Comprehensive medication guide to Qsymia including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$20–$60 copay for commercially insured patients with coverage; prior authorization required by nearly all plans. Medicare Part D typically does not cover Qsymia. Approximately one-third of ACA marketplace and Medicaid plans provide coverage.
Estimated Cash Pricing
$200–$282 retail for brand-name Qsymia without discounts; as low as $63–$98/month with SingleCare, GoodRx, or the Qsymia Engage home delivery program for a 30-day supply. Generic phentermine/topiramate ER (available since May 2025) may be available at lower cost.
Medfinder Findability Score
45/100
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Qsymia (phentermine and topiramate extended-release) is an FDA-approved prescription medication for chronic weight management. It is manufactured by VIVUS LLC and combines two active ingredients—phentermine, a Schedule IV controlled substance and sympathomimetic amine, and topiramate, an anticonvulsant medication—into a once-daily extended-release capsule taken in the morning.
First approved by the FDA in July 2012, Qsymia is indicated for adults with obesity (BMI ≥30 kg/m²) or overweight adults (BMI ≥27 kg/m²) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia. It received expanded approval for pediatric patients aged 12 and older with obesity in 2022.
Qsymia comes in four dose strengths: 3.75/23 mg (starter), 7.5/46 mg (recommended), 11.25/69 mg (intermediate escalation), and 15/92 mg (maximum). It must be taken in the morning due to phentermine's stimulant properties. Because of fetal harm risk from topiramate, Qsymia is only dispensed through pharmacies certified under the FDA-mandated Qsymia REMS program.
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Qsymia works through two distinct and complementary mechanisms. Phentermine is a sympathomimetic amine that stimulates the central nervous system to release norepinephrine in the hypothalamus, the brain's appetite control center. This creates a "fight-or-flight" response that suppresses hunger signals. Phentermine reaches peak concentration in approximately 6 hours and has a half-life of 20 hours.
Topiramate is an anticonvulsant whose exact weight-loss mechanism is not fully characterized, but is believed to involve: augmenting GABA (the brain's inhibitory neurotransmitter) to reduce appetite; inhibiting AMPA/kainate glutamate receptors to reduce food-seeking reward signals; modulating voltage-gated ion channels; and inhibiting carbonic anhydrase. Topiramate reaches peak concentration in approximately 10 hours and has a half-life of 65 hours, providing sustained satiety enhancement.
The combination is synergistic—producing greater weight loss than either drug alone at doses lower than those used in standalone therapy. Clinical data show that 1 in 5 adults and 1 in 4 adolescents taking the maximum dose (15/92 mg) lose at least 20% of their body weight.
3.75 mg/23 mg — extended-release capsule
Starting titration dose; take once daily in morning for 14 days
7.5 mg/46 mg — extended-release capsule
Recommended maintenance dose; taken once daily in morning
11.25 mg/69 mg — extended-release capsule
Intermediate escalation dose; taken once daily in morning for 14 days before advancing to maximum
15 mg/92 mg — extended-release capsule
Maximum recommended dose; taken once daily in morning. Taper before discontinuing.
Qsymia is not on the FDA's official drug shortage list as of 2026—the product is manufactured and available. However, it is significantly harder to find than most medications because it can only be dispensed by pharmacies certified under the Qsymia REMS program. Most retail pharmacies, including many chain locations, are not enrolled in this program and cannot legally fill Qsymia prescriptions.
Patients frequently report being turned away at pharmacies, facing insurance denials requiring prior authorization, or encountering sticker shock at the retail cash price ($200–$282/month without discounts). The Qsymia Engage home delivery program ($89/month), the GoodRx exclusive price ($149/month at 70,000+ retail pharmacies), and SingleCare discounts (as low as ~$63/month) provide significant cost relief.
If you're struggling to find Qsymia at a certified pharmacy near you, medfinder calls pharmacies on your behalf to locate which REMS-certified locations have your specific dose in stock, and texts you the results.
Qsymia is a Schedule IV controlled substance, so it can be prescribed by any licensed provider with a DEA registration for Schedule IV medications. No mandatory prescriber certification is required under the Qsymia REMS program, though voluntary prescriber training is encouraged. The prescribing provider is responsible for ensuring REMS compliance including pregnancy counseling and monthly pregnancy testing requirements.
Primary Care Physicians (PCPs) — Internal medicine, family medicine, and general practice physicians
Obesity Medicine Specialists — ABOM board-certified physicians, bariatricians
Endocrinologists — particularly for patients with metabolic conditions
Pediatricians and Adolescent Medicine Specialists — for patients aged 12 and older
Nurse Practitioners (NPs) and Physician Assistants (PAs) — in states where Schedule IV prescribing is within their scope of practice
Qsymia is available via telehealth prescription in most states where telemedicine prescribing of Schedule IV controlled substances is permitted. All REMS requirements apply regardless of how the prescription is written. Providers and patients can access the Qsymia Engage home delivery program for convenient, certified mail-order dispensing.
