Topamax For Weight Loss? How and Why it May Work (+ What to use Instead)

Topamax For Weight Loss? How and Why it May Work (+ What to use Instead)

Will using Topamax finally help you shed those unwanted pounds?

Maybe, but before you use it there are some things you need to know. 

In this guide you will learn how Topamax works for weight loss, why it may be effective, the side effects it can cause, what dose you need for it to work and other weight loss medications to compare it to

Let's jump in: 

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What is Topamax (Topiramate)?

Obesity, it seems, is turning out to be a much more complex disease than was once thought. 

We tend to think of weight gain as a simple equation and one which can be solved by manipulating the number of calories that we consume and the amount that we burn. 

The problem with this strategy is that it has an abysmal success rate around 1%. 

So, with 99% of people failing to lose weight and keep it off, many people have started to look to their doctor or to prescription medication to help with weight loss

But do these prescription medications (from your Doctor) actually help with weight loss?

The answer is yes, but not always (and not always as much as you'd like them to). 

And that's where Topamax steps in, the topic for today's conversation.  

Topamax, otherwise known as Topiramate, is a prescription medication which was actually originally designed to treat the condition epilepsy. (1)

weight loss in patients taking topamax vs placebo

It was found, though, that people who took Topamax started to notice weight loss (2) in addition to reducing the number of seizures that they had. 

This has obviously sparked great interest among both patients and Doctors as a potential way to lose weight. 

Recently, Topamax has been added to the medication phentermine in a combination weight loss pill known as Qsymia

So, with these concepts in mind, let's talk about who should use Topamax, who should avoid it and how it actually works. 

How Topamax May Help with Weight Loss

Most prescription weight loss medications focus on 1 of 3 very important mechanisms to help with weight loss:

  • Regulation of appetite (3) - Some medications focus on reducing your appetite which causes you to eat less food. These medications do NOT work very well long-term and almost always result in weight gain after you stop taking them. 
  • Regulation of hormones (4) - Other medications focus on "balancing" fat storing hormones such as leptin, insulin or thyroid hormones. Medications that focus on hormone balance tend to work long-term because they are treating the "root" of the problem. 
  • Regulation of metabolism (5) - Lastly, some other prescription medications help your body by increasing the number of calories that you burn. Medications that focus on this aspect usually result in long-term weight loss as well. 

Each prescription medication works slightly different from other medications which are why some tend to work better than others. 

In general, the more areas that your weight loss medication "attacks" the better and long lasting your results will be. 

For this reason, you generally want to avoid medications which focus solely on appetite reduction as a means of weight loss. 

Why?

Because these medications almost always result in the weight being regained once your appetite returns to normal making them largely ineffective! 

So, how does Topamax work? 

#1. Increases Energy Expenditure (Metabolism) 

One of the main benefits to using Topamax is that it may help increase what is known as your resting energy expenditure. (6)

This refers to the number of calories that your body burns on a daily basis and is closely correlated with your metabolism. 

One of the biggest reasons that you may regain weight after a diet is due to a damaged metabolism. 

It is well known that reducing caloric intake results in a compensatory drop in your resting energy expenditure. 

Put in simple terms:

As you reduce your calories your metabolism will drop to match the amount that you consume. 

This drop doesn't rebound for YEARS which means that once you start eating a normal amount of food you will now be in a caloric surplus and start to regain weight

Topamax may help to keep the number of calories that you burn "steady" by boosting your metabolism. 

Medications which boost your metabolism are probably the "best" medications for weight loss because you don't necessarily need to alter the number of calories that you consume for weight loss. 

#2. Regulates Appetite

There is evidence to suggest that Topamax also helps by regulating your appetite. (7)

And I don't necessarily mean that it reduces your appetite, I mean that it "regulates" it. 

Regulating refers to matching your appetite to the number of calories that you consume. 

In some people, this value is mismatched resulting in the consumption of more calories than what your body actually needs. 

Remember:

Your metabolism can become damaged as a result of dieting and other factors. 

If your metabolism is set at 1,500 calories per day and you believe it's at 2,000 calories per day then you may have a mismatch between the amount that you think you need to consume and the amount that you are actually burning. 

thyroid metabolism reset poster for side bar

In some instances, your brain may also send signals to your body to consume more food even though you don't need it. 

These scenarios are becoming more and more common with conditions such as leptin resistance. 

Topamax may help with weight loss (8) by regulating the appetite center of your brain or your hypothalamus. 

#3. Enhances Thermogenesis

Topamax has also been shown to increase fat oxidation in both brown fat tissue as well as skeletal muscle. (9)

Brown fat helps to provide your body with heat and is a crucial part of metabolism maintenance. 

Burning more calories in your muscles (skeletal muscles) may also be a way to improve metabolism and caloric burn day in and day out. 

This mechanism is not well understood but it appears that, through these mechanisms, Topamax may help increase the amount of energy and heat that your body produces. 

Why am I not Losing Weight on Topamax?

Let's face it:

Not all weight loss therapies work for all people. 

Even if your brother or sister used Topamax for weight loss (and it worked) doesn't mean it will work for you. 

Each of us has a different genetic composition and a different reason for weight gain. 

You may have gained weight due to extreme stress, due to binging or overeating or simply due to hormone imbalances such as menopause. 

The treatment for each of these will be different and they can't all be solved by one medication. 

So one of the main reasons that Topamax may not be working for you is because you are targeting the wrong problem. 

