A New Medication for Weight Loss

What is phentermine?

Phentermine was initially approved as a weight-loss drug in 1959. Phentermine is considered a stimulant-type appetite suppressant. Its major site of action is centrally in the brain. It effectively decreases hunger and gently increases metabolism. Phentermine has been studied numerous times for weight loss (in combination with diet and behavioral modification), as well as in the maintenance of weight loss.

What is topiramate?

Topiramate (Topamax®, Janssen Pharmaceuticals, Inc., Titusville, New Jersey) was originally approved in 1996 as a migraine-preventative treatment and seizure medication. Weight loss was initially seen as a side effect and it has now been studied directly for use in weight loss and in binge-eating disorder.

The mechanism of action of topiramate is not entirely known. One mechanism that may contribute to its weight loss effects is its effect on taste. Many patients taking this drug report certain foods taste different, especially diet colas. With altered taste sensations, some of the reward from eating certain foods may be altered. 

Who should consider using this drug?

The final requirements have not been released, but I suspect that someone will need either a body mass index (BMI) of 30 or BMI greater than 27 with certain cardiac risk factors, such as diabetes, high blood pressure and high cholesterol. If used, it should always be used as part of a complete weight-loss program. I believe its effects will be best when used with diet, exercise and behavior modification. It will best be used long-term as long as you are getting benefit from its use. 

Who should not use this drug?

This drug should absolutely not be used with patients with pre-existing heart disease or women who are going to become pregnant, as it has been shown to slightly increase the risk of birth defects, such as cleft lip and palate. There are several other possible side effects that should be discussed with the doctor who prescribes it for you, prior to starting it. A few possible side effects are rapid heart rate, temporarily increased blood pressure, forgetfulness, and kidney stones.