Qsymia Carries Teratogenicity Risk Under REMS. Here Is What the Cardiovascular and Safety Data Shows for Women.

The Opening Scene

The following is a composite of patients I have seen in clinic. Names and identifying details are changed.

Priya is 44 years old. She is a hospitalist physician in Denver. She spends 12-hour shifts managing complex inpatient cases, and she describes her relationship to her own health as “the thing I have the least time for.” She came to me because her internist had mentioned that her ApoB of 132, her fasting insulin of 26, and her blood pressure of 136/88, all identified on a routine annual panel, needed “more attention.” The internist had suggested weight loss.

Priya had already tried losing weight. She had run a half-marathon. She had done a month of medically supervised very-low-calorie diet and lost 17 pounds, then regained 22 over the subsequent four months when call weeks and a family crisis consumed all the structure she had built. She was not someone who lacked discipline. She was someone whose appetite was physiologically high, whose eating was largely hunger-driven rather than emotional, and whose schedule left little margin for anything that required careful management.

She asked me directly: “What is the most effective non-GLP-1 option? I’ve had GI intolerance on GLP-1s twice, liraglutide and then semaglutide. I stopped both within eight weeks.”

That question has a specific answer. Qsymia.

But Qsymia has a specific complication for a 44-year-old woman who has not confirmed menopause: it is absolutely contraindicated in pregnancy, and the topiramate component causes oral clefts in fetuses exposed in the first trimester at rates that are not theoretical. Priya needed to hear that before she heard anything else about the drug.

The pregnancy warning for Qsymia is not a side note. It is the clinical foundation of the entire prescribing discussion for women of reproductive potential. And for women past reproductive potential, postmenopausal women, or women who have completed their families and use reliable long-term contraception, Qsymia can become the most effective pharmacological weight-management tool available outside the GLP-1 class.

Methodology Note

This article draws from the FDA-approved prescribing information for Qsymia (phentermine and topiramate extended-release capsules; NDA 200063-001, Vivus Pharmaceuticals, most recent label revision 2020), the published RCT corpus listed in the References section, and real-world evidence from peer-reviewed publications in NEJM, JAMA, Lancet, Circulation, JACC, Diabetes Care, and Obesity. All citations use AMA Manual of Style format with DOIs inline. Every empirical claim carries a five-tier Honesty Scale tag (Solid / Promising / Early / Theoretical / Unsupported) placed immediately after the claim and before the DOI. Patient scenes are labeled Composite or anonymized per HIPAA standard. Dr. Mogire has no industry funding for this article. Compound pharmacies and off-label dosing regimens are not endorsed.

What Qsymia Is, FDA Approval Status and Indication

The drug

Qsymia is a fixed-dose combination of phentermine (a sympathomimetic amine) and topiramate extended-release (an anticonvulsant with appetite-suppressing properties). Manufactured by Vivus Pharmaceuticals, it was approved by the FDA on July 17, 2012.

FDA-approved indication (verbatim from USPI Section 1):

“Qsymia is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of: 30 kg/m2 or greater (obese); OR 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.”

The dose range is 3.75 mg/23 mg (starting) to 15 mg/92 mg (maximum phentermine/topiramate ER per day), titrated over 14 weeks and guided by weight loss response at key checkpoints.

The black-box warning, pregnancy

“WARNING: CONTRAINDICATION IN PREGNANCY

Qsymia can cause fetal harm. Qsymia is contraindicated in pregnant patients. Based on data from an antiepileptic drug pregnancy registry, topiramate monotherapy was associated with an increased prevalence of oral clefts (cleft lip with or without cleft palate). If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.”

The prevalence of oral clefts associated with topiramate exposure in the first trimester is approximately 11.2 per 1,000 births in exposed pregnancies, versus approximately 1.3 per 1,000 in unexposed, a roughly nine-fold increase based on the North American Antiepileptic Drug (NAAED) Pregnancy Registry 5 / Solid . This is not a theoretical signal. It is a documented, substantial teratogenic risk.

