Topiramate
Metabolic Health · Anticonvulsant
Tier B-
What this is
Qsymia (phentermine + topiramate ER) is FDA-approved and shows ~10% weight loss. Topiramate alone has off-label use. Strong teratogen — pregnancy avoidance required.
Mechanism
GABA potentiation; AMPA/kainate glutamate antagonism; carbonic anhydrase inhibition; appetite suppression mechanism unclear; dysgeusia may play a role
Dose & route
25-100 mg PO daily (monotherapy off-label); 23-92 mg + phentermine 3.75-15 mg in Qsymia
Citations
- https://pubmed.ncbi.nlm.nih.gov/22632912/
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60205-5/fulltext
- https://pubmed.ncbi.nlm.nih.gov/14678203/
- https://doi.org/10.6004/jadpro.2026.17.3.3
- https://pubmed.ncbi.nlm.nih.gov/40809604/
- https://doi.org/10.1101/2025.05.07.652668
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.