What is the efficacy of topiramate for weight loss?

From the Guidelines

Topiramate can be used for weight loss, though it's not FDA-approved specifically for this purpose, and its efficacy is supported by recent guidelines 1. When prescribed off-label for weight loss, topiramate typically starts at a low dose of 25mg daily, gradually increasing to 100-200mg daily divided into two doses. The medication works by reducing appetite, decreasing food cravings (particularly for carbohydrates), and potentially increasing feelings of fullness. Weight loss results vary but average around 5-10% of body weight over several months, as noted in studies on phentermine-topiramate ER, which combines phentermine with topiramate for weight loss 1. Common side effects include tingling sensations, altered taste, fatigue, difficulty concentrating, and kidney stones. Topiramate requires careful monitoring and should only be used under medical supervision, as it can cause serious side effects including cognitive impairment and birth defects if taken during pregnancy. It works best when combined with lifestyle modifications like diet and exercise. Patients with a history of kidney stones, glaucoma, or metabolic acidosis should use topiramate cautiously. The medication appears to affect brain chemicals that control appetite and may alter how the body processes calories, though the exact mechanisms for weight loss aren't fully understood. Recent guidelines suggest that phentermine-topiramate ER can be used with lifestyle modifications for adults with obesity or overweight with weight-related complications, with careful consideration of the patient's clinical profile and needs 1. Key considerations for the use of topiramate or phentermine-topiramate ER include monitoring for side effects, avoiding use in patients with certain comorbidities, and ensuring effective contraception in women of childbearing potential 1.

Some key points to consider when using topiramate for weight loss include:

• Starting with a low dose and gradually increasing as needed and tolerated
• Combining with lifestyle modifications for optimal results
• Monitoring for common side effects and serious adverse effects
• Careful patient selection, avoiding use in patients with certain comorbidities or risk factors
• Ensuring effective contraception in women of childbearing potential due to the teratogenic effects of topiramate. The American Gastroenterological Association recommends considering phentermine-topiramate ER as part of a comprehensive approach to weight management, taking into account the individual patient's needs and clinical profile 1. Overall, topiramate can be a useful option for weight loss when used judiciously and under medical supervision, with careful consideration of the potential benefits and risks.

From the Research

Efficacy of Topiramate for Weight Loss

• Topiramate has been associated with significant weight loss in clinical trials, with patients treated with topiramate losing an average of 5.34 kg more than those on placebo 2.
• The efficacy of topiramate treatment is influenced by treatment duration and dosage, with higher doses and longer treatment durations resulting in greater weight loss 2.
• Studies have shown that topiramate can be effective in reducing weight in overweight patients with affective disorders, with a mean weight loss of 7.75 kg at six months and 9.61 kg at 12 months 3.
• Topiramate has also been shown to be effective in reducing weight in adults with epilepsy, with a mean weight loss of 3.0 kg at 3 months and 5.9 kg at 1 year 4.
• The use of topiramate for weight loss has been investigated in several clinical trials, with results showing that it is significantly more efficacious than placebo and can produce sustained weight loss for up to 1 year 5.

Predictors of Weight Loss with Topiramate

• Reduced caloric intake has been correlated with weight loss during early treatment with topiramate 4.
• Higher baseline body mass index (BMI) has been correlated with greater weight loss during continued therapy with topiramate 4.
• Topiramate has been shown to be generally well tolerated, with adverse events being mild to moderate and mostly related to the central nervous system 5.

Combination Therapy with Topiramate

• The combination of phentermine and topiramate extended-release (phentermine/topiramate ER) has been approved for chronic weight management in obese adults and overweight adults with weight-related co-morbidities 6.
• Phentermine/topiramate ER has been shown to be an effective and safe weight-loss medication, producing and sustaining approximately 10% loss of body weight 6.