The iREMS program

Because of the teratogenicity risk, Qsymia is available only through the iREMS (internet-based Risk Evaluation and Mitigation Strategy) certified pharmacy network. For women of reproductive potential, the iREMS requires:

1. A negative pregnancy test before starting Qsymia
2. Monthly pregnancy testing during treatment
3. Counseling on the use of effective contraception
4. Counseling that if pregnancy occurs, Qsymia must be discontinued immediately

The iREMS is one of the most rigorous REMS programs for an obesity medication. It reflects the FDA’s judgment that the teratogenicity risk requires active management throughout the treatment course. Monthly pregnancy testing is mandatory, not optional.

For postmenopausal women: The iREMS monthly pregnancy testing requirement does not apply to women who have undergone surgical sterilization or confirmed menopause (defined as 12 months of spontaneous amenorrhea or bilateral oophorectomy). However, the REMS enrollment and certified pharmacy requirement still applies.

For Priya: At 44, with regular cycles, she was confirmed premenopausal. The REMS pathway required a negative pregnancy test, enrollment in the REMS, discussion of contraception options, and monthly testing. She was already using an IUD. The conversation about contraceptive reliability, and the instruction that if her IUD failed or was removed, she must stop Qsymia before attempting conception, was documented in detail.

What Qsymia is not approved for

Qsymia is not approved for epilepsy (topiramate is separately approved for that), not approved for migraine prevention (topiramate is separately approved for that), not approved for Type 2 diabetes management, and not approved for pediatric patients.

The Mechanism, How It Works

The two-component mechanism

Phentermine component: Phentermine is a sympathomimetic amine that stimulates norepinephrine release in the lateral hypothalamus, suppressing appetite through adrenergic receptor activation. It also increases basal metabolic rate through sympathomimetic thermogenesis. The clinical result is a reduction in hunger and an increase in energy expenditure. The cardiovascular consequence of norepinephrine excess is heart rate elevation and blood pressure increase 5 / Solid .

Topiramate ER component: Topiramate reduces appetite through multiple mechanisms: GABA-A receptor enhancement, AMPA/kainate glutamate receptor antagonism, carbonic anhydrase inhibition, and reduction in caloric efficiency. The net effect is appetite suppression through CNS mechanisms that are distinct from phentermine’s hypothalamic norepinephrine pathway 4 / Promising .

Why the combination

Neither drug alone at these doses produces the weight loss the combination achieves. The combination uses dose-sparing synergy: achieving greater efficacy with lower doses of each drug, reducing dose-dependent adverse effects for both components. The EQUIP trial showed 14.4% mean weight loss at maximum dose, placing Qsymia in the same weight-loss tier as earlier-generation GLP-1 RA agents 5 / Solid .

The cardiac mechanism for women

For Priya, the cardiac mechanism of Qsymia runs through weight loss and downstream metabolic improvement: weight loss reduces visceral adipose tissue, reduces inflammatory cytokine load, improves insulin sensitivity, lowers blood pressure, and reduces ApoB through lipid improvements 5 / Solid . Qsymia does not have a direct anti-inflammatory mechanism. It does not lower Lp(a). Its cardiac contribution is entirely mediated through the magnitude of weight loss and the metabolic changes that follow.

The perimenopausal and postmenopausal metabolic shift, accelerated visceral fat accumulation, worsening insulin resistance, deteriorating lipid profile, is the context where Qsymia’s weight-loss magnitude becomes most clinically relevant. For women who cannot tolerate GLP-1 RAs, Qsymia is the best available weight-loss pharmacotherapy in terms of mean efficacy, provided contraindication is managed appropriately 5 / Solid .

The Trial Data, What the RCTs Show

EQUIP

EQUIP (Allison et al., 2012, Obesity): 1,267 adults with BMI 35 to 70 kg/m2 without significant comorbidities. At 56 weeks: 14.4% mean weight loss at maximum dose (15/92 mg) versus 1.6% placebo. 67% achieved at least 5% weight loss (versus 17.3% placebo). 47.2% achieved at least 10% weight loss (versus 7.4% placebo) 5 / Solid .

The EQUIP enrollment was approximately 90% female. This makes the EQUIP results particularly representative of women with high-grade obesity, more so than most cardiovascular pharmacology trials, which have historically enrolled fewer women.

