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Combination phentermine and topiramate for weight maintenance: the first Australian experience

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The global obesity epidemic has not spared Australia; 62.8% of adults were classified as obese or overweight in the 2011–12 financial year.1 While bariatric surgery is effective, access is poor for those most in need.2 Calorie restriction diets are successful in inducing weight loss, but weight is usually regained with time owing to hormonal adaptations that increase hunger, which occur in response to weight loss.3 There is a clear role for pharmacotherapy in appetite suppression for maintenance of weight loss.

The US Food and Drug Administration recently approved combination phentermine and controlled-release topiramate (in doses ranging from 3.75 mg phentermine plus 23 mg topiramate to 15 mg phentermine plus 92 mg topiramate) for use in adults with a body mass index (BMI) > 30 kg/m2, or > 27 kg/m2 with at least one weight-related comorbidity. Phentermine is a sympathomimetic agent that induces serotonin, noradrenaline and dopamine reuptake inhibition, suppressing appetite. Topiramate causes weight loss;4 its postulated effects include increasing energy expenditure, decreasing energy efficiency and decreasing caloric intake. In Australia, phentermine is available for use as short-term monotherapy for obesity and topiramate…