Short answer: Some carry warnings about a rare eye emergency. The Qsymia label warns of sudden nearsightedness with angle-closure glaucoma from topiramate, usually in the first month. The Contrave label says bupropion can widen the pupil and set off an angle-closure attack in people with narrow angles. Phentermine labels such as Lomaira list glaucoma as a reason not to take the medicine.
The Qsymia label describes a syndrome of acute myopia (sudden nearsightedness) with secondary angle-closure glaucoma, reported with topiramate (section 5.3). Symptoms are a sudden drop in sharpness of vision, eye pain, or both. An eye exam can show redness, a widened pupil, a shallow front chamber of the eye and raised eye pressure.
Symptoms typically start within 1 month of starting topiramate but can occur at any time. Unlike the usual form of angle-closure glaucoma, which is rare under 40, this form has been seen in children and adults. The main treatment is stopping Qsymia as fast as possible with the treating doctor. Untreated high eye pressure can lead to permanent vision loss.
Loss of parts of the visual field, separate from eye pressure, has also been reported; in trials most cases reversed after topiramate was stopped. The label says to consider stopping Qsymia if vision problems occur.
| Medicine | What the label says |
|---|---|
| Qsymia (phentermine and topiramate) | Warning: acute myopia and secondary angle-closure glaucoma; stop as fast as possible if it occurs (section 5.3) |
| Contrave (naltrexone and bupropion) | Warning: pupil widening from bupropion may trigger an angle-closure attack in people with narrow angles who have not had a patent iridectomy (section 5.9) |
| Lomaira (phentermine) | Glaucoma is listed among the contraindications (Contraindications) |
Narrow angles are a feature of eye shape that an eye doctor can check for. The Contrave warning applies to people with narrow angles who do not have a patent iridectomy, an opening in the iris.
MedlinePlus lists symptoms of angle-closure glaucoma that may come and go at first or get steadily worse:
The Qsymia label asks people to report severe, lasting eye pain or significant vision changes to their provider right away. GLP-1 medicines have different eye questions; see GLP-1 medicines and vision problems.
People with glaucoma, or who have been told they have narrow angles, can raise it before starting any of these medicines and ask whether an eye check makes sense first. Dose Track keeps the start date and each dose change, which helps when the Qsymia label points to the first month.
Read more on Dose Track: Qsymia side effects · Contrave side effects · Lomaira side effects · Lomaira vs Qsymia