Is immediate-release topiramate an effective treatment for adult obesity?

Three other RCTs included in the meta-analysis specifically examined obese patients with type 2 diabetes, a population deemed more resistant to typical weight loss regimens, treated with immediate-release topiramate in dosages of 96 mg and 192 mg daily.^3-5 These patients also experienced greater weight loss than patients taking placebo, comparable to what was seen in the overall meta-analysis.

FDA approval and cost of therapy

Topiramate monotherapy isn’t approved by the US Food and Drug Administration (FDA) for obesity treatment. In 2012, the FDA approved phentermine/topiramate extended-release (Qsymia) for long-term treatment of obesity; the monthly cost for a maintenance dose of 7.5 mg/46 mg daily is approximately $185.⁶ Topiramate immediate-release tablets cost approximately $25 per month for twice daily doses of 50 to 100 mg.⁷

RECOMMENDATIONS

The US Preventive Services Task Force recommends screening all adults for obesity by measuring BMI and referring patients with a BMI ≥30 for high-intensity, comprehensive behavioral interventions. It makes no recommendation for pharmacologic management.⁸

The Institute for Clinical Systems Improvement concludes that pharmacotherapy should be used only as part of a comprehensive obesity treatment plan. Pharmacotherapy should be considered if obese patients are unable to lose 1 pound per week with diet, physical activity, and behavior modification.⁹