Topiramate for Weight Loss
Did you know that Topiramate can help you lose weight? Scroll down to learn about Topiramate-containing medications like Topamax, Qudexy XR, and Trokendi XR, and see if it may be an option for you.
What is Topiramate?
Topiramate is a prescription medication used to treat various medical conditions, including epilepsy, migraine headaches, and, more recently, weight management. It is sold in different forms under Topamax, Qudexy XR, and Trokendi XR. Qudexy XR and Trokendi XR are the “extended-release” forms, which means it stays in your system longer than Topamax, an immediate-release form of topiramate. This also means you do not have to take Qudexy XR and Trokendi XR as often as Topamax.
How Does Topiramate Work?
Topiramate is an anti-seizure medication that works on the inhibitory centers of the brain to prevent or reverse seizures caused by overactivation of the brain. It is believed to help with weight loss by reducing appetite and food cravings, although the exact mechanisms involved are not fully understood.
Who Qualifies for Topiramate?
Topiramate can be prescribed to children and adults suffering from seizure disorders. It can also be prescribed to those who suffer from recurrent migraines that other medications have not relieved.
Topiramate can be used off-label as a weight-loss medication for those who struggle with obesity. If you have a BMI greater than or equal to 30 or a BMI greater than 27 with at least one other weight-related condition (diabetes, high blood pressure, high cholesterol), you may be eligible for this medication.
Can Topiramate Be Used For Weight Loss?
Topiramate has always been shown to have a noticeable effect on weight loss. In a meta-analysis published in 2011, researchers gathered all of the most recent studies on the weight loss effects of topiramate and compared them to each other. They compared ten studies that looked at the weight loss effects of topiramate for at least 16 weeks of treatment. They found that people taking topiramate lost an average of 5.3 kg (~11 lbs) after 16 weeks. They also found that the longer people were on topiramate, the more weight loss they noticed. Therefore, topiramate has a significant effect on weight loss.
It must always be noted that topiramate and any prescription weight loss medication should be taken in conjunction with dieting and regular exercise.
Topiramate vs Other Prescription Weight Loss Medications
Topiramate vs Contrave and Bupropion (Wellbutrin, Aplenzin)
Contrave is an FDA-approved prescription weight loss medication that can be used for people struggling with obesity. It is a combination of two medications: Naltrexone and Bupropion. Bupropion is an antidepressant medication that can be used off-label for weight loss. It is sold under the brand names Wellbutrin and Aplenzin.
In the COR-II trial published in 2013, researchers studied the weight loss effects of Contrave for people struggling with obesity (2). They gave the participants Contrave for 56 weeks, a calorie-restricted diet, and regular exercise. They found that people taking Contrave lost around 6% of their body weight after 56 weeks. They also saw that Contrave reduced certain cardiometabolic risk factors, such as LDL cholesterol levels, fasting insulin levels, and waist circumference.
In a study published in 2012, researchers examined the weight loss effects of bupropion in patients struggling with obesity (1). The participants were given different doses of bupropion in combination with a calorie-restricted diet and regular exercise for 24 weeks. The results showed that people taking bupropion in combination with diet and exercise lost around 7-10% of their initial body weight.
When you compare the results of these trials, all of these medications have similar efficacy regarding weight loss. Topiramate may not benefit people with depression, so Bupropion or Contrave may be more appropriate for these patients. Contrave is approved for managing obesity, so finding insurance coverage for this medication may be easier.
Topriamate vs GLP-1 Medications
The GLP-1 agonist medications were all made to treat type 2 diabetes. They mimic the effects of the naturally produced hormone, GLP-1, released from cells in the gut to regulate blood sugar and slow food movement through the gut. There are many different kinds of GLP-1 agonist medications on the market today. Some are FDA-approved to treat obesity (Wegovy, Saxenda), while others can be used off-label for weight loss (Mounjaro, Ozempic, Rybelsus, Victoza, Trulicity). These medications have been shown to reduce body weight anywhere from 10-20%, depending on which GLP-1 agonist is used. This is seen especially when a GLP-1 agonist is used with diet and regular exercise. For example, in the SURMOUNT-1 Trial, people taking Mounjaro over 72 weeks noticed an average reduction in body weight of 15% (4).
Compared to the studies published for Topiramate, the GLP-1 medications may be more effective regarding weight loss, especially Mounjaro and Wegovy. However, these medications can be very expensive, and hard to find coverage from insurance plans. They also do not appear to be effective for seizure disorders or migraines.
Topiramate vs Qsymia
Qsymia is a prescription weight loss medication that is a combination of Topiramate and Phenteramine. Phentermine is an appetite suppressant that affects the central nervous system and helps to reduce food cravings. Topiramate enhances the effects of Phentermine and reduces food cravings, as mentioned before.