Other factors include:

  • It's not targeted to your weight gain - See above. Other common causes of weight gain include: insulin resistance, leptin resistance, binge eating disorder, menopause, thyroid disease and so on. 
  • You are not using the right dose - This usually isn't a problem but it's worth considering. We will discuss dosing below. 
  • There are better medications available to you - Not everyone will do well on Topamax and that's ok. Listen to your body and don't take the medication just because you really want it to work. 
  • You aren't combining it with a healthy diet or with exercise - No matter which weight loss medication you use you should always combine it with a healthy diet and exercise. Using weight loss medications by themselves often does not work. 
  • You haven't been using it long enough (10) - Weight loss should NOT be extreme and occur over a period of a few weeks. Long lasting weight loss often takes months and months to achieve. Topamax may take 6-8 weeks to kick in then months after that for more weight loss. 
  • Side effects of the medication may be causing weight gain - Some weight loss medications can paradoxically cause weight gain instead of weight loss. Be sure that you are not GAINING weight while taking Topamax. 

Topamax Dosage

The goal with dosing is to achieve a balance between dose and results. 

With this in mind, you'll want to use the smallest dose possible that still results in weight loss. 

For most people, this will be somewhere between 50 to 200mg per day. (11)

Using this strategy will help reduce the negative side effects of this medication (listed below). 

You might find more success in combining Topamax with other weight loss therapies, supplements and diets as a means to help keep your dose low. 

Side Effects

While Topamax may be effective for weight loss it doesn't come without cost. 

Because this medication was originally designed to treat seizures (epilepsy) it works primarily by acting on the brain. 

It does this by "slowing down" the brain which may result in symptoms such as fatigue, brain fog, slow thinking and overall sluggishness. (12)

These symptoms may be tolerable for some people, but for others, such as those who need a sharp mind for work, it may not be acceptable. 

It's always important to weigh the potential benefits vs the risks of using any therapy, including weight loss medications. 

You can see a long list of potential side effects of Topamax below:

  • Fatigue
  • Drowsiness
  • Diarrhea
  • Nausea
  • Brain fog
  • Slow thinking or poor cognition
  • Memory problems
  • Dizziness
  • Flu-like symptoms

The good news is that many of these symptoms tend to be dose-related, meaning the higher your dose the more likely you are to experience them. 

If you begin to experience these symptoms you may find relief by reducing your dosage to compensate or by adding another weight loss medication to your regimen. 

This is not a complete list of side effects, so just realize you may experience some not on this list. 

If you experience anything which you feel is serious, while using Topamax, make sure you discuss those symptoms with your Doctor! 

Topamax + Wellbutrin (or Topamax + Phentermine)

If you've been on my blog before you know I've discussed how other medications, such as Wellbutrin, can help with weight loss. 

You might be thinking that it's a potentially good idea to combine these medications together to enhance your results. 

And you may be right in that logic. 

Qsymia is a medication which has already done just that. 

Qsymia is the combination of Phentermine and Topamax in one pill. (13)

Each pill contains around 3.75mg of Phentermine and about 23mg of extended release Topiramate

This dose can be increased up to 15mg of Phentermine and 92mg of Topiramate. 

topamax can be combined with other weight loss medications

You can get by with smaller doses of Topamax if you combine medications together, so instead of using Topamax by itself at 200mg per day you can use it in combination with phentermine and use only half the dose. 

The same may also be potentially true for combining Wellbutrin with Topamax. 

But because these medications can both interfere with neurotransmitters, using them together should be done very cautiously. 

I'm personally of the belief that, even though they may work, there are better options available for weight loss. 

The problem with some of these other medications is that they can be more difficult to get when compared to Topamax or Wellbutrin. 

Because of this, it's important for you to know all available options. 

Other Weight Loss Medications

It's important to realize that Topamax isn't the only game in town. 

There are actually many other potentially useful weight loss medications that you can draw from if necessary. 

If you've tried Topamax and it hasn't worked for you, or you experience significant negative symptoms, or you are afraid to try it, then you might find success with other medications. 

I've included a list of weight loss medications below that may also be useful:

  • Saxenda/Victoza - These medications primarily help by regulating leptin and insulin. 
  • Phentermine - This medication is an appetite suppressant and also may help boost metabolism. 
  • Wellbutrin - Wellbutrin works in a variety of ways and may help people with certain conditions. 
  • LDN (low dose naltrexone) - LDN can help reduce inflammation and help with weight loss, especially in those with autoimmune diseases. 
  • Qsymia - (Discussed in this article)
  • T3 thyroid hormone - T3 is the active thyroid hormone and can help boost metabolism in those with thyroid disease. 
  • hCG - This hormone can be used by itself to help regulate sex hormones such as estrogen, progesterone and testosterone. 
  • Testosterone - Testosterone can be used by itself to help increase muscle mass which may help improve metabolism. 
  • Metformin - Metformin helps regulate insulin resistance and can be combined with other medications for weight loss. 
  • Contrave - Contrave is another combination medication which includes LDN and Wellbutrin. 

Conclusion

Topamax is a medication which can potentially help with weight loss. 

It seems to work by regulating appetite, improving metabolism and helping your body burn more calories

That being said, it's not for everyone. 

This medication carries with it some serious side effects that should not be ignored. 

Don't worry though, because if it doesn't work for you there are still many other options available to you!

Now I want to hear from you:

Have you used Topamax for weight loss?

Did it work for you? Why or why not?

Did you experience any negative side effects? If so, what helped alleviate them?

Leave your comments and questions below! 

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

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