Qsymia (phentermine/topiramate)

What this page used to say

• 2026-09-13 — When kidney or liver impairment limits the Qsymia dose. Was: Kidney or liver impairment of any degree caps the dose at 7.5 mg/46 mg. Now: Moderate or severe kidney impairment, or moderate liver impairment, caps the dose at 7.5 mg/46 mg; mild impairment changes nothing; on dialysis or with severe liver impairment, Qsymia is not to be used.
• 2026-09-11 — A drawback that no longer stood. Was: Topiramate raises the risk of oral clefts when taken in the first trimester. Qsymia is restricted under an FDA REMS requiring a negative pregnancy test before starting and monthly thereafter, plus effective contraception. Now: Topiramate raises the risk of oral clefts when taken in the first trimester. The label recommends a negative pregnancy test before starting and every month during treatment, with effective contraception, and Qsymia is dispensed only through pharmacies certified under an FDA REMS.
• 2026-09-11 — A point in its favor that no longer stood. Was: Approved down to age 12, where the newer agents have narrower labels. Now: Approved down to age 12, as Wegovy and Saxenda are; Zepbound is for adults only.
• 2026-09-11 — Pointed a footnote at the source it rests on. Was: Cited: CONQUER: phentermine plus topiramate, phase 3 (The Lancet). Now: Cited: Qsymia Engage home delivery pricing, qsymia.com.
• 2026-09-11 — What the label says about pregnancy testing. Was: A negative pregnancy test is required before starting and every month afterwards, under an FDA REMS. Now: The label recommends a negative pregnancy test before starting and every month during treatment; the REMS restricts which pharmacies dispense it.
• 2026-09-11 — What the dosage page said the steps cost. Was: $70 a month on a 90-day prescription, $98 for a 30-day fill through Costco — the cheapest branded route on this site, and the one with a pregnancy test every month attached. Now: $74.99 a month through Qsymia Engage home delivery at every dose, or $210 for 90 days — $70 a month; Costco members pay $65.99 for a 30-day fill. The cheapest branded route on this site, with a monthly pregnancy test recommended alongside it.
• 2026-09-05 — The monthly price, and the page it is read from. Was: $98 a month, sourced from qsymia.com/pricing. Now: $74.99 for a 30-day supply, or $210 for 90 days — $70 a month, sourced from qsymia.com/patient/multiple-ways-to-save.
• 2026-09-05 — Replaced the missed-dose answer with the label's rule and corrected the week-12 note on the dosage page. Was: Missed dose: 'Take it in the morning; an evening dose causes insomnia. The 15/92 dose must be tapered rather than stopped, to avoid a seizure.' Step note: 'Escalation beyond it depends on weight lost by week 12.' Now: Missed dose: wait until the next morning and take the usual dose, do not double up; the label says to avoid evening dosing because of the possibility of insomnia; the 15 mg/92 mg dose is tapered one capsule every other day for at least a week. Step note: after 12 weeks at 7.5/46 (about week 14 of treatment), an adult who has not lost at least 3% of body weight moves to 11.25/69 for 14 days, then 15/92.
• 2026-09-05 — Changed the trial figure to the intention-to-treat result on the FDA label. Was: CONQUER and SEQUEL, phase 3: 6.6% to 8.6% mean weight loss at 56 weeks by dose. Now: 9.8% — CONQUER, Study 2 on the label, 56 weeks: 9.8% mean weight loss at the 15 mg/92 mg dose against 1.2% on placebo, intention-to-treat.
• 2026-09-05 — Replaced the serious reactions on the side-effects page with the label's section 5, in the label's order. Was: Seven items: fetal harm, suicidal behavior and ideation, eye effects, mood and sleep disorders, cognitive effects, metabolic acidosis, and 'Raised heart rate'. Now: The label's sixteen section-5 headings, each with the label's key fact: fetal harm with the monthly pregnancy test and the REMS; suicidal behavior and ideation; eye reactions; mood and sleep disorders; cognitive impairment; slowing of growth in 12- to 17-year-olds; metabolic acidosis; decrease in renal function; seizures on abrupt withdrawal; kidney stones; oligohidrosis and hyperthermia; hypokalemia; DRESS; serious skin reactions; anaphylaxis and angioedema; allergic reactions to FD&C Yellow No. 5. 'Raised heart rate' is gone.
• 2026-09-05 — Added the maker's own pricing page to the sources behind the price. Was: Qsymia REMS: pregnancy testing and contraception requirements (FDA); CONQUER: phentermine plus topiramate, phase 3 (The Lancet); Qsymia CONQUER trial results (manufacturer HCP site); Assessment of the REMS for phentermine–topiramate (Annals of Internal Medicine); FDA prescribing information for QSYMIA. Now: Qsymia Engage home delivery pricing, qsymia.com; Qsymia REMS: pregnancy testing and contraception requirements (FDA); CONQUER: phentermine plus topiramate, phase 3 (The Lancet); Qsymia CONQUER trial results (manufacturer HCP site); Assessment of the REMS for phentermine–topiramate (Annals of Internal Medicine); FDA prescribing information for QSYMIA.
• 2026-09-05 — The 30-day price, and who can get it. Was: $70 a month only on a 90-day prescription; a 30-day fill is $98 and only for Costco members. Now: $74.99 a month home delivery for anyone, $75 retail with the manufacturer discount, $65.99 for Costco members, $70 a month on a 90-day prescription.
• 2026-09-05 — Checked the contraindications against section 4 and corrected the fifth. Was: Known hypersensitivity to phentermine, topiramate or the sympathomimetic amines. Now: Known hypersensitivity to phentermine, topiramate or any other ingredient of Qsymia, or idiosyncrasy to the sympathomimetic amines. The label notes that anaphylaxis and angioedema have occurred with topiramate.
• 2026-08-18 — Average weight loss in the pivotal trial. Was: 10% mean weight loss. Now: 6.6–8.6% by dose over 56 weeks (CONQUER and SEQUEL).

Every correction on this site, dated →