Short answer: It can. In the label's 1-year adult trials, mood and sleep side effects were reported by 15% on the 7.5 mg/46 mg dose and 21% on 15 mg/92 mg, against 10% on placebo. Problems with attention, memory or finding words were reported by 5.0% and 7.6%, against 1.5%. The label also carries the warning on suicidal thoughts that applies to seizure medicines such as topiramate.
The label groups mood and sleep side effects together (sections 5.4, 6.1). They occurred in people with and without a history of depression.
| Side effect | Placebo | Qsymia 7.5 mg/46 mg | Qsymia 15 mg/92 mg |
|---|---|---|---|
| Any mood or sleep side effect | 10% | 15% | 21% |
| Sleep problems, mostly insomnia | 5.8% | 8.1% | 11% |
| Anxiety | 2.6% | 4.8% | 7.9% |
| Depression or mood problems | 3.4% | 3.8% | 7.6% |
The label says people with past depression may be at higher risk of it coming back, and that a lower dose or stopping is considered for symptoms that are significant or do not go away.
In the same trials, 5.0% on 7.5 mg/46 mg and 7.6% on 15 mg/92 mg reported one or more thinking-related side effects, against 1.5% on placebo (section 6.1). These were mostly problems with attention or concentration, memory, and language, especially finding words. They occurred at any time during treatment.
The label says raising the dose quickly or starting high may bring higher rates (section 5.5). Alcohol and other medicines that slow the brain, such as sleeping pills and benzodiazepines, may add dizziness, drowsiness and thinking problems. It advises caution with driving or machinery until people know how Qsymia affects them.
Topiramate is a seizure medicine, and the label repeats the class warning for seizure medicines (section 5.2). In a pooled analysis of 199 placebo-controlled trials of 11 such drugs, the risk of suicidal thinking or behavior was about twice that on placebo: 0.43% against 0.24%, about one extra case for every 530 people treated. The rise showed as early as 1 week after starting.
In a trial in teenagers, 1 of 167 on Qsymia (0.6%) had suicidal thoughts and behavior that needed a hospital stay, and none on placebo did. The label says to avoid Qsymia in people with past suicide attempts or current suicidal thoughts, and to stop it if such thoughts appear. See GLP-1 medicines and suicidal thoughts for how a different drug class handles this question.
The label asks people to tell their provider right away about mood changes, depression or suicidal thoughts, and about changes in attention, concentration or memory. MedlinePlus adds signs for family or caregivers to watch for, including panic attacks, agitation, new or worse irritability, anxiety or depression, trouble sleeping, and withdrawing from friends and family. A short daily note on sleep, mood and focus, with the dose and date of each increase, can show whether a change lined up with a dose step. Dose Track keeps those notes next to the dose log.
Read more on Dose Track: Qsymia side effects · Qsymia dosing schedule · Phentermine-topiramate · Placebo