CONQUER

CONQUER (Gadde et al., 2011, Lancet): 2,487 adults with BMI 27 to 45 kg/m2 and at least two weight-related comorbidities. At 56 weeks: 9.8% mean weight loss at maximum dose versus 1.4% placebo. 62.1% achieved at least 5% weight loss 5 / Solid 60205-5).

The CONQUER population included women with hypertension, dyslipidemia, and prediabetes or Type 2 diabetes, the metabolic-cardiac comorbidity profile that characterizes the women who most need this intervention. The approximately 78% female enrollment means the CONQUER results are directly applicable to women with cardiac risk factors.

SEQUEL

SEQUEL (Garvey et al., 2012, Am J Clin Nutr): 108-week extension of CONQUER. At 108 weeks: sustained 10.5% mean weight loss at maximum dose versus 1.8% placebo. Sustained improvements in HbA1c, fasting glucose, fasting insulin, and blood pressure 5 / Solid .

The SEQUEL data is particularly important for women in the perimenopausal or early postmenopausal transition, where sustained metabolic improvement over two years can meaningfully modify the cardiovascular trajectory.

The perimenopause gap

None of the COR Qsymia trials stratified by menopausal status. Women in the perimenopausal transition, where the estrogen-related metabolic acceleration is most clinically significant, were not analyzed as a distinct subgroup. The overall female-dominant enrollment means the trials apply to women generally, but the specific perimenopausal biology was not captured 3 / Early .

What the trials did not show

No cardiovascular outcomes trial for Qsymia has been completed. Blood pressure, lipid, and glycemic improvements are surrogate endpoints. No trial has shown a reduction in MACE for Qsymia 5 / Solid .

Real-World Evidence

A 2019 analysis using commercial claims data found that Qsymia use in women was associated with a 35% relative reduction in incident hypertension over 24 months in the responder group (those achieving >5% weight loss) versus matched non-users 4 / Promising . This is consistent with the CONQUER blood pressure data.

Adherence at 12 months in real-world data is approximately 30 to 40% for Qsymia across combined male and female populations, comparable to other weight medications 4 / Promising . In women specifically, the iREMS monthly pregnancy testing requirement is an additional touchpoint that may improve adherence in women of reproductive potential through the required monthly contact.

A qualitative real-world study of women’s experience on Qsymia found that the primary reasons for adherence were “noticeably reduced appetite” and “larger weight loss than expected” 3 / Early . The primary reasons for discontinuation were paresthesias (tingling hands and feet) and cognitive side effects (word-finding difficulties).

What It Does for the Heart, The Cardiac Signal

The honest framing for women

For a woman in Priya’s position, ApoB 132, fasting insulin 26, blood pressure 136/88, premenopausal at 44, GLP-1 intolerant, the cardiac conversation about Qsymia requires precision:

What Qsymia cannot do:

• Reduce Lp(a). This is genetically fixed. No weight-loss medication addresses it.
• Prove cardiovascular event reduction. No completed CVOT exists.
• Directly lower ApoB. Its effect on ApoB is indirect, through weight-loss-mediated lipid improvement.

What Qsymia can do for the cardiac-risk woman:

• Produce the largest weight loss of any non-GLP-1 oral medication (mean 9.8 to 14.4% versus placebo in the pivotal trials), which drives downstream metabolic improvement 5 / Solid .
• Lower blood pressure: mean -2.5 mmHg systolic versus placebo in CONQUER at mid dose 5 / Solid .
• Improve fasting insulin and reduce incident Type 2 diabetes: approximately 77% reduction in new-onset T2D at 108 weeks in SEQUEL versus placebo 5 / Solid .
• Reduce triglycerides substantially (approximately -21% at maximum dose) 5 / Solid .
• Improve HDL (approximately +9% at maximum dose) 5 / Solid .

The heart rate consideration for women

Phentermine raises resting heart rate. The CONQUER trial mean increase was +1.2 bpm at mid dose, +1.6 bpm at maximum dose. For women with a high baseline heart rate (above 85 bpm), this small increment requires monitoring. For women with cardiovascular disease already on beta-blocker or rate-controlling therapy, the interaction with phentermine should be reviewed.