Qsymia is very effective at managing obesity. In the CONQUER Trial published in 2011, researchers examined how effective Qsymia was at treating obesity. The study was done over a 52-week period where participants took different doses of Qsymia. Depending on the dose, people on Qsymia lost around 8-10 kg (18-22 lbs). They also saw that around 68% of people noticed at least a 5% reduction in weight after one year (3). This was followed by the SEQUEL trial, extending the CONQUER trial for 52 weeks. The researchers noticed an even greater and more sustainable weight loss effect in the long term.
Based on the results, Qsymia appears more effective for weight loss. This is likely due to combining the weight loss effects of two medications. Qsymia is also FDA-approved for managing obesity, which may make it easier to find coverage.
Topiramate Side Effects
The most common side effects of topiramate are:
- Blurred vision
- Burning, prickling, or tingling sensations
- Clumsiness or unsteadiness
- Confusion
- Continuous, uncontrolled back-and-forth or rolling eye movements
- Dizziness
- Double vision
- Drowsiness
- Eye redness or pain
- Generalized slowing of mental and physical activity
- Memory problems
- Trouble in concentrating or paying attention
- Unusual tiredness or weakness
Topiramate Dosage and Administration
Topiramate dosing differs between Topamax, Qudexy XR, and Trokendi XR. Overal. The best dose for weight loss varies from person to person. Be sure to work with your healthcare provider to find the range that works for you.
Topamax is usually taken twice daily (Morning and Evening) and can be started at 50 mg daily (two 25 mg tablets). It can be increased gradually to a max of 400mg per day based on your tolerability and the presence of a significant weight loss effect.
Trokendi XR and Qudexy XR can be started at 50mg to 100mg once a day. Like Topamax, it can be gradually increased to a maximum dose of 400mg daily based on tolerability and desired weight loss effect.
Topiramate Contraindications and Warnings
Severe Allergic Reaction
You may experience a severe allergic reaction to Topiramate when first taking it. Signs of a severe allergic reaction include swelling of your face, lips, tongue, or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat. Let your provider know immediately if you have experienced this when taking Topiramate in the past.
Pregnancy
Topiramate can cause fetal harm and malformations if taken during pregnancy. If you are pregnant or planning on becoming pregnant, you should not take any topiramate products.
Topiramate Coverage and Cost
The price of topiramate varies depending on which of the brand names you are planning to buy.
Topamax is fairly inexpensive and can cost from $3-$20, depending on the pharmacy. There are also generic versions of Topamax that may be even cheaper.
Qudexy XR is more expensive than Topamax. The average cost of Qudexy is around $80-$120 for a month’s supply. Trokendi XR is the most expensive form of topiramate, costing around $950 for a month’s supply. Depending on your insurance, you may be eligible for the Trokendi Co-Pay Savings Program to get Trokendi for free. Most insurances cover Trokendi, but you should contact your provider to see what is covered.
Where Can I Get Topiramate?
If you want to learn more about Topiramate or see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Mochi Health is a virtual obesity medicine practice that connects you with medical providers, like licensed physicians and nurse practitioners, to help you optimize your weight loss journey. We provide monthly video chats with actual medical providers to provide guidance about weight management and to get you started on prescription weight loss medications to supplement your weight loss plan.
References
- Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL. Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials. Obes Rev. 2011 May;12(5):e338-47. doi: 10.1111/j.1467-789X.2010.00846.x. Epub 2011 Mar 28. PMID: 21438989.
- Apovian, C.M., Aronne, L., Rubino, D., Still, C., Wyatt, H., Burns, C., Kim, D., Dunayevich, E. and (2013), A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity, 21: 935-943. https://doi.org/10.1002/oby.20309
- Anderson, J.W., Greenway, F.L., Fujioka, K., Gadde, K.M., McKenney, J. and O'Neil, P.M. (2002), Bupropion SR Enhances Weight Loss: A 48-Week Double-Blind, Placebo-Controlled Trial. Obesity Research, 10: 633-641. https://doi.org/10.1038/oby.2002.86
- Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038. Epub 2022 Jun 4. PMID: 35658024
- Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, Day WW. 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 Apr 16;377(9774):1341-52. doi: 10.1016/S0140-6736(11)60205-5. Epub 2011 Apr 8. Erratum in: Lancet. 2011 Apr 30;377(9776):1494. PMID: 21481449.
- Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, Schwiers M, Day WW, Bowden CH. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012 Feb;95(2):297-308. doi: 10.3945/ajcn.111.024927. Epub 2011 Dec 7. PMID: 22158731; PMCID: PMC3260065.
