MEDICATION GUIDEQSYMIA® (Kyoo sim ee’ uh)(phentermine and topiramate extended-release capsules)
for oral use, CIV
Read this Medication Guide before you start taking QSYMIA and each time you get a refill. There may be
new information. This information does not take the place of talking to your healthcare provider about
your medical condition or treatment. If you have any questions about QSYMIA, talk to your healthcare
provider or pharmacist.
What is the most important information I should know about QSYMIA?
QSYMIA can cause serious side effects, including:• Major birth defects. If you take QSYMIA during pregnancy, your baby has a higher risk for birthdefects including cleft lip and cleft palate. Your baby may also be smaller than expected at birth. The
long-term effects of this are unknown. These defects can begin early in pregnancy, even before you
know you are pregnant.
Patients who are pregnant must not take QSYMIA.
Patients who can become pregnant should:
1. Have a pregnancy test before taking QSYMIA and every month while taking QSYMIA.
2. Use effective birth control (contraception) consistently while taking QSYMIA. Talk to yourhealthcare provider about how to prevent pregnancy.
If you become pregnant while taking QSYMIA, stop taking QSYMIA immediately and tell yourhealthcare provider right away. Healthcare providers and patients who become pregnant shouldreport all cases of pregnancy to: FDA MedWatch at 1-800-FDA-1088
Because of the risk for birth defects (cleft lip and cleft palate), QSYMIA is available through arestricted program called the QSYMIA Risk Evaluation and Mitigation Strategy (REMS).
QSYMIA is only available through certified pharmacies that participate in the QSYMIA REMS
program. Your healthcare provider can give you information about how to find a certified pharmacy.
For more information, go to www.QSYMIAREMS.com or call 1-888-998-4887.
•Increases in heart rate. QSYMIA can increase your heart rate at rest. Your healthcare provider
should check your heart rate while you take QSYMIA. Tell your healthcare provider if you experience,
while at rest, a racing or pounding feeling in your chest lasting several minutes when taking QSYMIA.

•Suicidal thoughts or actions. Topiramate, an ingredient in QSYMIA, may cause you to havesuicidal thoughts or actions.
Call your healthcare provider right away if you have any of these symptoms, especially if they
are new, worse, or worry you:o thoughts about suicide or dyingo attempts to commit suicide
o new or worse depressiono new or worse anxiety
o feeling agitated or restlesso panic attacks
o trouble sleeping (insomnia)
o new or worse irritability
o acting aggressive, being angry, or violent
o acting on dangerous impulses
o an extreme increase in activity and talking (mania)o other unusual changes in behavior or mood
Do not stop QSYMIA without first talking to a healthcare provider.
• Stopping QSYMIA suddenly can cause serious problems.
• Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal
thoughts or actions, your healthcare provider may check for other causes.
How can I watch for early symptoms of suicidal thoughts and actions?
• Pay attention to any changes, especially sudden changes in mood, behaviors, thoughts, orfeelings.
• Keep all follow-up visits with your healthcare provider as scheduled.

••Call your healthcare provider between visits as needed, especially if you are worried aboutsymptoms.

Serious eye problems which include:o any sudden decrease in vision, with or without eye pain and redness,o a blockage of fluid in the eye causing increased pressure in the eye (secondary angle
closure glaucoma).
These problems can lead to permanent vision loss if not treated. Tell your healthcare provider
right away if you have any new eye symptoms.

QSYMIA can have other serious side effects. See “What are the possible side effects of Qsymia?”
What is QSYMIA?
• QSYMIA is a prescription medicine that contains phentermine and topiramate extended-release that
may help some adults and children 12 years and older with obesity, or some overweight adults who
also have weight-related medical problems lose weight and keep the weight off.
• QSYMIA should be used with a reduced calorie diet and increased physical activity.
• It is not known if QSYMIA changes your risk of heart problems or stroke or of death due to heartproblems or stroke.
• It is not known if QSYMIA is safe and effective when taken with other prescription and over-thecounter medicines, or herbal weight loss products.
• It is not known if QSYMIA is safe and effective in children under 12 years old.
• QSYMIA is a federally controlled substance (CIV) because it contains phentermine and can beabused or lead to drug dependence. Keep QSYMIA in a safe place, to protect it from theft. Nevergive your QSYMIA to anyone else, because it may cause death or harm them. Selling or giving awayQSYMIA is against the law.
Who should not take QSYMIA?
Do not take QSYMIA if you:• are pregnant, planning to become pregnant, or become pregnant during QSYMIA treatment.
• have glaucoma.
• have thyroid problems (hyperthyroidism).
• are taking certain medicines called monoamine oxidase inhibitors (MAOIs) or have taken MAOIs inthe past 14 days.
• are allergic to topiramate, sympathomimetic amines such as phentermine, or any of the ingredients inQSYMIA. See the end of this Medication Guide for a complete list of ingredients in QSYMIA.
Before taking QSYMIA, tell your healthcare provider about all of your medical conditions,including if you:• have had a heart attack or stroke.
• have or have had an abnormal heart rhythm.
• have or have had depression, mood problems, or suicidal thoughts or behavior.
• have eye problems, especially glaucoma. See “Who should not take QSYMIA?”• have a history of too much acid in the blood (metabolic acidosis) or a condition that puts you at higher
risk for metabolic acidosis such aso chronic diarrhea, surgery, a diet high in fat and low in carbohydrates (ketogenic diet), weak, brittle,
or soft bones (osteoporosis, osteomalacia (rickets), - osteopenia), or decreased bone density• have type 2 diabetes and take medicine to control your blood sugar.
• have kidney problems, kidney stones, or are getting kidney dialysis.
• have liver problems.
• have seizures or convulsions (epilepsy).
• are breastfeeding or plan to breastfeed. QSYMIA can pass into your breast milk and may harm yourbaby. You and your healthcare provider should decide if you will take QSYMIA or breastfeed. Youshould not do both.
Tell your healthcare provider about all the medicines you take, including prescription and over-thecounter medicines, vitamins, and herbal supplements. QSYMIA taken with other medicines may affecthow each medicine works and may cause side effects.
Especially tell your healthcare provider if you take:• Birth control pills. Tell your healthcare provider if your menstrual bleeding changes while you aretaking birth control pills that contain both estrogen and progestin (combination oral contraceptives)
and QSYMIA.
• Water pills (diuretics) such as hydrochlorothiazide (HCTZ).

