Do you need to wean off Qsymia (phentermine and topiramate)?

Weaning Off Qsymia

Yes, you must taper Qsymia when discontinuing—do not stop abruptly. The medication should be gradually reduced over at least 1 week to minimize the risk of seizures from the topiramate component. 1

Why Tapering is Required

• Topiramate, one of the two active ingredients in Qsymia, is an anti-epileptic medication that requires gradual discontinuation to prevent withdrawal seizures. 1
• The American College of Clinical Pharmacology explicitly recommends a discontinuation protocol for Qsymia that requires tapering over at least 1 week rather than abrupt cessation. 1
• This is consistent with standard practice for all topiramate-containing medications, where sudden discontinuation can precipitate seizure activity even in patients without epilepsy. 2

Recommended Tapering Protocol

• Reduce the dose gradually over a minimum of 1 week before complete discontinuation. 1
• If you are on the maximum dose (15/92 mg daily), step down to a lower dose strength (such as 11.25/69 mg or 7.5/46 mg) for several days before stopping completely. 3
• The specific tapering schedule should account for your current dose—higher doses require more gradual reduction. 3

Clinical Context for Discontinuation

• Treatment should be discontinued if you have not achieved at least 5% weight loss after 12 weeks at the maximum dose of 15/92 mg daily, as this indicates inadequate response. 4, 3
• Qsymia must also be discontinued at least 4 days before any procedures requiring general anesthesia due to perioperative complications. 5
• If you experience serious adverse effects such as acute angle-closure glaucoma, severe metabolic acidosis, or psychiatric emergencies, discuss with your healthcare provider whether immediate discontinuation with close monitoring is necessary despite the seizure risk. 1, 2

Critical Safety Considerations During Discontinuation

• Monitor for withdrawal symptoms during the taper, including potential mood changes, anxiety, or sleep disturbances, which can occur with both phentermine and topiramate withdrawal. 1, 2
• The cognitive impairment that can occur with Qsymia makes it particularly important that patients receive clear, repeated instructions about the tapering protocol. 1
• If you miss multiple doses and have essentially self-discontinued, contact your healthcare provider before restarting, as you may need to restart at a lower dose with gradual re-titration rather than resuming your previous dose. 3

Common Pitfall to Avoid

• Never run out of medication abruptly without planning for a taper—this is the most common scenario leading to unintentional abrupt discontinuation and potential seizure risk. 1, 2
• Patients should be counseled at the time of initial prescription about the need for tapering if discontinuation becomes necessary. 1