New pharmacological options in obesity treatment often attract interest. One such preparation is Qsiva. LuMedic has prepared this article to help you understand this drug in detail.
Qsiva – What Is It?
Composition and mechanism of action
Qsiva is a medication containing two active substances – phentermine and topiramate.
- Phentermine stimulates the release of norepinephrine in the hypothalamus and slightly affects dopamine levels, which ultimately reduces and delays the sensation of hunger.
- Topiramate has a multidirectional effect. In Qsiva, it influences satiety, partly by inhibiting gastrointestinal motility and affecting metabolic pathways.
Indications
Qsiva is indicated for adult patients with:
- Obesity: BMI ≥30 kg/m²,
- Overweight: BMI ≥27 kg/m² when additional weight-related risk factors are present (e.g., hypertension, type 2 diabetes, dyslipidemia).
It is important to note that the medication is prescribed only as an adjunct to a reduced-calorie diet and increased physical activity. Ignoring diet and exercise will not provide the desired results.
Qsiva and Pregnancy
Qsiva is strictly contraindicated during pregnancy. Topiramate, one of its components, can cause congenital malformations in the fetus. Pregnancy registry data – especially concerning topiramate – indicate an increased risk of developmental defects and other complications.
Qsiva in women of childbearing potential
Women of childbearing potential using Qsiva must employ reliable contraception. If pregnancy is confirmed during treatment, the drug should be discontinued, and a physician must be consulted immediately.
Qsiva Dosing
- Initial dose: 3.75 mg + 23 mg once daily (for 14 days),
- Next step: 7.5 mg + 46 mg once daily (for 12 weeks, followed by clinical assessment of weight loss).
If further dose escalation is required:
- 11.25 mg + 69 mg once daily (for 14 days), followed by
- Maximum dose: 15 mg + 92 mg once daily, with reassessment of weight reduction outcomes.
Important: Qsiva must not be discontinued abruptly. The dose must be tapered gradually, e.g., administering every other day for at least one week before complete withdrawal. Sudden discontinuation at the maximum dose may trigger seizures.
If weight reduction is insufficient, therapy should be discontinued.
Qsiva in Obesity Treatment
How much weight can be lost with Qsiva?
- Clinical trials demonstrated weight loss of 6.3%–10.5% after 6 months,
- After 12 months, weight reduction ranged between 9%–15.9%.
Comparison with other therapies
- Compared with monotherapy (phentermine or topiramate alone), Qsiva provides synergistic action and more significant weight loss.
- Compared with GLP-1 receptor agonists (e.g., semaglutide, dulaglutide), Qsiva acts through different mechanisms (norepinephrine, neurotransmitter modulation, metabolic pathways via topiramate).
It may serve as an alternative for patients intolerant to or contraindicated for GLP-1 therapy, or when different treatment expectations exist.
Note: Qsiva is associated with a higher risk of adverse effects and requires careful monitoring, especially at higher doses or in patients with comorbidities. Therefore, the indication for its use must always be thoroughly evaluated by a physician.
Qsiva – Availability in Poland and Europe
Marketing authorization status
Qsiva is available in four strengths, supplied in bottles containing 30 capsules each:
- Qsiva 3.75 mg + 23 mg,
- Qsiva 7.5 mg + 46 mg,
- Qsiva 11.25 mg + 69 mg,
- Qsiva 15 mg + 92 mg.
The drug is not reimbursed in Poland, meaning patients must cover the full cost. Prices vary depending on dosage and pharmacy, typically ranging from 550–600 PLN or more for a 30-capsule pack. Availability may be limited, as not all pharmacies keep it in stock.
Adverse Effects of Qsiva
The most common side effects include:
- Dry mouth,
- Paresthesia (tingling, numbness, or “electric shock” sensations, particularly in hands and feet),
- Constipation.
Summary – Key Facts About Qsiva
Qsiva is a combination drug (phentermine + topiramate) indicated for obesity and overweight with comorbidities, as an adjunct to diet and physical activity. Its dual mechanism of action may enhance weight reduction but also carries a higher risk of adverse effects, particularly at higher doses.
In Poland, Qsiva is available by prescription only and is not reimbursed, meaning patients pay the full price. Before initiating therapy, benefits and risks must be carefully evaluated, and treatment should always be tailored to the individual patient’s medical history and expectations.
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