Phentermine and topiramate (Qsymia)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization

  • Indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management.

Patients must meet the following criteria for the indications above:

  • BMI > 30 kg/m2 AND
  • At least one comorbid condition confirmed by chart note documentation/prescription data:
    • Hypertension
    • Diabetes
    • Hyperlipidemia

The following conditions do not meet the criteria for use as established by the WHA P&T Committee:

  • All non-FDA approved indications
  • Patients who are pregnant or may become pregnant during therapy

Dosing:

  • Initially 3.75 mg/23 mg once daily in the morning for 14 days, then increased to 7.5 mg/46 mg  once daily in the morning
  • Maximum dose 15 mg/92 mg once daily
  • Discontinue if weight loss >5% not achieved in 12 weeks
  • Discontinue 15 mg/92 mg dose gradually to prevent possible seizure

Approval:

  • Initial approval: 12 weeks
  • Renewal: 6 months
  • Renewal requires chart note documentation of reduction in patient weight

 

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.

Press Esc to cancel

El sitio Web al que está siendo transferido no es provisto por WHA. Las Condiciones de Uso y las Prácticas de Privacidad en Internet de WHA no se aplican a este sitio Web asociado que usted está usando. Revise las políticas sobre la privacidad y condiciones de uso de este sitio Web asociado. WHA no tiene control sobre la exactitud, la totalidad o la actualidad del contenido del sitio Web asociado. WHA no puede garantizar que los servicios de traducción de idiomas estarán disponibles en el sitio vinculado.

Presione «Esc» para cancelar