Injection
Tirzepatide + B12
A weekly dual-action GLP-1/GIP injection for meaningful weight loss and appetite control, paired with vitamin B12 for energy.
Starting at $198/mo
Weight lossControlledExtended-release
Phentermine + Topiramate
RxPrescription onlyTaken by mouth · Once a day · 15–30 mg phentermine / 12.5 mg topiramate · Weight loss · Controlled · Extended-release
Starting at $129/mo
FDA-approved combination (Qsymia) of phentermine plus topiramate extended-release for long-term weight loss. Stronger than phentermine alone; requires careful medical screening and ongoing monitoring. Teratogenic; not for pregnancy.
How many capsules per month?
MonthlyEvery 3 months
30 capsulesper month
You'll receive 30 capsules per month. $149 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- FDA-approved for long-term weight loss
- Stronger effect than phentermine or topiramate alone
- Extended-release formulation
Every plan includes
- Personalized, physician-guided plan
- 30 capsules per month, monthly and 3-month
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is Phentermine + Topiramate ER?
(Qsymia, controlled appetite suppressant + anticonvulsant)
Qsymia is an FDA-approved combination of phentermine (appetite suppressant) and topiramate (anticonvulsant) in extended-release form. It produces greater weight loss than either drug alone. Long-term use is approved, but requires medical screening for cardiovascular disease, glaucoma, and psychiatric conditions. Teratogenic in pregnancy.
- How it is taken
- Taken by mouth
- How often
- Once a day
- Dose range
- 15–30 mg phentermine / 12.5 mg topiramate
- Form
- Weight loss · Controlled · Extended-release
Long-term
FDA-approved combination with extended-release; teratogenic in pregnancy
Phentermine/topiramate ER produces mean 10% weight loss at the higher dose in clinical trials. Extended-release allows longer use than phentermine alone. Cognitive side effects and increased heart rate are possible. Absolutely not for pregnancy or women of childbearing potential without strict contraception.
How it works,
week by week.
Day 1
Video consultation with a US-licensed physician. Medical screening: blood pressure, heart rate, ECG may be required. Detailed discussion of risks, benefits, and contraindications. Informed consent required.
Week 1
Start your dose (low dose for phentermine). Appetite suppression often noticeable within days. Energy increases. Monitor for jitteriness, heart palpitations, or insomnia.
Weeks 2–4
Weight loss accelerates. Appetite remains suppressed. Your physician checks in weekly or biweekly to monitor cardiovascular and psychological effects.
Weeks 5–12
Steady, significant weight loss. Physician continues close monitoring. At week 12 (or sooner if phentermine alone), plan for pause or switch to longer-term option.
Week 12+
Maintenance or transition: if using phentermine alone, pause it (cannot use continuously). Phentermine/topiramate ER may continue if tolerated. Your physician guides next steps.
What you may notice,
and when.
Rapid weight loss
3–5 kg in 12 weeks (phentermine); up to 10% body weight (combination)
Energy boost
increased alertness and motivation (stimulant effect)
Cardiovascular monitoring
blood pressure and heart rate require close tracking
Psychiatric vigilance
mood, anxiety, and sleep need supervision
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
Phentermine and phentermine/topiramate are controlled medications with significant risks. Do not use with uncontrolled high blood pressure, heart disease, recent heart attack or stroke, glaucoma, or history of substance abuse. Cardiovascular effects include increased heart rate, elevated blood pressure, and palpitations. Neurological effects include anxiety, insomnia, tremor, and (with topiramate combination) cognitive impairment. Phentermine/topiramate is absolutely teratogenic (causes birth defects); women of childbearing potential must use strict contraception. Tell your physician about all medications, cardiovascular disease, psychiatric conditions, and any history of drug or alcohol abuse. Stop and seek care for chest pain, severe headache, palpitations, shortness of breath, or psychiatric symptoms.
The research behind
phentermine and topiramate.
Phentermine with topiramate is an approved combination for obesity (Qsymia). Its evidence is placebo-controlled trials of 56 to 108 weeks, mostly of the controlled-release capsule.
