Qsymia vs. Farxiga

See how Qsymia and Farxiga compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Qsymia is FDA-approved for chronic weight management, while Farxiga is approved for type 2 diabetes, heart failure, and chronic kidney disease, not weight loss.

  • Qsymia is a Schedule IV controlled substance dispensed only through certified REMS pharmacies, while Farxiga is a standard prescription tablet with no such restrictions.

  • Farxiga can lead to modest weight loss as a side effect in diabetes and heart failure trials, but using it specifically for weight loss would be off-label.

Qsymia vs. Farxiga Drug Summary

Qsymia

Qsymia combines phentermine, a stimulant appetite suppressant, with topiramate, an anticonvulsant, in one daily extended-release capsule. It is FDA-approved for chronic weight management in adults with obesity or overweight plus a weight-related condition, and in adolescents 12 and older with obesity. The dose is increased gradually over about 16 weeks to reach a maintenance level.

Farxiga

Farxiga (dapagliflozin) is an SGLT2 inhibitor tablet taken once daily. It is FDA-approved to lower blood sugar in type 2 diabetes, reduce heart failure hospitalizations, and slow chronic kidney disease progression, not for weight loss. Any weight reduction seen in trials is a secondary effect rather than an approved use.

Qsymia vs. Farxiga Side Effects

Qsymia

Most common
paresthesia (up to 21%)
dry mouth (up to 19%)
constipation (up to 16%)
insomnia (up to 11%)

Farxiga

Most common
female genital mycotic infxn (up to 6.9%)
nasopharyngitis (up to 6.3%)
urinary tract infections (up to 4.3%)
back pain (up to 4.2%)

Qsymia vs. Farxiga Dosage

Qsymia

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 3.75 mg/23 mg once daily Days 1-14
Maximum dose 15 mg/92 mg once daily Week 17 onward
Dose changes 3 increases As tolerated

Farxiga

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 10 mg once daily If needed
Dose changes 1 increase As tolerated

Qsymia vs. Farxiga Indications

Qsymia

Qsymia is approved for long-term weight management alongside diet and exercise. It works by suppressing appetite and increasing feelings of fullness through combined stimulant and anticonvulsant effects.

  • Chronic weight management in adults with obesity

  • Chronic weight management in adults who are overweight with a weight-related condition

  • Chronic weight management in adolescents 12 and older with obesity

Farxiga

Farxiga is approved to manage blood sugar in type 2 diabetes and to protect the heart and kidneys in at-risk patients. It is not indicated for weight loss, though some patients lose a modest amount of weight while taking it.

  • Blood sugar control in adults and children 10 and older with type 2 diabetes

  • Reducing heart failure hospitalization risk in type 2 diabetes with cardiovascular risk

  • Treating heart failure to reduce cardiovascular death and hospitalization

Qsymia vs. Farxiga Pros and Cons

Qsymia

Qsymia produces some of the largest average weight loss seen with oral weight-loss medications, but it is a controlled substance available only through certified REMS pharmacies. It also carries contraindications for pregnancy, glaucoma, and hyperthyroidism that require careful screening before starting.

Pros

  • Associated with substantial average weight loss in trials

  • Once-daily oral capsule, no injections

  • Long track record since its 2012 approval

Cons

  • Schedule IV controlled substance with abuse potential

  • Requires REMS enrollment and dispensing through certified pharmacies

  • Not safe in pregnancy; requires monthly pregnancy testing

  • Roughly $200 to $350 per month without insurance, before savings programs

Farxiga

Farxiga offers proven cardiovascular and kidney protection beyond blood sugar control, benefits Qsymia does not provide. It is not a controlled substance, but genitourinary infections and volume depletion require monitoring, especially in older or kidney-impaired patients.

Pros

  • Reduces heart failure hospitalization and cardiovascular death risk

  • Slows chronic kidney disease progression

  • Not a controlled substance, no REMS requirement

Cons

  • Risk of genital yeast infections and urinary tract infections

  • Rare but serious risk of Fournier's gangrene

  • Not recommended in severe kidney impairment or on dialysis

  • Roughly $400 to $785 per month without insurance, before savings programs

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