Who cannot take Qsymia?: A Comprehensive Guide to Contraindications and Safety

October 7, 2025 •

4 min read

The U.S. Food and Drug Administration (FDA) has specific warnings and contraindications for Qsymia, particularly concerning serious birth defects. Understanding who cannot take Qsymia is crucial for preventing severe adverse reactions and ensuring treatment is both safe and effective.

Quick Summary

This article details the absolute contraindications and significant safety precautions for Qsymia, covering patient groups like pregnant women, individuals with glaucoma, and those with specific cardiovascular issues. It also outlines critical drug interactions and medical conditions that preclude or require cautious use of the medication.

Key Points

Pregnancy Risk: Qsymia is strictly contraindicated during pregnancy due to the risk of birth defects like cleft lip and palate.
Ocular Health: Patients with glaucoma should not take Qsymia, as it can cause serious eye problems, including secondary angle-closure glaucoma.
Thyroid Conditions: Individuals with an overactive thyroid (hyperthyroidism) must avoid Qsymia because its stimulant component can worsen their condition.
MAOI Interactions: Qsymia cannot be taken with or within 14 days of taking a Monoamine Oxidase Inhibitor (MAOI) due to the risk of a dangerous increase in blood pressure.
Cardiovascular and Mental Health Precautions: Caution is required for patients with a history of heart disease, uncontrolled blood pressure, depression, or suicidal ideation, and close monitoring is necessary.
Renal and Hepatic Considerations: Qsymia should be used with caution in patients with kidney or liver impairment, with dosage adjustments needed for moderate dysfunction and avoidance in severe cases.
Abrupt Withdrawal: Stopping Qsymia suddenly, especially at higher doses, can trigger seizures and requires a gradual tapering schedule.

Understanding Qsymia's Safety Profile

Qsymia is a prescription medication used for chronic weight management in adults and children (aged 12 and older) with obesity or in overweight adults with weight-related medical conditions. It is a combination of two drugs: phentermine, a stimulant that suppresses appetite, and topiramate, an anticonvulsant that can increase feelings of fullness and make foods taste less appealing. Due to its powerful active ingredients, Qsymia carries specific risks that make it unsuitable for certain individuals. A thorough medical evaluation by a healthcare provider is essential before starting this medication.

Absolute Contraindications for Qsymia

Certain medical conditions and situations represent absolute contraindications for Qsymia use, meaning the medication must not be taken. These are non-negotiable restrictions to avoid severe and potentially life-threatening side effects.

Pregnancy: Qsymia can cause serious birth defects, specifically cleft lip and cleft palate, if taken during the first trimester. A negative pregnancy test is required before starting treatment for women who can become pregnant, and they must use effective contraception consistently during therapy. If pregnancy occurs, Qsymia must be stopped immediately.
Glaucoma: The topiramate component of Qsymia can cause acute myopia and secondary angle-closure glaucoma, leading to sudden vision problems and potentially permanent vision loss. Patients with pre-existing glaucoma should not take Qsymia.
Hyperthyroidism (Overactive Thyroid): Qsymia contains phentermine, a sympathomimetic amine. These stimulants can worsen the symptoms of an overactive thyroid gland, making it unsafe for individuals with this condition.
Monoamine Oxidase Inhibitors (MAOIs): Taking Qsymia with MAOIs or within 14 days of stopping an MAOI is strictly forbidden due to the risk of a hypertensive crisis, a life-threatening increase in blood pressure.
Hypersensitivity or Idiosyncrasy: Individuals with a known allergy to phentermine, topiramate, or any other ingredients in Qsymia should not use the medication. The inactive ingredient FD&C Yellow No. 5 (tartrazine) can also trigger allergic reactions in susceptible individuals.

Significant Warnings and Precautions

Beyond the absolute contraindications, several conditions require extreme caution, dose adjustments, or heightened monitoring while taking Qsymia. These are not complete prohibitions but require careful medical oversight.

