Weight Loss Pill

[bertine]

Qnexa, a weight loss drug, is in the approval phase of the FDA right now. This medication is a combination of two already used drugs, phentermine, an appetite suppressant, and topiramate, an anticonvulsant.

I don't know anything about phentermine. However, I do know a lot about topiramate (aka Topamax) because I had been on it for two years. Before I went on this medication I weighed ~185 pounds. After I got to the full dosage of this medication I was easily able to keep my weight at ~170 pounds. Once I stopped taking the medication I went right back up to 185 pounds. That is a weight loss of about 8%, pretty impressive when I didn't do anything other than take a pill every day.

Topiramate is a widely prescribed drug for both migraines and epilepsy. I think it is used for other conditions also but I don't know about those. It does has side effects but I didn't really get them. I was on a much higher dosage (300mg daily) than is in the top dosage of Qnexa (92mg daily) and I haven't heard of most of the annoying side effects happening at that low of a dosage.

Anyways, the worst side effect of topiramate is a high incident of birth effects (cleft lip and cleft palate). I was warned about them and I went off of it before I got my IUD out. However, the FDA is going one step further with Qnexa that seems like overkill to me since so many woman of childbearing age are already on topiramate:

"To prevent birth defects, patients who take the drug will have to undergo monthly pregnancy testing and healthcare providers will get special training on the medication's risks and benefits."

I never had a pregnancy test the entire time I was on this medication. It wasn't even brought up. I was already on this medication when I got my IUD so it wasn't just having that as a birth control medication.

I don't know what the point of writing this is other than I find it strange that they are treating this drug so differently when it is used for one condition than when it is used for another. Who knows, maybe they will start requiring monthly pregnancy tests for people who are using it for migraines and epilepsy. I would find this annoying.

*In the migraine world Topamax is called Dopamax because it makes people feel like their brain is moving slower. I never noticed this and since migraines make you not able to think anyways it might be worth it for some.

**I am no longer on this medication because I am trying to have a baby. I miss it. I have so many more migraines now.

Comments

[avecvu.livejournal.com]

Topamax fucked my brain way the hell up. Dopamax/Stupamax does not even BEGIN to cover it. Obviously taking a pill is going to rate higher than diet/exercise, but why the FDA would ever approve Topamax for people without neurological problems is just way beyond me.

They make women take monthly pregnancy tests for Accutane too. I'm sure other things. This isn't without precedent.

[avecvu.livejournal.com]

Also, I had most of the worst side-effects before I got to the optimal dosage for me (I think 200mg, it's been a while).

[bertine.livejournal.com]

My impression from the Migrane community is that most people don't have many side effects until 100mg. That might be why they are keeping the amount in Qnexa so low.

[avecvu.livejournal.com]

Actually, I think 100mg was my sweet spot. I felt like I got hit by a truck every time I upped my dosage: the first time I started at 25mg, then 50mg, then 75mg, then I was completely dreading taking 100mg but that seemed to be the best dose for me.

[bertine.livejournal.com]

I was really tired for a couple weeks whenever I upped my dosage but it went away. I wasn't ever spacy.

[avecvu.livejournal.com]

The day after I would up my dosage I would feel horribly run-down and miserable and it would gradually abate. When I got to 100mg I felt completely fine, although the mild-ish aphasia never went away.

[bertine.livejournal.com]

I didn't have any major issues with it. However, it is funny that they don't talk about the Dopamax side effects at all in these articles about it.

I didn't know you had to take a monthly pregnancy tests for Accutane. Do you do that at home or do you have to go into the doctor's office? Is that covered by insurance?


I sort of agree that it is silly that they would give topamax to people without neurological problems. I have read so many things about problems people have had with it. I know I was tested every six months to see if I had metabolic acidosis. It worked for weight loss but it seems like a pretty dangerous solution for weight loss. However, I have heard that some doctor's are already using it off-label for weight loss so they might as well put a system in place for this.

[lonely-doll.livejournal.com]

I did a round of Accutane when I was around nineteen or twenty, and I had to get a pregnancy test, as well as cholesterol and - oh I can't remember now, but there were a couple of blood tests they did. It's a miracle drug - nothing else I'd tried up to that point got rid of my acne, and Accutane got rid of it and it's never come back. But it can really fuck you up.

[bertine.livejournal.com]

So Accutane isn't something you have to be on for a long time? I guess the weird part for me with these pregnancy tests is that it seems like you have to have a monthly pregnancy test the entire time you are on it. So, if they did the same requirements for any topamax user I would have to have a monthly pregnany test until menopause. It just seems like a lot.

[lonely-doll.livejournal.com]

No, most people take it for four months. Sometimes, in cases of really severe acne, people are prescribed two rounds, but that's pretty unusual, from what I understand.

[avecvu.livejournal.com]

I don't take Accutane, but I'm fairly certain that you have to go into the office.

Topamax is scary and dangerous and I hope I never have to be back on it. It seriously messed my brain up and I never felt like I got over it, even though my psychiatrist told me that my post-Topamax neurological issues were probably more mental than physical. My memory has never been the same, my word-finding abilities have never been the same, and I just feel in general like my IQ dropped 20 points forever after I took it.

