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Ideal Time To Take For Weight Loss


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#1 In_Remission_Anouk

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Posted 10 August 2011 - 04:08 PM

This might seem silly, but after having gained 70 or so pounds on Seroquel and moved into the realm of the morbidly obese, I'd like to maximize the punch of the anorectic side effects of my 200 mg of Topamax a day (100 bid), so I really want to get the timing down so I can.

The doctor in the hospital wanted me to take it at night and in the morning, saying that would be the optimal way to have it constantly in my bloodstream. I countered that perhaps it might be best to take one 100 when I first woke and then another around 3p to counter nighttime hunger. He said that these meds "don't work like that," and urged me to take them as he prescribed them.

My regular doctor agreed with me and said to take them during the day. So have been taking them as per his instruction.

I found the hospital doctor to be really, really knowledgeable and quite a bit better than my regular doctor, but what the latter said sounded to me like common sense--of course, it did just reinforce what I thought, though.

Does anyone have any idea on this issue? I'm filling up my pill boxes for the week and was hoping to figure out the best way to do this :)

Thanks people.

Edited by Anouk, 10 August 2011 - 04:19 PM.




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#2 dymphna

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Posted 11 August 2011 - 02:09 AM

This might seem silly, but after having gained 70 or so pounds on Seroquel and moved into the realm of the morbidly obese, I'd like to maximize the punch of the anorectic side effects of my 200 mg of Topamax a day (100 bid), so I really want to get the timing down so I can.

The doctor in the hospital wanted me to take it at night and in the morning, saying that would be the optimal way to have it constantly in my bloodstream. I countered that perhaps it might be best to take one 100 when I first woke and then another around 3p to counter nighttime hunger. He said that these meds "don't work like that," and urged me to take them as he prescribed them.

My regular doctor agreed with me and said to take them during the day. So have been taking them as per his instruction.

I found the hospital doctor to be really, really knowledgeable and quite a bit better than my regular doctor, but what the latter said sounded to me like common sense--of course, it did just reinforce what I thought, though.

Does anyone have any idea on this issue? I'm filling up my pill boxes for the week and was hoping to figure out the best way to do this :mad:

Thanks people.


There isn't an optimal time, because it isn't a weight loss drug.

I'm sorry that your doctors presented it to you in that manner, but weight loss on Topamax is a quirk, not a feature. eg: some people get it, some people don't. Just as some people become a box of rocks on it and some people don't.

By and large, most people will lose some weight on the drug, but it is not due to anything magical in the drug beyond a dulling of food flavors. At that point, it is actually you, not the drug -- food tastes like ass, so you don't eat it. This really isn't anything you couldn't do without the drug: deciding that a food isn't "tasty enough" to bother eating. And with the latter, you don't endanger your liver or kidneys.

I've been on Topamax since 2001. I started at X, I dropped 22 lbs (I also quit Depakote and became an aerobics instructor, so that probably had a LOT to do with it), and now I'm back up 16 lbs. My eating habits haven't changed. I'm not an aerobics instructor, but I *do* exercise. The biggest difference is that my crazy has changed. Mania burns more calories than does stability. I'm not manic, and the other crap wrong with me has gotten worse over the past ten years. In the short run? Sure, it may drop some weight. In the long run? It's not a diet drug. (and we say this all. over. the. site.)

[There is a reason the FDA keeps shit-canning new drug applications for Topamax and Topamax + other drugs to be marketed as diet drugs]


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#3 Blue Heron

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Posted 11 August 2011 - 02:18 PM

Anouk, you're not going to get a different answer by lecturing and/or sucking up to a moderator. Give it up.

Have you looked at the main drug site's entry for Topamax? It says, "The promise of losing weight is oversold and often leads to disappointment. Topamax can make you dumber than a box of rocks." The webpage also lists recommended dosing schedules for treating migraines and epilepsy.
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#4 Jerod Poore

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Posted 11 August 2011 - 03:35 PM

I should get the bad news over with.

I had really good results last time I took it-


The weight-loss effect is the one thing Topamax may not give you a second chance on. And if it does, it may not work as well. Sorry.

In any event, your question is interesting. Unfortunately I couldn't find anything. All the studies did the standard twice-a-day, morning and bedtime dosing, because that's the norm for taking Topamax for epilepsy or migraines. It makes me hungry after taking it, so anything is possible. Topamax does affect lipids and glycemic control (see studies below), so if it's going to work, which it may not, you'll have to find that one out for yourself.

