From the Guidelines
Phentermine is a suitable alternative to Topiramate for weight loss, with a recommended dosage of 15 to 37.5 mg orally once daily in the morning. According to a 28-week, randomized, controlled trial comparing phentermine/topiramate extended-release with phentermine monotherapy and topiramate monotherapy in adults with obesity, phentermine alone (15 mg daily) was associated with a 6.0-kg weight loss at 28 weeks, compared with a placebo 1. This study, published in the journal Gastroenterology in 2017, highlights the efficacy of phentermine as a weight loss medication.
Some key points to consider when prescribing phentermine include:
- The medication is a Schedule IV medication and should not be used with monoamine oxidase inhibitors or other sympathomimetic amines
- Common side effects include dry mouth, difficulty sleeping, dizziness, and irritability
- Appropriate candidates for phentermine include patients with obesity who need assistance with appetite suppression, particularly younger patients without evidence of active or unstable coronary disease, or uncontrolled hypertension
- Patients who have anxiety or insomnia might feel their condition is exacerbated by phentermine, and would not be ideal candidates 1.
Other FDA-approved medications for weight loss, such as orlistat, naltrexone-bupropion, liraglutide, semaglutide, and setmelanotide, may also be considered as alternatives to Topiramate, depending on individual factors including medical history, other medications, side effect profiles, and insurance coverage 1. However, phentermine is a well-established and commonly prescribed anti-obesity medication, making it a viable option for patients seeking an alternative to Topiramate.
From the Research
Alternative Weight Loss Medications
There are several alternatives to Topiramate for weight loss, including:
- Phentermine 2, 3, 4
- Orlistat 5, 2, 3
- Liraglutide 5, 2, 3
- Naltrexone/bupropion 5, 2, 3
- Semaglutide 5, 2
- Tirzepatide 5, 2
- Setmelanotide 5
Efficacy and Safety
These medications have been shown to produce varying degrees of weight loss, with Semaglutide producing an average of 15% weight loss at 1 year 5. However, they also have potential side effects and interactions, and their use should be approached with caution 6, 3.
FDA-Approved Medications
The FDA has approved seven anti-obesity medications, including phentermine, orlistat, phentermine/topiramate ER, naltrexone SR/bupropion SR, liraglutide 3.0 mg, semaglutide 2.4 mg, and tirzepatide 2. These medications should be prescribed with the intention of long-term use and as part of a comprehensive treatment plan for obesity.