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
Farxiga
Qsymia vs. Farxiga Dosage
Qsymia
Farxiga
| 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 |
| 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
| 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
| 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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