Any medicines that impair or decrease your thinking, concentration, or muscle coordination.
Carbonic anhydrase inhibitors such as ZONEGRAN (zonisamide), DIAMOX (acetazolamide) orNEPTAZANE (methazolamide).
• Seizure medicines such as Valproic acid (DEPAKENE or DEPAKOTE).
Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist eachtime you get a new medicine. Do not start a new medicine without talking to your healthcare provider.
How should I take QSYMIA?
• Your healthcare provider should start you on a diet and exercise program when you start taking
QSYMIA. Stay on this program while you are taking QSYMIA.
• Take QSYMIA exactly as your healthcare provider tells you to take it.
• Do not change your dose without talking to your healthcare provider.
• Take QSYMIA daily in the morning.
• QSYMIA can be taken with or without food.
• If you miss a dose of QSYMIA, wait until the next morning to take your usual dose of QSYMIA. Do
not double your dose.
• To start treatment with QSYMIAo Take 1 QSYMIA 3.75 mg/23 mg capsule (Figure A) 1 time each morning for the first 14 days.
o After taking QSYMIA 3.75 mg/23 mg capsule for 14 days, then take 1 QSYMIA 7.5 mg/46 mg
capsule (Figure B) 1 time each morning.
• After taking QSYMIA for 12 weeks
o Your healthcare provider may tell you to increase your dose of QSYMIA if you do not lose a certain
amount of weight or do not have a certain decrease in BMI for children 12 years and older, within
the first 12 weeks of treatment at the recommended dose.
• If your healthcare provider increases the dose of QSYMIAo Take 1 QSYMIA 11.25 mg/69 mg capsule (Figure C) 1 time each morning for 14 days.
o After taking 14 days of QSYMIA 11.25 mg/69 mg capsule, then take 1 QSYMIA 15 mg/92 mgcapsule (Figure D) 1 time each morning.
• Stopping QSYMIA treatment
Your healthcare provider should tell you to stop taking QSYMIA if you have not lost a certain amountof weight or do not have a certain decrease in BMI for children 12 years and older, after an additional
12 weeks of treatment on the higher dose.
Do not stop taking QSYMIA without talking to your healthcare provider. Stopping QSYMIA suddenly
can cause serious problems, such as seizures. Your healthcare provider will tell you how to stoptaking QSYMIA slowly.
••

If you take too much QSYMIA, call your healthcare provider or go to the nearest emergency room rightaway.
What should I avoid while taking QSYMIA?
• Do not get pregnant while taking QSYMIA. See “What is the most important information I
should know about QSYMIA.”• Do not drink too much alcohol while taking QSYMIA. QSYMIA and alcohol can affect each othercausing side effects such as sleepiness or dizziness.
• Do not drive a car, operate heavy machinery, or do other dangerous activities until you knowhow QSYMIA affects you. QSYMIA can slow your thinking and motor skills and may affect vision.
What are the possible side effects of QSYMIA?
QSYMIA can cause serious side effects, including:••••••••••••••