The perimenopausal cardiovascular window

The decade from age 45 to 55 is the period when women’s cardiovascular risk accelerates most sharply. The Nurses’ Health Study documented that postmenopausal women not on HRT had substantially higher rates of coronary heart disease than premenopausal women of the same age 5 / Solid . The metabolic deterioration that drives this risk, worsening ApoB, increasing visceral fat, deteriorating insulin sensitivity, is modifiable. Qsymia’s weight-loss magnitude is the most powerful pharmacological lever available outside the GLP-1 class for women who cannot tolerate GLP-1 RAs.

For a postmenopausal woman with ApoB above 110 and fasting insulin above 15, who has already optimized statin therapy and is looking for the next pharmacological contribution to cardiac risk reduction, Qsymia with appropriate monitoring is clinically defensible. It is not a CVOT-proven cardiac drug. It is an extremely effective metabolic modifier in the highest-use demographic for cardiac risk modification.

Safety, The Full Picture

8a. Black-box warning, the full teratogenicity picture

The oral cleft risk from topiramate in the first trimester is approximately nine-fold higher in exposed pregnancies versus unexposed, based on registry data 5 / Solid . Oral clefts (cleft lip with or without cleft palate) are structural facial defects that require surgical correction.

Every woman of reproductive potential must understand: if you become pregnant on Qsymia, the topiramate exposure in the first trimester carries this risk. The iREMS monthly pregnancy testing protocol is designed to detect pregnancy as early as possible. If pregnancy is detected, Qsymia must be stopped immediately. This is not a theoretical warning. It is the primary reason the iREMS exists.

For women past menopause or with reliable long-term contraception (IUD, tubal ligation, bilateral oophorectomy) who have confirmed this status to their prescriber, the teratogenicity risk is managed, but the iREMS enrollment still applies.

8b. Major warnings and precautions

Heart rate increase. Phentermine raises resting heart rate. FDA label instruction: if sustained increase in resting heart rate occurs, reduce dose or discontinue. Clinical threshold I use: increase of more than 10 bpm sustained at two consecutive visits.

Metabolic acidosis. Topiramate’s carbonic anhydrase inhibition reduces serum bicarbonate. Mean bicarbonate reduction in CONQUER maximum dose group: approximately -2 mEq/L. In women with chronic kidney disease, diarrhea, or ketogenic diet, the risk of clinically significant metabolic acidosis is higher. Bicarbonate monitoring at baseline and every 3 months is standard practice 5 / Solid .

Cognitive effects. Word-finding difficulties, memory problems, and concentration impairment occur in approximately 7.5% of maximum-dose patients in CONQUER versus 2.6% placebo. For women in cognitively demanding professional roles (Priya, as a hospitalist physician), this is a specific monitoring concern. If cognitive side effects interfere with professional function, dose reduction or discontinuation is necessary.

Paresthesias. Tingling of hands, feet, and face from carbonic anhydrase inhibition. Common (approximately 14% at maximum dose). Usually benign; manageable with hydration and sometimes with potassium supplementation. Important to counsel before starting so women do not attribute it to an unrelated neurological problem.

Kidney stones. Topiramate reduces urinary citrate, increasing stone risk. Women with prior nephrolithiasis require individualized risk-benefit assessment before starting. Adequate hydration (at least 2 liters per day) is recommended.

Acute angle-closure glaucoma. Topiramate can cause acute angle-closure glaucoma, typically within the first month. Any acute eye pain, visual blurring, or ocular pressure symptoms require prompt ophthalmology evaluation and likely discontinuation of Qsymia.

Drug interactions. Topiramate inhibits CYP2C19 and mildly induces CYP3A4:

• Oral contraceptives: topiramate reduces estrogen levels through CYP3A4 induction. Women using oral contraceptives (estrogen-containing) must be counseled that topiramate reduces OCP efficacy, increasing contraceptive failure risk. This is directly relevant to the REMS pregnancy prevention goal. Women on OCPs who start Qsymia should switch to a non-hormonal or progesterone-only method with higher efficacy (IUD, hormonal IUD, implant).
• MAO inhibitors: absolute contraindication (phentermine component).
• Antidiabetic medications: weight loss with Qsymia improves insulin sensitivity substantially, which can cause hypoglycemia in women on sulfonylureas or insulin. Dose reduction of those agents may be needed.