For anyone else interested in considering Topamax as an add-on for weight loss due to crazy med-induced weight gain...

I don't know how you define "weight loss drug" but I assume that any drug that induces weight loss beyond diuretic effect would be such a drug. Topamax has been demonstrated to be such a drug.


Sort of. The results were pretty good in Johnson & Johnson's last big clinical trial of using Topamax for what they thought a sulfamate-substituted monosaccharide would be good for when it was first developed in the 1970s - a diabetes treatment:

The safety population consisted of 1282 subjects, and the MITT efficacy population was 854 subjects. At 60 weeks, subjects in the placebo group lost 1.7% of their baseline body weight, while subjects in the topiramate 96, 192, and 256 mg/day treatment groups lost 7.0, 9.1, and 9.7%, respectively (P<0.001, MITT, last observation carried forward). Weight loss >/=5% of baseline weight was achieved by 18% of subjects in the placebo arm vs 54, 61, and 67% of subjects receiving topiramate 96, 192, and 256 mg/day, respectively; weight loss >/=10% was achieved by 6 vs 29, 40, and 44%, respectively (P<0.001). Weight loss was accompanied by significant improvements in blood pressure (systolic/diastolic changes of +0.4/+1.0, -3.1/-1.3, -5.7/-3.4, and -4.6/-2.4 mmHg were observed for placebo, topiramate 96 mg/day, 192 mg/day, and 256 mg/day, respectively, P<0.001) and glucose and insulin.


You don't see the term "modified intent to treat" (MITT) in a lot of studies. I'll get to that.

I think that the problem the FDA had with it was that it had too many side effects, although I'm unsure of what those were.

It's not the FDA that has a problem with the side effects, it's Johnson & Johnson. Rather, the people in the clinical trials. J&J keep shutting down the trials because too many people drop out due to intolerable adverse effects. From the same clinical trial:
Attached File  topamaxtrial.jpg   213.81KB   7 downloads

21% of the people taking Topamax dropped out because the side effects sucked more than having a BMI above 30. From what I've read of what people will do to lose weight, those have to be some pretty harsh side effects.
So they used the term MITT to indicate their data came from everyone who took at least one dose of Topamax. Just so they'd have enough to be statistically significant, since J&J ended the trial a year ahead of schedule.

Don't hold your breath waiting for Topamax CR. That trial failed as well. The results were still good, people losing an average of 6 kilos, good glycemic and lipid numbers, but with 91% of people taking Topamax reporting adverse events, and 9% dropping out before four months are up, J&J may have finally given up.

But those are for people with diabetes. What about weight gain induced by other meds? There are a bunch of case reports and studies, mostly small-to-medium sized. This one sums it up nicely:

Efficacy of add-on topiramate therapy in psychiatric patients with weight gain.

RESULTS:Forty-one patients were included in the study. There was a 58.5% (n = 24) response rate. Mean reductions in weight and BMI were approximately 2.2 kg and 0.5 points, respectively. Responders lost an average of 7.2 kg, whereas nonresponders gained an average of 5.0 kg. Patients with a baseline weight of at least 91 kg and those receiving a greater number of psychotropic medications were more likely to experience success with topiramate therapy. Of the 24 patients who responded to therapy, 22 experienced onset of weight reduction by the next clinic visit (1-4 mo) following either initiation of therapy or titration to the eventual therapeutic dose, and the usual rate of weight loss was 0.45-1.4 kg per month. Therapy was typically initiated at 50 mg/day. The mean maximum dose was 93.9 mg/day and the median maximum dose was 100 mg/day. Seven (17.1%) patients had documented adverse effects to topiramate therapy.
CONCLUSIONS:Topiramate therapy resulted in overall modest (ie, <2%) decreases in weight and BMI, but many patients experienced more impressive weight loss.


That's why Topamax has this reputation as a weight-loss wonder drug. For some people the results are spectacular, and when it does work, it works especially well for people taking antipsychotics. That it does anything at all for people taking Clozaril or Zyprexa is considered a huge win.

But when it doesn't work - it really doesn't work. You get to gain weight and deal with the side effects. Ask me about my kidney stones. OK, they're more like kidney sand and pebbles, and since I've been taking magnesium citrate I'm only bothered by them two or three times a month instead of twice a week, but it's only around a 1.5% chance of having annoying kidney problems i.e. not bad enough to require surgical intervention.
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