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  • How I use Topamax for weight loss by Robert Skversky, MD

    Posted by .(JavaScript must be enabled to view this email address)
    Tuesday, July 20, 2010 11:58 am Email this article
    “In my experience I believe Topamax is a great adjunct for weight-loss especially when combined with anorectic agents [ such as phentermine ]," says Robert Skversky, MD, a weight loss doctor from Newport Beach, California.

    “I use it primarily in patients who have plateaued in spite of taking combination anorectic/SSRI medication [ serotonin reuptake inhibitors ]; or other combinations using SNRI’s [ serotonin / noradrenaline reuptake inhibitors ] and or Glucophage [ metformin ].


    Dosage—150-200 mg

    “Most patients I find will need 100-150 mg for good weight-loss although dosing can vary from 50 mg to 400 mg.

    “I find that most patients who can tolerate the drug will lose weight.



    Dropouts Due To Side Effects—15-20% of Patents

    “Unfortunately, 15-20% of patients have cognitive or other side effects resulting in discontinuation.

    “Sometimes we will compromise on dosage, and thus weight-loss, thus causing fewer side effects.


    When Used a Second Time

    No Less Effective When Tried Again

    “I haven’t seen tolerance to Topamax in patients who restart after a hiatus.


    When Used a Second Time

    Start With A Low Dose—25 mg—And Slowly Increase

    “The key is to begin at low dose (i.e. 25mg) and titrate [ increase the dose ] gradually.

    “Thus if someone was previously on 300 mg and doing well it could take a number of weeks once restarting to reach therapeutic dose.


    May Take a Few Weeks to Start Working The Second Time

    It May Take Several Weeks For Weight Loss To Start In Someone Starting Topamax A Second Time

    “Finally, since being overweight/obese is a progressive and chronic disease, patients restarting a program who weigh 20-30 pounds more than a previous visit may experience weight stabilization for several weeks before weight-loss begins.”


    Adding to Phentermine

    I Usually Only Add Topamax After A Patient Has Plateaued On Phentermine

    “In general, I have only used (added) Topamax after patients have plateaued or have become resistant [ that is, stopped losing weight on phentermine. ]

    “Since I believe Topamax in combination with anorectics can achieve the most weight loss in pounds, although not necessarily tolerability.

    “I rarely begin anyone on Topamax/phentermine with few exceptions.

    “My reasoning is that assuming dosing gets to therapeutic levels and they don’t respond then from a medication perspective there are few options.


    Adding an SSRI?

    Adding an SSRI or Glucophage or Didrex Doesn’t Help Much

    “Adding an SSRI and or glucophage or a drug like Didrex doesn’t seem to offer much.

    “By the same token, I don’t ‘sit’ on my patients if they are doing their share and not losing.


    Switching to Zonegran

    If A Patient Does Not Tolerate Topamax, I Try Them On Zonegran

    “I add Topamax to their regime and if not tolerated give them the option of trying Zonegran (zonisamide).


    Zonegran Better Tolerated

    Many Tolerate Zonegran Better Than Topamax, and Weight Loss is Similar

    “Many will tolerate this better, however, weight loss not as good in my practice although studies seem fairly comparable.


    One-Third on Topamax

    Roughly One-Third of Weight Loss Patients on Topamax

    “Overall, probably 30-35 % of my patients are placed on Topamax over time.

    “Admittedly, when the initial rumors of Qnexa ( phentermine / topiramate ) , Contrave (Wellbutrin (bupropion) plus naltrexone) , and Lorcaserin’s (serotonin agonist) future approval became known to me I began using Topamax/topiramate a bit earlier in treatment.

    “When patients ask me about new medications on the horizon I tell them (up until few days ago) that it was likely that 3 new medications would be approved by early 2011.

    “Two of them are “combination” drugs that other Bariatric docs and myself have been using separately for years and the other is a “pondimin-like (fenfluramine-like)” drug which we would probably be combining with phentermine/Adipex, etc.


    Woman loses 40 lbs on Topamax

    One of Dr. Skversky’s female patients loses 40 lbs on Topamax

    A video clip of a woman who lost 40 lbs on Topamax is posted here.


    Woman loses 115 lbs on phentermine, Topamax and Lexapro

    One of Dr. Skversky’s female patients loses 115 lbs on phentermine, Topamax and Lexapro

    A video clip of a woman who lost 115 lbs on phentermine, Topamax and Lexapro is posted here.


    Dr. Skversky’s Contact Information

    Robert Skversky, MD
    Weight No More—Newport Beach Office
    320 Superior Avenue, Suite 210
    Newport Beach, CA 92663
    (949) 645-2930 phone
    (949) 645-1059 fax

    .(JavaScript must be enabled to view this email address)
    View Map of the Office Location

    Weight No More—Temecula Office
    28441 Rancho California Road, Suite 104
    Temecula, CA 92590
    (951) 699-0848 phone
    (951) 699-0509 fax

    .(JavaScript must be enabled to view this email address)
    View Map of the Office Location

    “Before” and “After” photos of weight loss patients

    Patient Information
    Locations and Hours
    Patient Education
    The Program

    About Robert Skversky, MD

    Originally from Philadelphia, Dr. Skversky received his medical degree from Hahnemann University (formerly Hahnemann Medical College) in 1970. He completed his family practice residency at Hoag Memorial Hospital in Newport Beach, CA, in 1973 and became a diplomate of the American Board of Family Practice the same year. Dr. Skversky is a staff physician at Hoag Memorial Hospital, a member of the American Medical Association, Orange County Medical Association, and the American Society of Bariatric Physicians. Dr. Skversky had been a family practice physician in Newport Beach for more than 22 years before practicing bariatrics full-time.