- Weight8.1 kg and 10.2 kg
CONQUER: 2,487 adults with overweight or obesity and at least two conditions, 56 weeks. Mean loss was 8.1 kg on the low dose and 10.2 kg on the high dose, against 1.4 kg on placebo.
CONQUER, Lancet 2011 - Reaching 5%62% and 70%
CONQUER: 62% of the low-dose group and 70% of the high-dose group lost at least 5% of body weight, against 21% on placebo.
CONQUER, Lancet 2011 - Pooled trialsabout 7.7 kg
A 2020 meta-analysis of trials, published as a preprint and not yet peer reviewed, pooled about 7.7 kg more loss than placebo for the combination.
Meta-analysis, medRxiv 2020 (preprint)
What the studies found
- Mean loss of 10.2 kg (9.8%) on the high dose at 56 weeks, against 1.4 kg on placebo (CONQUER, Lancet 2011).
- Lowered waist size, blood pressure, fasting glucose and lipids more than placebo at 56 weeks (EQUIP, Obesity 2012).
- In people with prediabetes or metabolic syndrome, progression to type 2 diabetes was 70.5% lower on the low dose and 78.7% lower on the high dose over 108 weeks (Diabetes Care 2014, subgroup analysis).
- Reached at least 5% weight loss in 62% and 70% of people on the two doses, against 21% on placebo (CONQUER, Lancet 2011).
Trial results are for the controlled-release capsule at the doses studied, in trial settings. They are averages, not predictions. Compounded combinations of the two drugs were not studied.
What this does not say
- Dry mouth, tingling and constipation were the most common side effects in CONQUER.
- The trials ran 56 to 108 weeks. No long-term outcome trial is cited here.
- The combination is not for people who are or may become pregnant; the label contraindicates it in pregnancy.
The research
behind it.
In clinical trials, phentermine/topiramate ER produced mean 10% weight loss, nearly double that of phentermine alone. Effects persist for a year of continuous use.
The combination is potent but requires careful screening for heart disease, glaucoma, and psychiatric conditions. Cognitive effects ('topiramate fog') and increased heart rate occur in some users.
GLP-1 beyond the scale:
what the research showsHeart, kidneys, liver, sleep and joints: the trials, with their numbers and their limits.Read the researchMicrodosing GLP-1:
what we know, and what we don’tLower doses are everywhere online. Here is what has actually been studied, and how our physicians use dose.Read the research
what the research showsHeart, kidneys, liver, sleep and joints: the trials, with their numbers and their limits.Read the researchMicrodosing GLP-1:
what we know, and what we don’tLower doses are everywhere online. Here is what has actually been studied, and how our physicians use dose.Read the research
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I take Phentermine / Topiramate?
Taken by mouth, once a day, in the morning. The starting prescription is 1 capsule (15 mg phentermine / 12.5 mg topiramate) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Phentermine / Topiramate come in?
The pharmacy carries 2: 15 mg / 12.5 mg, 30 mg / 12.5 mg. Your physician chooses which one you get.
What exactly is in it?
Phentermine, Topiramate.
How much arrives in each shipment?
30 capsules at the starting strength, shipped to your door from a licensed US pharmacy.
Is it a controlled substance?
Yes. The law requires a live video visit with the physician before it can be prescribed.
Why is this stronger than phentermine alone?
Topiramate adds appetite suppression and metabolic support. Together, they produce more weight loss than either alone. The extended-release form also allows longer use (beyond 12 weeks) while monitoring for side effects.
Why are these medications controlled?
Phentermine is similar to amphetamine; it stimulates the central nervous system and carries risks of dependence, cardiovascular effects, and psychiatric symptoms. Schedule IV reflects these risks. Strict medical supervision is required.
Can I use phentermine longer than 12 weeks?
Continuous phentermine use is FDA-approved only for 12 weeks or less. After that, tolerance develops and risks increase. Your physician may pause (typically 2–4 weeks) and restart, or switch to the combination (phentermine/topiramate ER, which is approved for longer use).
Phentermine + Topiramate ER educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
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References
- 1.Phentermine efficacy and cardiovascular safety: randomized controlled trials. Obesity, 2019
- 2.Phentermine/topiramate ER for long-term weight loss (Qsymia): efficacy and safety. Lancet, 2012 (Gadde KM et al.)
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.