Does Off-Label Topiramate Support Weight Management?
Several studies have demonstrated how topiramate can help with weight loss. One randomized controlled trial compared topiramate to a placebo in 385 patients ages 18 to 75 with a body mass index (BMI) between 30 and 50. The patients who were given topiramate took four doses ranging between 64 and 384 milligrams. The study found that all four doses led to significant weight loss compared with the placebo group, with higher doses corresponding to greater weight loss. Research has also shown it to be well tolerated, causing few side effects.
Ann Rogers, MD, a bariatric surgeon and weight loss expert at Penn State Health in Middletown, Pennsylvania, says that off-label drug use isn’t uncommon. This means that a doctor has decided that there is a good reason to use the drug for a purpose other than its FDA-approved use.
“Doctors will find out that certain medications do certain things effectively, and then will start using them for that purpose,” Dr. Rogers says. “Part of the reason that topiramate may not be FDA-approved for weight loss is that although research has found that it can be effective, researchers don’t yet fully understand how it achieves this weight loss effect.”
A doctor might prescribe topiramate for weight loss if other options haven’t worked, have led to severe side effects, or are too costly for the patient, she adds.
“It all comes down to what insurance will cover, what works, and what the patient can afford,” Rogers says. “If a patient also lives with migraine, a doctor might choose topiramate to try to achieve both effects with a single medication.”
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