I also didn't experience any weight loss on Topamax. It's a common side-effect but I guess being an exception to that particular one just makes it more frustrating for me to see a drug that I feel messed me up irreversibly to be used as a replacement for healthy living.

[bertine.livejournal.com]

Really? Other people on the migraine community here on LJ say the same thing but I always figured it was more mental than anything. One of the signs of my migraines is problems finding words so I actually got better with that on topamax. Plus, since I am a programmer, I would have noticed an issue with my memory pretty quickly.

I had weight loss but I didn't care about it. I am fine with my weight (except some of my pants are too small, which annoys me because they were expensive).

[avecvu.livejournal.com]

OH and the pregnancy tests probably are because Topamax can render hormonal birth control ineffective as well as cause birth defects. I forgot that part until right now.

[bertine.livejournal.com]

It is funny, I don't think I was ever told that. However, I went on an IUD pretty quick.

[eyelid.livejournal.com]

The precedents are fucked up too, then.

[i12bmore.livejournal.com]

I was given Topamax for depression. Everyone has different reactions to medicine, I understand, but I had horrible reactions: joint pain, insomnia, night terrors, the driest mouth I can imagine. I felt like I was turning into a 90yo man, and I was taken off it after just a week.

[beg-jon13.livejournal.com]

I have nothing at all to contribute in terms of input on these medications. I do find myself wondering if there is any fertility promoting yoga that you could begin (or already are) doing? This may sound like horse $@#% but hear me out here: so I started getting migraines pretty chronically for a while during my period of near LJ silence and I started trying a lot of things to make it better. The only thing that actually seems to work at all was when I started doing some light yoga semi-regularly. (Relevant side note: The chiropractic probably helped me get to where I could do the yoga effectively but it was the yoga that kept me good.) Now admittedly I was never put on long term medication for the problem, so I don't know if that would have worked as well, or better, or even been necessary in my situation. Your migraines could be a hell of a lot worse than mine were. Anyway, the point I'm trying to make is that doing what I did set some nasty stuff going on in my body right and after I had gotten in the habit of doing this I realized that I wasn't getting migraines hardly at all anymore and when they do set in I can usually knock them out relatively quickly with this. So, y'know, maybe this is helpful to you or maybe it's bull and doesn't appeal to you or apply to your situation but I figure I ought to at least put it out there just in case. Always wishing you health and wellness.

[bertine.livejournal.com]

I am not really worried about fertility. At least not yet. We haven't been trying for that long.

My main trigger for migraines is hormonal. So I think I am pretty stuck with them until I hit menopause.

[beg-jon13.livejournal.com]

That sucks all kinds of crazy :( For me the migraines were mostly in response to spinal misalignment (I think) so that's probably why this worked.

[sterlingphoenix.livejournal.com]

I'm pretty sure the only "fertility promotion" yoga can do is how hot you look in yoga pants.

[beg-jon13.livejournal.com]

I admittedly know jack about yoga beyond how it applies directly to me.

[eyelid.livejournal.com]

word

[eyelid.livejournal.com]

that is... seriously disturbing.

[bertine.livejournal.com]

I know they are trying to get this on the market and to do so they have to appease people that this won't cause more birth defects. Also using topamax this way is different than using it for neurological conditions, which I am not sure how I feel about.

However:

1) This is already on the market and child-bearing age woman are already taking it. At what point do they add these requirements to those woman?

2) Anything that cause woman to be treated differently than everyone else seems wrong to me becuase of the added cost and inconvience. Who is going to pay for all these pregnancy tests? Does the woman have to go to the doctor's office every month to have it or can she take it at home?

3) This isn't a short term course of drugs like Accutane where you can get a pregnancy test at the begginning and you are good. You have to be on this medication for a long time to get the benefits of the weight loss.


This rankles me just like all that stuff that went around 5 years ago about how women should act like they are possibly pregnant all the time. If I had time I would look that up (and then be even more annoyed).

[eyelid.livejournal.com]

2) Anything that cause woman to be treated differently than everyone else seems wrong to me becuase of the added cost and inconvience. Who is going to pay for all these pregnancy tests? Does the woman have to go to the doctor's office every month to have it or can she take it at home?


this. Also, it strikes me as incredibly invasive and paternalistic - towards women, and women only.

[bertine.livejournal.com]

EXACTLY!

[sharya.livejournal.com]

I think think the difference in treatment in indications is the population for whom it will likely be prescribed.

Just a guess there.

On one hand, it frustrates me that there are drugs they make you jump so many hoops to get, when I feel like I'm a highly responsible adult. On the other hand, it would be devastating to me if, for whatever reason, I managed to accidentally get pregnant, and then not notice (because I wasn't trying), and completely ruined the life of my child with a debilitating birth defect. If that were a possibility, I would prefer to be forced to get monthly pregnancy tests - less of an inconvenience and less emotionally scarring (for parent and child) than having a deformed baby, especially when it was preventable.