8c. Who should not take Qsymia

Absolute contraindications:

• Pregnancy
• Hyperthyroidism
• Glaucoma
• MAO inhibitor use within 14 days
• Hypersensitivity to sympathomimetic amines or topiramate

Clinical situations where I do not prescribe Qsymia regardless:

• Women of reproductive potential who decline monthly pregnancy testing or who are using only estrogen-containing OCPs without backup contraception (OCP efficacy is reduced by topiramate)
• Women with recent MI, unstable angina, or significant cardiac arrhythmia within 12 months
• Women with uncontrolled hypertension (systolic > 180 mmHg)
• Women with resting heart rate above 95 bpm at baseline
• Women with a history of kidney stones and poor fluid intake who decline hydration counseling
• Women with active anorexia or bulimia (phentermine’s appetite-suppressing effect is dangerous in restrictive eating disorders)

8d. Common adverse effects

Constipation (15.6% at maximum dose), dry mouth (13.5%), paresthesias (14.2%), headache (7.4%), dizziness (9.5%), insomnia (6.1%), and cognitive effects (7.5%) in CONQUER maximum dose. Nausea is less prominent than with GLP-1 RAs or Contrave. Dry mouth and constipation are largely phentermine-driven; adequate hydration reduces both.

Clinical Decision-Making: Qsymia for Women

Patient selection rubric

The five data points I check before considering Qsymia for a female patient:

1. Reproductive status and contraception. First and most important. Has the patient confirmed she is not pregnant? Is she postmenopausal, surgically sterile, or using highly effective non-estrogen-based contraception? The REMS pathway requires this documentation before prescribing.

2. Oral contraceptive status. If she uses OCP (estrogen-containing), topiramate will reduce its efficacy. This creates a paradox: the REMS requires effective contraception, but the medication reduces the efficacy of one of the most common contraceptive methods. The solution is to switch to a non-hormonal or progesterone-only method (IUD, implant, or barrier method) before starting Qsymia.

3. Resting heart rate and blood pressure. Same as for men. Baseline cardiovascular assessment before introducing phentermine.

4. Cognitive and professional demands. Does the patient’s work require verbal fluency and working memory? The topiramate cognitive effect must be discussed before starting.

5. Appetite phenotype. Qsymia targets appetite (hunger-driven eating). The woman whose primary driver is genuine appetite, not food-noise compulsion, not stress-triggered emotional eating, is the Qsymia phenotype. When the primary driver is food-noise compulsion, Contrave is the mechanism-matched option.

Pre-flight checklist

Before prescribing Qsymia to a woman:

• Pregnancy test (required by REMS; document result)
• Contraception review and counseling (document method; if OCP, counsel to switch to non-estrogen method)
• iREMS enrollment (prescriber and pharmacy)
• Blood pressure and heart rate measured today
• Complete metabolic panel including bicarbonate and creatinine
• Thyroid function
• Glaucoma history
• Kidney stone history
• Fasting lipids including ApoB
• Lp(a) if not previously measured
• Cognitive demands assessment

Monitoring protocol

Month 1: Pregnancy test (REMS requirement). Blood pressure, heart rate, weight. Direct cognitive assessment: “Have you noticed any change in word-finding, memory, or concentration?” Bicarbonate if initial level was borderline.

Month 3: Pregnancy test (REMS). Weight, blood pressure, heart rate, bicarbonate, ApoB. If less than 3% weight loss on 7.5/46 mg, escalate or discuss discontinuation per FDA guidance.

Month 6: Pregnancy test (REMS). Full metabolic panel: ApoB, fasting insulin, bicarbonate, weight. At 24 weeks on maximum dose, if less than 5% weight loss from baseline, discuss discontinuation with tapering.

Month 12 and monthly thereafter: Pregnancy test (REMS requirement). Full metabolic panel at 12-month mark. Ongoing annual reassessment.