See “What is the most important information I should know about QSYMIA?”.
Mood changes and trouble sleeping. QSYMIA may cause depression or mood problems, andtrouble sleeping. Tell your healthcare provider if symptoms occur.
Concentration, memory, and speech difficulties. QSYMIA may affect how you think and cause
confusion, problems with concentration, attention, memory, or speech. Tell your healthcare provider if
symptoms occur.
Slowing of growth. QSYMIA may slow the increase in height in children 12 years and older, whenused for a long time.
Increases of acid in bloodstream (metabolic acidosis). If left untreated, metabolic acidosis cancause brittle or soft bones (osteoporosis, osteomalacia (rickets), osteopenia), kidney stones, can slow
the rate of growth in children, and may possibly harm your baby if you are pregnant. Metabolic
acidosis can happen with or without symptoms. Sometimes people with metabolic acidosis will:o feel tired
o not feel hungry (loss of appetite)o feel changes in heartbeato have trouble thinking clearlyYour healthcare provider should do a blood test to measure the level of acid in your blood before andduring your treatment with QSYMIA.
Decrease in kidney function. QSYMIA may cause a decrease in kidney function. Your healthcare
provider should do a blood test to measure your kidney function before and during treatment withQSYMIA.
Low blood sugar (hypoglycemia) in people with type 2 diabetes mellitus who also takemedicines used to treat type 2 diabetes mellitus. Weight loss can cause low blood sugar in people
with type 2 diabetes mellitus who also take medicines used to treat type 2 diabetes mellitus (such asinsulin or sulfonylureas). You should check your blood sugar before you start taking QSYMIA andwhile you take QSYMIA.
Low blood pressure (hypotension) in people who take high blood pressure medicines. Weightloss can cause low blood pressure in people who take medicines to treat high blood pressure. Call
your healthcare provider if you have symptoms of low blood pressure such as dizziness, feelinglightheaded, and fainting during treatment with QSYMIA. Your healthcare provider should check yourblood pressure before you start taking QSYMIA and while you take QSYMIA.
Possible seizures if you stop taking QSYMIA too fast. Seizures may happen in people who mayor may not have had seizures in the past if you stop QSYMIA too fast. Your healthcare provider willtell you how to stop taking QSYMIA slowly.
Kidney stones. Drink plenty of fluids when taking QSYMIA to help decrease your chances of getting
kidney stones. If you get severe side or back pain, or blood in your urine, call your healthcare
provider.
Decreased sweating and increased body temperature (fever). People should be watched forsigns of decreased sweating and fever, especially in hot temperatures. Some people may need to behospitalized for this condition.
Low potassium. QSYMIA can increase your risk of low potassium levels. Your healthcare provider
should do a blood test to measure the level of potassium in your blood before and during treatment
with QSYMIA.
Serious skin reactions. QSYMIA may cause a severe rash with blisters and peeling skin, especiallyaround the mouth, nose, eyes, and genitals (Stevens-Johnson Syndrome). QSYMIA may also causea rash with blisters and peeling skin over much of the body that may cause death (Toxic Epidermal
Necrolysis). Call your healthcare provider right away if you develop a skin rash or blisters.
Allergic reaction to FD&C Yellow No. 5. QSYMIA capsules contain the inactive ingredient FD&C
Yellow No. 5 (tartrazine) which can cause allergic-type reactions (including bronchial asthma) incertain people, especially people who also have an allergy to aspirin.

Common side effects of QSYMIA in adults include:• numbness or tingling in the hands, arms, feet, or face (paraesthesia)• dizziness• change in the way foods taste or loss of taste (dysgeusia)• trouble sleeping (insomnia)• constipation• dry mouth
Common side effects of QSYMIA in children 12 years and older include:• depression• dizziness• joint pain
• fever• flu• ankle sprain
Tell your healthcare provider if you have any side effect that bothers you or does not go away.
These are not all of the possible side effects of QSYMIA. For more information, ask your healthcare
provider or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088.
You can also report side effects to VIVUS at 1-888-998-4887.
How should I store QSYMIA?
• Store QSYMIA at room temperature between 68°F to 77°F (20°C to 25°C).
• Keep QSYMIA in a tightly closed container.
• Keep QSYMIA dry and away from moisture.
Keep QSYMIA and all medicines out of the reach of children.
General Information about the safe and effective use of QSYMIA.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not
use QSYMIA for a condition for which it was not prescribed. Do not give QSYMIA to other people, even if
they have the same symptoms you have. It may harm them.
You can ask your pharmacist or healthcare provider for information about QSYMIA that is written for
health professionals.
What are the ingredients in QSYMIA?
Active Ingredient: phentermine hydrochloride and topiramate extended-release
Inactive Ingredients: FD&C Blue #1, FD&C Red #3, FD&C Yellow #5 and #6, ethylcellulose, gelatin,methylcellulose, microcrystalline cellulose, povidone, starch, sucrose, talc, titanium dioxide, andpharmaceutical black and white inks.
Copyright © 2024 VIVUS LLC All rights reserved.
VIVUS LLC
900 E. Hamilton Ave., Suite 550
Campbell, CA 95008 USA

US Patent Numbers: 7,056,890; 7,553,818; 7,659,256; 7,674,776; 8,580,298; 8,580,299; 8,895,057; 8,895,058; 9,011,905; and 9,011,906
QSYMIA is a registered trademark of VIVUS LLC
This Medication Guide has been approved by the U.S. Food and Drug Administration

Revised: 02/2024

ME-03-001-10

Revised 02/2024