, such as Topiramate and atogepant, may be a useful treatment option for patients with migraine who are also overweight or obese 3, 4, 5, 6, 7.
- Clinicians should carefully consider the potential weight-loss effects of migraine medications when selecting a treatment plan for patients with migraine.
- Further research is needed to fully understand the mechanisms by which these medications induce weight loss and to determine their long-term efficacy and safety in patients with migraine.