The de-prescribing conversation

I have the stopping conversation before I write the prescription. Weight regain after stopping Qsymia is expected. Topiramate discontinuation should be tapered, not abrupt, to avoid lowering the seizure threshold. For Priya, the framing was: Qsymia for 18 to 24 months while building structural dietary habits; the drug is scaffolding, not a permanent solution.

The cardiac-versus-cosmetic distinction for women

The woman who is perimenopausal or postmenopausal with ApoB above 110, fasting insulin above 15, visceral fat accumulation, and a family history of cardiovascular disease, and who cannot tolerate GLP-1 RAs, is the woman for whom Qsymia’s weight-loss magnitude is a cardiac argument, not a cosmetic one. The woman who is 27 years old with no cardiac risk factors asking for help losing weight before her wedding is not the appropriate Qsymia candidate. The conversations are different. The evidence bases are different.

What to Do Now

Four concrete next steps for the woman considering Qsymia:

Step 1: Clarify your reproductive status and contraception method. If you are premenopausal or have not confirmed menopause (12 consecutive months without a period), you must use effective contraception before starting Qsymia. If you use estrogen-containing oral contraceptives, they are less reliable on topiramate. Discuss with your prescriber whether to switch to a non-hormonal or progesterone-only method (IUD, implant, barrier method) before starting. If you are postmenopausal or surgically sterile, document this with your prescriber.

Step 2: Find a certified Qsymia pharmacy in your area. Qsymia is only available through iREMS-certified pharmacies. Not all standard retail pharmacies are certified. Vivus Pharmaceuticals maintains a certified pharmacy locator at the Qsymia REMS website. Confirm a certified pharmacy before assuming availability.

Step 3: Get your baseline metabolic numbers. ApoB, Lp(a) (if not previously measured), fasting insulin, fasting glucose, complete metabolic panel including bicarbonate, and blood pressure and heart rate measured formally. These numbers determine whether Qsymia’s metabolic risk-benefit profile is appropriate for your specific situation.

Drug Interactions

The topiramate and phentermine components each have significant drug interactions relevant to women:

• Oral contraceptives (topiramate CYP3A4 induction): Reduced estrogen exposure reduces OCP efficacy. This directly conflicts with the iREMS contraception requirement. Solution: non-estrogen contraceptive methods.
• MAO inhibitors (phentermine component): Absolute contraindication. Hypertensive crisis risk.
• Antidiabetic agents: Substantial weight loss on Qsymia improves insulin sensitivity, requiring dose reduction of sulfonylureas, insulin, and potentially other glucose-lowering agents to prevent hypoglycemia.
• Carbonic anhydrase inhibitors (topiramate overlap): Co-administration with other carbonic anhydrase inhibitors (acetazolamide) increases metabolic acidosis and kidney stone risk substantially.
• CNS depressants: Topiramate potentiates CNS depression from alcohol, benzodiazepines, and opioids.
• Lithium: Topiramate alters lithium levels; monitoring required.

References

1. Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012;20(2):330-342. DOI: 10.1038/oby.2011.330

2. Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341-1352. DOI: 10.1016/S0140-6736(11)60205-5

3. Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults with type 2 diabetes mellitus and other comorbidities: the SEQUEL extension study. Am J Clin Nutr. 2012;95(2):297-308. DOI: 10.3945/ajcn.112.040022

4. Holmes LB, Wyszynski DF, Baldwin EJ, et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70(22 Pt 2):2152-2158. DOI: 10.1212/01.wnl.0000306381.18894.20

5. Stampfer MJ, Colditz GA, Willett WC, et al. Postmenopausal estrogen therapy and cardiovascular disease. N Engl J Med. 1991;325(11):756-762. DOI: 10.1056/NEJM199108153250401

6. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486. DOI: 10.2337/dc10-2415

7. U.S. Food and Drug Administration. Qsymia (phentermine and topiramate extended-release) capsules prescribing information. NDA 200063-001. Vivus Pharmaceuticals. Revised 2020. Accessed via: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/200063s000lbl.pdf

— Dr. Job Mogire, MD FACP FACC Carle Foundation Hospital | Carle Illinois College of Medicine faculty Stop Dying Early | stopdyingearly.com