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Mark Holland MD Qnexa Interview

Interview Mark Holland MD About Qsymia

Q: What is Qsymia and why should anyone care?
A: Qnexa is a new weight loss drug made by combining two older medications into one dose. People may care about this because because it appears to actually work better than each single medication by itself.

Q: So Qsymia is effective? It really works?
A: Yes.

Q: And it works better than any other weight loss in history?
A: Whoa! I didn't say that. Studies show that Qsymia helps many people lose up to about 10% of their starting body weight. That's certainly not a miracle drug, but it is among the more effective agents we've seen in a long time.

Q: 10%? So if I weigh, say 250 pounds, then if I take Qsymia I could expect to lose about 25 pounds and end up weighing about 225 pounds?
A: Yes.

Q: Couldn't I do the same thing just by eating right and exercising?
A: Yes. You could in fact do a lot better than 10%

Q: So why on Earth would anyone want to take Qsymia when he or she could do it with lifestyle changes?
A: First of all because some (but not all) of the 10% weight loss seen with Qsymia will be added to whatever weight loss people achieve through lifestyle changes.

Q: So if I lose 50 pounds with diet and exercise and end up weighing about 200 pounds and THEN I take Qsymia, I'll lose about 10% MORE weight.... which is about 20 more pounds... and end up weighing about 180?
A: Provided that you continue to make the lifestyle changes that got you to 200 pounds in the first place.

---" I think that the dosages are all wrong in Qsymia."

Q: OK. So in a sense, Qsymia might get me a "free ride" of about 10% more weight loss?
A: You could put it that way I suppose. That at least is the basic concept behind all medical weight loss.

Q: So medical weight loss, using medications like Qsymia to help people get thinner, isn't about using medication instead of lifestyle but rather in ADDITION to lifestyle.
A: Precisely.

Q: Aren't there a lot of other weight loss drugs already on the market?
A: There are a handful of weight loss drugs on the US market, yes.

Q: Do they work too?
A: Yes, they do, sometimes very well. In fact phentermine is a weight loss drug that has been on the market in the US since 1959. Phentermine is also one of the two ingredients in Qsymia.

Q: Isn't phentermine part of Fen-Phen?
A: Fen-Phen was a combination of fenfluramine and phentermine. Yes.

Q: But fen-phen caused heart damage. Why would anyone ever take such a dangerous medication?
A: Fen-phen DID cause heart valve damage in some of the patients who took it, but the phentermine had nothing to with it. The dangers of fen-phen were all caused by the OTHER "fen", a drug called fenfluramine or Pondimin. Phentermine, as I said, has been on the US market since 1959 and has an excellent safety record. 

Q: So back to Qnexa. I notice from reading your website that you are not exactly a fan of the drug. Why is that?
A: I think that the dosages are all wrong in Qsymia.

Q: What do you mean?
A: Qnexa uses VERY low dosages of phentermine and relatively high doses of topiramate. In my experience with these two drugs, and I have used the combination "off-label" for weight loss for over 14 years, the combination works much better if one uses standard (higher) doses of phentermine and lower doses of topiramate. Furthermore, this reduces the unpleasant side effects of topiramate. Qsymia is basically topiramate with a tiny amount of phentermine and it's going to produce the same side effects as pure topiramate.

Q: So if I understand correctly, you don't object to the idea of combining phentermine and topiramate per-se, just to the way these medications are prescribed in Qnexa?
A: Exactly. As I said, I have had very good results with phentermine and topiramate combined, but not in the doses used in Qsymia.

Q: So what are the side effects of Qnexa?
A: They'll be the same as topiramate alone: sedation, foggy thinking, numbness and tingling.

Q: That sounds terrible.
A; It can be pretty bad for some people. Patients who have taken higher doses of topiramate for migraine headaches often refer to the drug as "dopamax".

----"...most "experts" expect it to cost about $4 to $6 per day, perhaps more."

Q: Still, you have used it for years?
A: As I said, I have prescribed higher-doses of phentermine and lower doses of topiramate and people do well with that.

Q: Let's move on to a different subject. When will Qsymia be available?
A: Probably by the end of this year.

Q: Will you prescribe it?
A: Yes, but as I have said here over and over again, I basically already AM prescribing it and HAVE been prescribing it for years, but in dosages that I strongly believe work better.

Q: How much will Qsymiacost?
A: I have no idea but most "experts" expect it to cost about $4 to $6 per day, perhaps more.

Q: Yikes! How will people afford that?
A: Unless covered by medical insurance, and that remains to be determined, most people probably can't afford Qsymia.