QUICKLINKS AND VIEW OPITONS
Sunday, August 26, 2012 10:04 am Email this article
The Vivus Company, maker of Qsymia, offered me a plane ticket, hotel room and $2500 cash to attend their "Speaker Training Program" in Dallas. I won't go. It is a bribe to get me and other doctors to prescribe Qsymia. I can't be bought.
Years ago I attended the kick-off of Meridia in Phoenix to take advantage of the free ticket to Phoenix where my daughter lives. I spent the time with her. I went to only one meeting, the evening Q&A session. We had to write our questions down on index cards. The cards were screened by company reps before being given to the expert panel. Having no patience with fools, I stood up and asked my questions aloud regarding some misleading data. You know that Meridia was withdrawn a few years later for its ineffectiveness and substantial risk.
This new thing, Qsymia is a combination of phentermine, the oldest diet pill still in use, and topirimate (brandname: Topamax) an antiseizure drug useful for preventing migraines. Dr. Robert Skversky knows more about phen/Topamax than anyone; he will correct me if I say anything wrong.
I will not prescribe Qsymia for the following reasons:
- Generic phentermine and topirimate can be prescribed together for a lower cost and with greater flexibility of dosing than Qsymia.
- No data have been presented to show that Qsymia works any better, longer, on more patients or with less side-effects than phentermine alone. No head-to-head study was published. The FDA should have required one.
- MANY people don't tolerate topirimate. The initial drop-out rate in the two Qsymia studies was 40% and 31%. (See the prescribing information here).
- Some doctors, unwilling to prescribe phentermine or phen-pro for long-term use, will be willing to prescribe Qsymia because the FDA approved it for one year use. Such doctors are unaware of the fact that they are allowed to prescribe phentermine or phen-pro for any length of time since both medicines were approved by the FDA for some use. The FDA expressly says so in the Preamble to the PDR, a book in every doctor's office.
- Mucho data and experience already exist for the phentermine-Prozac (phen-pro) combination.
- I don't focus on pills anyway. I focus on teaching my patients the Eight Lessons. Obesity is behavioral in origin.
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