Phentermine + Topiramate Weight Loss
Combination therapy — known by the brand name Qsymia — prescribed and monitored by our physicians, using brand-name or compounded alternatives as clinically appropriate.
How This Combination Works
Appetite Suppression
The phentermine component reduces hunger signals so you eat less without the constant fight against cravings.
Greater Satiety & Fewer Cravings
Low-dose topiramate promotes early fullness and blunts food cravings, which is why the combination outperforms phentermine alone.
Physician-Prescribed & Monitored
We prescribe phentermine/topiramate — brand-name or a compounded alternative when appropriate — with ongoing clinical monitoring.
What to Expect
Medical Evaluation
We review BMI, blood pressure, heart rate, medication list, pregnancy status, and history of glaucoma, kidney stones, or thyroid disease.
Low-Dose Start & Titration
Treatment begins at the lowest strength and is stepped up gradually over several weeks to limit side effects and find your effective dose.
Monthly Follow-Up
We track weight, vitals, side effects, and labs, adjust dosing, and pair the medication with nutrition and activity coaching.
Candidacy & Safety
You May Be a Good Candidate If
BMI of 30 or higher, or 27 or higher with a weight-related condition such as type 2 diabetes, hypertension, or sleep apnea
Appetite and portion control are the main barriers to progress
Willing to attend regular follow-up visits and monitoring
Willing to pair medication with nutrition and activity changes
Safety & Monitoring
Not for use in pregnancy — pregnancy testing and reliable contraception are required for patients who can become pregnant
Blood pressure and heart rate are checked at every visit
Report mood changes, vision changes or eye pain, or persistent tingling promptly
Stay well hydrated to reduce the risk of kidney stones
Higher doses are tapered, never stopped abruptly
Denton Family Practice Clinic does not sell brand-name medication. Our providers evaluate, prescribe, and monitor phentermine/topiramate therapy or an appropriate compounded alternative dispensed by a licensed pharmacy. Brand names are referenced for identification only.
Frequently Asked Questions
What is phentermine/topiramate (Qsymia)?
It is a once-daily oral combination of phentermine, an appetite suppressant, and extended-release topiramate, which increases fullness and reduces cravings. It is FDA-approved for chronic weight management. We prescribe and monitor this therapy — brand-name or a compounded alternative — we do not sell medication.
How much weight do people lose on it?
In clinical trials, patients on the higher doses lost roughly 8–10% of body weight at one year, with some losing more. Results depend on dose, adherence, and diet and activity changes.
How fast does it start working?
Appetite changes are often noticed within the first one to two weeks. Providers typically reassess at about 12 weeks; if you have not lost at least 3–5% of body weight, the dose is increased or the plan is changed.
What are the common side effects?
Tingling in the hands and feet, dry mouth, constipation, altered taste (especially of carbonated drinks), insomnia, dizziness, and increased heart rate. Most are dose-related and improve with slower titration.
Who should not take it?
It should be avoided in pregnancy or when planning pregnancy, and in people with glaucoma, hyperthyroidism, recent or unstable heart disease, uncontrolled hypertension, or MAO inhibitor use. Topiramate carries a risk of birth defects, so contraception and pregnancy testing are required for those who can become pregnant.
Is it better than phentermine alone?
For most patients, yes. Adding low-dose topiramate typically produces about twice the weight loss of phentermine alone, and it can be used long term, whereas phentermine alone is generally a short-term option.
How long can I stay on it?
It is approved for chronic, long-term use as long as it is working and well tolerated. If it is stopped, the higher doses should be tapered rather than stopped abruptly.
What is a compounded alternative?
When brand-name therapy is unavailable or cost-prohibitive, your provider may prescribe the individual generic components or an appropriate compounded formulation from a licensed pharmacy. Your provider will explain the differences and pick what fits your case.
Will insurance cover it?
Coverage for weight-management medication varies widely by plan and often requires prior authorization. We help check benefits and can discuss affordable cash-pay prescribing options.
Can it be combined with a GLP-1 like semaglutide?
Sometimes. Combining weight-management medications is done selectively and only under close physician supervision. Your provider will decide whether combination therapy is appropriate for you.
What happens if I stop taking it?
Appetite usually returns and some weight regain is common without a maintenance plan. We build a nutrition, activity, and follow-up strategy before any planned taper.
You May Also Be Interested In
Phentermine
FDA-approved appetite suppressant for physician-supervised short-term weight loss.
Learn More 
Semaglutide (GLP-1)
Breakthrough weekly injection delivering 15–20% body weight loss with metabolic benefits.
Learn More
Naltrexone + Bupropion
Oral combination therapy targeting cravings and emotional eating, prescribed and monitored by our physicians.
Learn More
Ready for a Primary Care Partner?
Book an appointment today and get comprehensive care close to home.
Serving Denton and surrounding areas.