Yes. Qsymia is classified as a Schedule IV controlled substance under the federal Controlled Substances Act (DEA Schedule C-IV). This classification is due to the phentermine component, which is chemically and pharmacologically related to amphetamines and carries potential for misuse and physical dependence. Topiramate itself is not a controlled substance.
As a Schedule IV drug, Qsymia has specific prescribing and dispensing restrictions. In some states, prescriptions cannot be transmitted electronically or by phone, requiring a written or faxed prescription. Some states also restrict the use of third-party discount coupons (such as GoodRx or manufacturer savings cards) on Schedule IV controlled substances. Refills are permitted—typically up to 5 refills within 6 months before a new prescription is required, though rules vary by state.
In addition to the Schedule IV classification, Qsymia also requires dispensing through the FDA-mandated Qsymia REMS program due to fetal harm risk from topiramate. This means that even with a valid prescription, Qsymia can only be filled at pharmacies specifically certified under the REMS program.
In adult clinical trials, the following side effects occurred in at least 5% of Qsymia patients at at least 1.5 times the rate seen with placebo:
Paresthesia — tingling or "pins and needles" in hands, feet, or face (most common)
Dizziness
Dysgeusia — altered or impaired sense of taste
Insomnia — take in the morning to minimize
Constipation
Dry mouth
Fetal harm — Risk of cleft lip/palate; REMS required; contraindicated in pregnancy
Suicidal thoughts or behavior — monitor for mood changes; call 988 if in crisis
Acute angle-closure glaucoma — stop immediately if eye pain or vision changes occur
Metabolic acidosis — monitor serum bicarbonate
Increased heart rate — monitor in patients with cardiac conditions
Kidney stones — drink plenty of water; avoid ketogenic diet and carbonic anhydrase inhibitors
Oligohidrosis — decreased sweating; risk of overheating during exercise
Growth slowing in adolescents — monitor height velocity in patients aged 12–17
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Contrave (naltrexone/bupropion ER)
FDA-approved oral weight-loss medication; not a controlled substance; no REMS required; ~$50–$150/month generic; 5–6% average weight loss
Wegovy (semaglutide)
Weekly GLP-1 receptor agonist injection; 15–17% average weight loss; no REMS; higher cost
Zepbound (tirzepatide)
Weekly dual GLP-1/GIP receptor agonist injection; 20–22% average weight loss; highly effective but expensive
Orlistat (Xenical/Alli)
Blocks dietary fat absorption; OTC available (Alli); no REMS; $40–$60/month; 3–5% average weight loss
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MAO Inhibitors (phenelzine, tranylcypromine)
majorAbsolutely contraindicated. Risk of hypertensive crisis and severe sympathomimetic reaction. Do not use within 14 days of an MAOI.
Valproic Acid (Depakote)
majorCombination with topiramate can cause hyperammonemia with encephalopathy. Monitor ammonia levels.
Carbonic Anhydrase Inhibitors (zonisamide, acetazolamide)
majorAvoid combination. Greatly increases risk of kidney stones and metabolic acidosis.
Oral Contraceptives
moderateTopiramate reduces efficacy of hormonal contraceptives. Use additional/alternative contraception required by REMS.
Antidiabetic Medications (insulin, sulfonylureas)
moderateWeight loss and phentermine may increase hypoglycemia risk. Monitor blood glucose closely; dose adjustments may be needed.
CNS Depressants (alcohol, benzodiazepines, opioids)
moderateAdditive sedation, cognitive impairment, and psychomotor slowing. Avoid alcohol. Use caution with sedatives.
Amitriptyline (tricyclic antidepressants)
moderateTopiramate significantly increases amitriptyline blood levels. Dose reduction of amitriptyline may be required.
Ketogenic diet
moderateGreatly increases kidney stone formation risk when combined with topiramate's carbonic anhydrase inhibition.
Qsymia is one of the most effective oral weight-loss medications available, with clinical data showing up to 20% body weight reduction in some patients at the highest dose. Its combination of phentermine and topiramate targets appetite through two distinct brain pathways, making it more powerful than either ingredient alone and often more accessible than GLP-1 injectable medications for patients who prefer oral therapy.
The primary challenges are its REMS distribution restrictions (limiting it to certified pharmacies), cost without discount programs ($200–$282 retail), and its pregnancy contraindication requiring strict safety protocols. However, with the launch of a generic in May 2025, the GoodRx exclusive pricing at $149/month, and home delivery options at $89/month, access and affordability have improved significantly in 2026.
If you're struggling to find Qsymia at a pharmacy near you, medfinder can help you locate a REMS-certified pharmacy that carries your specific dose—saving you time and frustration.
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