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Combining Medications: Phentermine and Topiramate - - Medical Minutes Episode 12

Welcome to another medical minute.

This week, I’m going to talk about the combination of anti-obesity medications.

The combination of drugs is used every day in medicine. We use it in infection control with antibiotics. We use it in hypertension, where sometimes you may use three and even four medications to control someone’s blood pressure. We use it in cholesterol, again all the time. We actually have used it in weight management since at least 2012.

The two medicines I’m going to talk about today, the first is Phentermine. Phentermine is a very commonly used weight loss medication. It’s been out since 1959. It has stood the test of time.

And then Topiramate. Topiramate, classically, is an anti-seizure medication, and then it got approval a while back for migraine headache prevention. My guess, as when they were doing those studies, they noticed that people on the drug were losing weight and the patients who are not on the drug, obviously either not losing weight or potentially even gaining weight.

And so there were several small studies done in the past, looking at Topiramate as a weight loss drug. By itself, it actually is a pretty good weight loss drug, though it’s not super potent. Although some do get exceptional benefit.

The benefit when you combine medications is a concept called synergy. In synergy, very simply, one plus one equals more than one, hopefully three, four or five.

In this sense, when you combine Phentermine plus Topiramate, we get the most potent of the weight loss drugs without getting a lot more side effects.

As always, Phentermine’s biggest side effect, in the beginning, is because it is a mild stimulant. You may lose sleep for roughly the first three nights. For some people, it causes a little bit of dry mouth, but it works really, really well in appetite suppression. The only problem in that, is because of this stimulant and has to wear off, we want the effect of Phentermine to come up in the daytime and go down in the evening.

Topiramate is a continuous drug. It helps appetite all hours of the day, both in the morning hours, in the evening hours, and even if you woke up at two in the morning with some hunger, it will be controlling it then.

Remember there is no one weight loss drug that is great or perfect for everybody, but

The combination of Phentermine and Topiramate is one that should be explored if you haven’t tried it yet.

Have a great week.


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