Before taking phentermine and topiramate,
tell your doctor and pharmacist if you are allergic to phentermine (Adipex-P, Suprenza); topiramate (Topamax); sympathomimetic amine medications such as midodrine (Orvaten, ProAmatine) or phenylephrine (in cough and cold medications); any other medications, or any of the ingredients in phentermine and topiramate capsules. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
tell your doctor if you are taking a monoamine oxidase inhibitor (MAOI) including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken one of these medications during the past two weeks. Your doctor will probably tell you not to take phentermine and topiramate if you are taking one or more of these medications or have taken one of these medications during the past 2 weeks.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention other prescription or nonprescription medications or herbal products for weight loss and any of the following: amitriptyline (Elavil); carbonic anhydrase inhibitors such as acetazolamide (Diamox), methazolamide, or zonisamide (Zonegran); diuretics ('water pills') including furosemide (Lasix) or hydrochlorothiazide (HCTZ); insulin or other medications for diabetes; ipratropium (Atrovent); lithium (Lithobid); medications for anxiety, high blood pressure, irritable bowel disease, mental illness, motion sickness, Parkinson's disease, ulcers, or urinary problems; medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin), or valproic acid (Stavzor, Depakene); pioglitazone (Actos, in Actoplus, in Duetact); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you have glaucoma (condition in which increased pressure in the eye can cause vision loss) or an overactive thyroid gland. Your doctor will probably tell you not to take phentermine and topiramate.
tell your doctor if you have had a heart attack or a stroke in the past 6 months, if you have ever thought about killing yourself or tried to do so, and if you are following a ketogenic diet (high fat, low carbohydrate diet used to control seizures). Also tell your doctor if you have or have ever had depression; an irregular heartbeat; heart failure; seizures; metabolic acidosis (too much acid in the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are brittle or weak and may break easily); ongoing diarrhea; any condition that affects your breathing; diabetes; kidney stones; or kidney or liver disease.
tell your doctor if you are pregnant or plan to become pregnant. If you take phentermine and topiramate during pregnancy, your baby may develop a birth defect called cleft lip or cleft palate. Your baby may develop this birth defect very early in the pregnancy, before you know that you are pregnant. You must use birth control to prevent pregnancy during your treatment. You must take a pregnancy test before you begin your treatment and once every month during your treatment. If you become pregnant while taking phentermine and topiramate, stop taking the medication and call your doctor immediately.
you can use oral contraceptives (birth control pills) to prevent pregnancy during your treatment with phentermine and topiramate. You may experience unusual spotting (unexpected vaginal bleeding) if you use this type of birth control. You will still be protected from pregnancy if you are spotting, but you can talk to your doctor about other forms of birth control if the spotting is bothersome.
tell your doctor if you are breast-feeding.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking phentermine and topiramate.
you should know that phentermine and topiramate may slow your thinking and movements and affect your vision. Do not drive a car or operate machinery until you know how this medication affects you.
do not drink alcoholic beverages while you are taking phentermine and topiramate. Alcohol can make the side effects of phentermine and topiramate worse.
you should know that phentermine and topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual.
you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking phentermine and topiramate. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took antiepileptics such as topiramate to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as 1 week after they started taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.