Cardiovascular Disease: The phentermine component can increase resting heart rate and blood pressure. Therefore, Qsymia use is not recommended for patients with recent or unstable cardiovascular or cerebrovascular disease. Patients with a history of cardiac arrhythmias should be closely monitored.
History of Depression or Suicidal Ideation: The topiramate component is associated with an increased risk of suicidal thoughts and behaviors. All patients must be monitored for new or worsening depression or unusual mood and behavior changes. It should be avoided in patients with a history of suicidal attempts or active suicidal ideation.
Renal and Hepatic Impairment: Patients with moderate or severe kidney impairment require a reduced maximum dose of Qsymia. The medication should be avoided entirely in patients with end-stage renal disease on dialysis and those with severe hepatic impairment.
Metabolic Acidosis and Kidney Stones: Qsymia can cause metabolic acidosis and increase the risk of kidney stones. Patients with a history of these conditions or those on a ketogenic diet need close monitoring of serum bicarbonate levels. Drinking plenty of fluids is recommended.
Cognitive Impairment: Patients may experience issues with concentration, memory, and speech, especially during the initial phase of treatment or with higher doses. Patients should be cautioned against operating hazardous machinery until they know how the medication affects them.

Qsymia Drug Interactions

Numerous drugs can interact with Qsymia, potentially increasing the risk of adverse effects. It is vital to provide your healthcare provider with a complete list of all medications, supplements, and vitamins you are taking.

CNS Depressants (e.g., alcohol): Can potentiate the CNS depressant effects of Qsymia, causing increased dizziness and drowsiness.
Oral Contraceptives: Qsymia can alter the exposure of hormones in birth control pills, potentially causing irregular bleeding. It's recommended to use an additional method of contraception.
Diuretics (Water Pills): Non-potassium-sparing diuretics taken with Qsymia can increase the risk of low potassium (hypokalemia).
Carbonic Anhydrase Inhibitors: Taking Qsymia with other carbonic anhydrase inhibitors can worsen metabolic acidosis and increase kidney stone risk.
Antidepressants (SSRIs): Concurrent use with SSRIs carries a low risk of serotonin syndrome.

Comparison of Qsymia's Contraindications and Precautions


Feature	Absolute Contraindications (Cannot take)	Precautions (Require Caution and Monitoring)
Patient Population	Pregnant women, women planning pregnancy, breastfeeding women, patients with glaucoma, hyperthyroidism, or MAOI use.	Women of reproductive potential (REMS program), patients with cardiovascular disease, history of depression or suicidal ideation, children (growth velocity).
Organ Systems	Eyes (glaucoma), Thyroid (hyperthyroidism), Fetal development (teratogenicity).	Heart (increased heart rate), Brain (suicidal thoughts, cognitive issues), Kidneys (metabolic acidosis, stones), Liver (hepatic impairment).
Drug Interactions	MAOIs.	CNS depressants, alcohol, oral contraceptives, certain diuretics, carbonic anhydrase inhibitors.
Severity	High risk of severe harm or death from medication.	Risk of serious side effects that can be managed or avoided with monitoring and dose adjustment.

Conclusion

While Qsymia is a valuable tool for chronic weight management for many, it is not suitable for everyone. The long list of contraindications and warnings underscores the importance of a thorough consultation with a healthcare provider before beginning treatment. Key groups, including pregnant women, those with glaucoma, hyperthyroidism, and patients using MAOIs, must avoid Qsymia due to the high risk of serious adverse effects. For other individuals, careful monitoring and consideration of existing medical conditions are necessary to minimize potential risks. Always disclose your full medical history and current medications to your doctor to ensure Qsymia is a safe option for you.

This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment.

Frequently Asked Questions

Yes, but with strict precautions. A woman who can become pregnant must have a negative pregnancy test before starting Qsymia and every month during treatment. She must also use effective contraception consistently.

Qsymia's phentermine component can increase resting heart rate and blood pressure, posing risks for individuals with underlying cardiovascular conditions, such as unstable cardiac or cerebrovascular disease.

If you become pregnant while on Qsymia, you must stop taking it immediately and contact your healthcare provider right away. All pregnancies must be reported to the Qsymia Pregnancy Surveillance Program.

It is not recommended to drink alcohol while taking Qsymia. Alcohol can increase the risk of side effects such as dizziness, drowsiness, and impaired concentration.

Patients with a history of depression may be at increased risk of mood problems with Qsymia. All patients should be monitored for suicidal thoughts or behavior, and the medication may be discontinued if symptoms develop.

You should contact your healthcare provider immediately. The topiramate in Qsymia can cause serious eye problems, and prompt treatment is necessary to prevent permanent vision loss.

Abruptly stopping Qsymia, particularly the topiramate component, can increase the risk of seizures. For patients on the highest dose, it must be tapered gradually under a doctor's supervision.