    Dr. Skversky has committed the past fifteen years of his professional career to the medical treatment of the overweight and obese patient. He has been at the forefront of treating obesity as a chronic disease using combination drug therapy, in addition to diet and exercise protocols on a long term basis.

    He has written numerous articles discussing the myths associated with weight control, putting diet and exercise in proper perspective, and the essential role of pharmacotherapy for long term weight loss. Dr. Skversky states, “Obesity is a metabolic, chronic and progressive disease with a significant genetic predisposition. It is similar to other diseases like diabetes and hypertension which it can cause or make worse. Chronic diseases need long term drug therapy, in most cases, for control not cure.”

    Dr. Skversky has been featured in the Wall Street Journal and has appeared on “Good Morning America,” “The Today Show,” and “The Early Show” discussing the appropriate use of medication “off-label” for long-term weight loss.

    Dr. Skversky states “The goal of a prudent weight-loss program goes beyond weight loss itself, but extends to the improvement in self esteem and empowerment as unexpected gifts of long term weight-loss control. This disease obesity needs to be taken seriously, treated seriously and most important, treated with respect.”

    “My commitment to my patients goes far beyond just helping them lose weight. My personal hope is that success in our program will be a stepping stone to an increase in self-esteem and will inspire people to achieve and excel beyond what they thought was possible.”

    Articles on the same subject can be found here:


    On Mar 18, 2011 at 9:22 pm Linda Tidwell wrote:

    . . . . .

    I saw Dr. Skversky on the Dr. Oz show today. I live in Pensacola, Fl. Do you know of any Dr's in my area that practice this same type of drug combo weight loss? I so want to lose weight and have struggled with it for years. This program truly inspired me. Also, I was curious, can a person take Metformin for weight loss even if they are NOT diabetic? And if so, what would be a good milligram to take and how many times per day? Pls. give me a response to these questions. Thank you so very much! Linda Tidwell

    On Mar 19, 2011 at 9:24 am Larry Hobbs wrote:

    . . . . .


    Sorry, but I don't know any doctors in your area.

    You might email Dr. Skversky directly and see if he knows of anyone. His email address is above.

    Video clips of Dr. Skversky on the Dr. Oz Show are posted on the DoctorOz.com website here:

    There are 5 parts.






    Larry Hobbs

    On Mar 19, 2011 at 12:03 pm Robert Skversky, MD wrote:

    . . . . .

    Linda, You might try http://www.phenpro.com or ASBP.org for physician referral in your area. I do use metformin as an adjunct for weight-loss in my diabetic and non-diabetic patients. The weight-loss is better in those who are diabetic in part because we can often take them off other andi-diabetic meds that have a propensity for weight gain. Ideally in the non-diabetic one should do a fasting insulin level to see if they have hyperinsulinemia . (a precursor to diabetes in many patients. (Glucophage xr, Fortemet, and Glumetza.are better forms of metformin and have fewer side effects and can be taken once/daily)

    On Aug 09, 2011 at 2:03 pm Angie wrote:

    . . . . .

    You said in the doctor oz show to take it at night about what time to take it. I got my Dr. to to put me on the comb. and I lost 30 pounds but i can't lose no more then that. I am 5'4 and at 160 pounds and need to lose some more. I take 100 mg of topiramate and 37.5 mg of phentermine do i need to increase anything?

    On Aug 09, 2011 at 5:32 pm Robert Skversky, MD wrote:

    . . . . .

    Linda, I give topiramate at night before going to sleep only because it can cause tiredness in some and thus helps one sleep better. My suggestion is that your physician increases your dose gradually by 25 mgs/week assuming you do not experience any cognitive side effects such as short term memory loss, word finding difficulties, disorientation, etc. Many of my patients will need 150 mg to 300 mg or more for continued weight loss. In addition yourphysician can increase your phentermine by an additional 18.75mg at 2 pm and 18.75 mg at 5 pm. This should also be done gradually. He/might also consider switching to a better quality phentermine (Adipex-P) although it is much more expensive. Adherence to prescribed diet and exercise protocols are also important and careful evaluation of thyroid and diabetic status.

    Robert Skversky, MD

    On Sep 01, 2011 at 11:34 am Angie wrote:

    . . . . .

    You said something in one of your interviews about giving a carb blocker? Is that a prescription also? Do you take that with the combination of the topamax and phentermine?

    On Sep 02, 2011 at 9:08 am Admin2 wrote:

    . . . . .


    Carb blockers have NOT been shown to cause weight loss.

    I an not aware of ANY weight loss doctors who use them.

    Larry Hobbs

    On Oct 30, 2011 at 8:38 am DEMETRIA wrote:

    . . . . .

    I am currently taking 400 mgs of Topimarate and 20 mgs of Fluoxetine. I want to add 37.5 mgs of Phentermine. Is this safe?

    On Oct 30, 2011 at 1:06 pm Robert Skversky, MD wrote:

    . . . . .

    The combination of topiramate and phentermine we have been using for over 13 years in our weight loss practice. It should only be used under physician supetvision who is knowledgeable in reference to above drug combination. There are certain contraindications for using phentermine which your physician needs to be aware of.

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