From the Guidelines
No, Topamax is not approved for weight loss. Topamax, also known as topiramate, is an antiepileptic drug that has been used off-label for weight loss, but it is not FDA-approved as an anti-obesity medication (AOM) 1. While topiramate has been shown to be effective in reducing weight in some studies, its use for weight loss is not recommended due to the lack of FDA approval and potential side effects 1. Instead, FDA-approved weight loss medications such as Qsymia (phentermine-topiramate), which combines phentermine and topiramate, are available and have been shown to be effective in promoting weight loss 1. Other approved options include Wegovy (semaglutide), Saxenda (liraglutide), Contrave (naltrexone-bupropion), and Xenical (orlistat) 1. These medications work through different mechanisms, such as appetite suppression, reduced food absorption, or mimicking hormones that regulate hunger, and should only be used under medical supervision as part of a comprehensive program that includes dietary changes and increased physical activity. If you're considering medication for weight management, consult with a healthcare provider who can evaluate your specific health situation and recommend appropriate, evidence-based treatments. Key considerations for weight loss medication include the patient's clinical profile, comorbidities, preferences, costs, and access to therapy, as outlined in the American Gastroenterological Association (AGA) clinical practice guideline on pharmacological interventions for adults with obesity 1.
From the Research
Topiramate Approval for Weight Loss
- Topiramate, also known as Topamax, has been found to be associated with weight loss in clinical trials 2.
- The drug was approved by the Food and Drug Administration (FDA) for weight loss in patients with a body mass index (BMI) > 30, in combination with phentermine 3.
- Topiramate's mechanism of action for weight loss is thought to be based on the selective inhibition of mitochondrial carbonic anhydrase isoforms, and it may contribute to weight loss by reducing calorie intake, decreasing fat gain, and lowering triglyceride and cholesterol levels 4, 5.
- Clinical studies have supported the use of topiramate as a weight-loss medication, demonstrating its effectiveness in reducing body weight across different dosages and sustaining weight loss over time 2, 5.
Safety and Efficacy
- The most common adverse events associated with topiramate use are paresthesia, fatigue, decreased appetite, nausea, diarrhea, weight decrease, and taste perversion 4, 3.
- Topiramate has been found to be generally well-tolerated in clinical studies, with few side effects observed 5.
- The odds ratio for adverse events leading to topiramate withdrawal was 1.94 (95%CI 1.64-2.29) compared with the control group 2.
Clinical Uses
- Topiramate is approved by the FDA for epilepsy treatment and migraine prophylaxis 3.
- It is also used as adjunctive therapy for patients with mood and eating disorders, as well as for alcohol use disorders 5.
- The current target dosing for topiramate monotherapy is 400 mg/day and 100 mg/day to treat epilepsy and migraines, respectively 3.