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 lossAnticonvulsantOral
Topiramate
RxPrescription onlyTaken by mouth · Once a day · 25–50 mg · Weight loss · Anticonvulsant · Oral
Starting at $79/mo
Oral topiramate, an anticonvulsant used off-label for weight loss. Topiramate may reduce appetite and increase satiety, supporting gradual, steady weight loss.
How many tablets per month?
MonthlyEvery 3 months
30 tabletsper month
You'll receive 30 tablets per month. $99 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Off-label for appetite reduction and weight support
- Oral daily medication, no injections
- Gradual weight loss with lifestyle changes
Every plan includes
- Personalized, physician-guided plan
- 30 tablets 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 Topiramate?
(anticonvulsant, carbonic anhydrase inhibitor)
Topiramate is approved for seizures and migraines. Off-label use for weight loss is based on its appetite-suppressing effects. Mechanism likely involves carbonic anhydrase inhibition and effects on GABA signaling, which may reduce hunger and increase fullness.
- How it is taken
- Taken by mouth
- How often
- Once a day
- Dose range
- 25–50 mg
- Form
- Weight loss · Anticonvulsant · Oral
Modest to moderate
average 5–9% weight loss with topiramate plus lifestyle
Topiramate produces modest to moderate weight loss, generally less than GLP-1 medications but more than metformin alone. Results depend heavily on diet and activity. Cognitive side effects (difficulty concentrating, word-finding) occur in some users.
How it works,
week by week.
Day 1
A US-licensed physician reviews your health, metabolism, and why an oral medication may help you. Explains the medication's mechanism and what to expect.
Week 1–2
Start your dose. You may feel appetite changes within days, or changes may take weeks. GI effects (metformin) or mood changes (naltrexone) are possible early on.
Weeks 3–6
Your appetite and eating patterns shift. Fullness comes sooner. Your physician checks in and may adjust your dose based on response and tolerability.
Months 2–3
Steady, gradual weight loss. Metabolism and appetite remain improved. Your physician monitors for any side effects and adjusts dosing.
Beyond
Maintenance: your physician works with you to hold results or adjust as your body changes. Long-term monitoring ensures ongoing safety.
What you may notice,
and when.
Weight loss
steady but modest; depends on diet and activity
Appetite change
reduced hunger or improved fullness is common
Energy and metabolism
gradual improvement with weight loss and diet
Medical oversight
your physician monitors for side effects and efficacy
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
Oral weight-loss medications (metformin, naltrexone, topiramate) have different safety profiles. Metformin: GI side effects (nausea, diarrhea) common, especially initially; not for severe kidney disease. Naltrexone: generally well-tolerated; headache or dizziness possible. Topiramate: cognitive effects ('topiramate fog', difficulty concentrating, word-finding) in 10–15%; kidney stones possible. All are off-label for weight loss; efficacy and safety are not FDA-approved for this use. Tell your physician about all medications, kidney disease, and any history of kidney stones (topiramate). Stop and seek care for severe GI pain (metformin), severe headache, allergic reactions, or eye pain (topiramate).
The research behind
topiramate.
Topiramate is an anti-seizure drug used off label for weight. The evidence is a pooled set of trials in overweight and obese adults, many with other conditions.
- Pooled weightabout 5.3 kg
Ten randomized trials with 3,320 participants: topiramate gave 5.34 kg more weight loss than placebo (meta-analysis, 2011).
Kramer et al., Obesity Reviews 2011 (PubMed 21438989) - Dose and time6.6 kg at 28+ weeks
In trials giving 96 to 200 mg a day, loss was 6.58 kg in trials longer than 28 weeks and 4.11 kg in shorter trials.
Kramer et al., Obesity Reviews 2011 (PubMed 21438989) - Stoppingodds ratio 1.94
People on topiramate were about twice as likely to stop for adverse events as those on placebo. The common effects were paresthesia (tingling), taste impairment and psychomotor disturbances.
Kramer et al., Obesity Reviews 2011 (PubMed 21438989)
What the studies found
- Pooled trials: 5.34 kg more weight loss than placebo across 10 randomized trials and 3,320 people (Kramer et al., Obesity Reviews 2011).
- Longer trials showed more loss: 6.58 kg at more than 28 weeks against 4.11 kg at 28 weeks or less, at 96 to 200 mg a day (Kramer et al., 2011).
- The weight loss was seen across overweight and obese adults, many with other conditions such as hypertension or diabetes (Kramer et al., 2011).
Trial results are for the prescription tablet at the doses studied, as averages. The trials mixed people with and without diabetes, and these sources contain no separate analysis for people without diabetes. Compounded forms were not studied.
What this does not say
- The trials were in overweight and obese adults, many with other conditions, so the pooled figure is not specific to people without diabetes.
- Topiramate is approved as an anti-seizure drug, not as a weight-loss drug.
- The pooled review is from 2011; newer trials may differ.
The research
behind it.
Topiramate in randomized trials produces average 5–9% weight loss, often combined with phentermine for larger effect. Off-label use for weight loss alone is supported by mechanism and clinical experience.
Weight loss is gradual (weeks to months). Some users experience cognitive effects ('topiramate fog'); these often improve with dose adjustment.
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 Topiramate?
Taken by mouth, once a day, at bedtime. The starting prescription is 1 tablet (25 mg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Topiramate come in?
The pharmacy carries 2: 25 mg, 50 mg. Your physician chooses which one you get.
How much arrives in each shipment?
30 tablets at the starting strength, shipped to your door from a licensed US pharmacy.
Does topiramate really help with weight loss?
Yes, moderately. Topiramate reduces appetite and increases fullness in many users. Results are smaller and slower than GLP-1 drugs but real, especially with diet and exercise. Your physician monitors for cognitive side effects and adjusts doses if needed.
Why are these off-label?
These medications are FDA-approved for other conditions (diabetes, seizures, addiction) but not specifically for weight loss. Off-label use is legal and common; your physician prescribes based on research and experience.
Which one should I choose?
That depends on your health profile, goals, and what side effects you can tolerate. Metformin is gentlest but least effective. Naltrexone is experimental. Topiramate is moderate. Your physician will recommend based on your individual needs.
Can I combine these with GLP-1 drugs?
Yes, some combinations are used; for example, topiramate plus phentermine. However, combining multiple weight-loss medications requires careful physician oversight.
What if these don't work?
If you see minimal effect after 8–12 weeks, your physician may increase the dose, switch medications, or recommend GLP-1 drugs like semaglutide or tirzepatide for stronger effect.
Topiramate 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.Metformin and weight loss: a systematic review of non-diabetic use. Obes Surg, 2017
- 2.Topiramate for weight loss: clinical efficacy and safety review. Drugs Today, 2019
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.