WARNING

Compounded medications are not FDA-approved or evaluated for safety or efficacy but include active ingredients sourced from FDA-registered facilities. If you notice any changes in the appearance, color, or consistency of the medication, please contact your prescriber immediately before using it.

Do not use this medication if you are or suspect you may be allergic to any of the ingredients in the compounded product. Other ingredients include:

• Disodium phosphate dihydrate
• Sodium chloride
• Benzyl alcohol
• Hydrochloric acid
• Sodium hydroxide

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration: It is important to stay well hydrated and drink plenty of fluids while on this medication.
• Kidney problems/kidney failure: Vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis.
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see “Black Box Warning”).
• Pancreatitis: Severe pain in your abdomen or back that will not go away.
• Acute gallbladder disease: Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis, elevated liver enzymes, or jaundice.
• Diabetic retinopathy problems: Changes in vision in those with type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy.
• Severe gastrointestinal disease: May cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease.
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness): While this is rare with semaglutide, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams)—drink juice or regular soda, or eat some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylureas), it is best to talk to your health care provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidality.
• Never reuse or share needles, syringes, or vials.

SIDE EFFECTS

Many people experience no side effects while taking semaglutide. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased lipase or amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with other drugs that may lower blood sugar, such as insulin or insulin secretagogues such as sulfonylureas. Semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting semaglutide, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (i.e., warfarin) should be monitored closely while on semaglutide. Talk to your health care provider if you are taking levothyroxine before taking semaglutide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to compounded semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please get in touch with your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration; it is important to stay well hydrated and drink plenty of fluids while on this medication.
• Kidney problems/kidney failure: vomiting, nausea, and diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; it may sometimes lead to the need for hemodialysis.
• Severe stomach problems, including abdominal bloating or pain, acid reflux, a feeling of fullness after eating just a few bites of food, nausea, and vomiting, including vomiting undigested food eaten a few hours earlier. This may be a symptom of gastroparesis. Also tell your health care provider if you have stomach problems that will not go away.
• An inability to pass gas or stool is a symptom of possible bowel obstruction. Other symptoms may include severe abdominal pain, nausea, and vomiting.
• Thyroid C-cell tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below).
• Pancreatitis: Severe pain in your abdomen or back that will not go away.
• Acute gallbladder disease: Pain in the middle or right upper stomach, fever, white parts of your eyes or skin turning yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder are suspected, further studies are needed.
• Hepatitis, elevated liver enzymes/jaundice.
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems, may worsen in those with a history of diabetic retinopathy.
• Severe gastrointestinal disease: may cause gastrointestinal disease; do not it use if you have a history of severe gastrointestinal disease.
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness): While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams)—drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (e.g., sulfonylurea), it is best to talk to your health care provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidality.
• Note: Never share your Zepbound pen with other people.

SIDE EFFECTS INFORMATION

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased lipase or amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Zepbound can interact with alcohol and some prescription and non-prescription drugs and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Zepbound delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, before starting Zepbound please review the timing of taking it with your prescribing doctor as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (e.g., warfarin) should be monitored closely while on Zepbound.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions, and additional information.

To report suspected adverse reactions to Zepbound, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergency, please call 911 or go to the nearest emergency room.

Compounded medications are not FDA-approved or evaluated for safety or efficacy but include active ingredients sourced from FDA-registered facilities. If you notice any changes in the appearance, color, or consistency of the medication, please contact your prescriber immediately before using it.

Do not use this medication if you are or suspect you may be allergic to any of the ingredients in the compounded product. Other ingredients include: 

• vitamin B-6 (Pyridoxine HCL), 10 mg per tablet 
• sucralose

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience any of the following:

• Severe nausea and/or vomiting resulting in dehydration: It is important to stay well hydrated and drink plenty of fluids while on this medication. Dehydration may lead to low blood pressure or kidney problems. 
• Kidney problems/kidney failure: Vomiting, nausea, and diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis.
• Thyroid C-cell tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see “Black Box Warning” above).
• Pancreatitis: Severe pain in your abdomen or back that will not go away.
• Acute gallbladder disease: Pain in the middle or right upper stomach, fever, white parts of your eyes or skin turning yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected, further study is needed.
• Hepatitis, elevated liver enzymes, or jaundice.
• Diabetic retinopathy problems: Changes in vision in those with type 2 diabetes, particularly vision problems, may worsen in those with a history of diabetic retinopathy.
• Severe gastrointestinal disease: May cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease.
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness): While this is rare with semaglutide, if it occurs, please seek in-person care immediately. Do not drive if your blood sugar has been low. There is a greater chance of you having a crash. Very low blood sugar can lead to seizures, passing out, long-lasting brain damage, and sometimes death. It may be harder to control blood sugar during stress, such as fever, infection, injury, or surgery. A change in physical activity, exercise, or diet may also affect blood sugar. If you have symptoms of low blood sugar, try having liquid or food containing sugar (around 15-20 grams)—drink juice or regular soda, or eat some hard candies right away, as this will help raise your blood sugar quickly. Contact your care provider for instructions on how to manage low blood sugar. If compounded semaglutide is taken with insulin or an insulin secretagogue (i.e., sulfonylureas), it is best to talk to your health care provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidality.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.

Many people experience no side effects while taking semaglutide. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased lipase or amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. 

Too much vitamin B-6 taken for a year or longer can cause disease of the nervous system (neuropathy) and loss of control of voluntary body movements (ataxia). Symptoms usually stop if you stop taking B-6 as soon as symptoms appear. Too much vitamin B-6 can also cause painful skin lesions, sensitivity to light, nausea, and heartburn. 

For a complete list of side effects, review the medication packaging inserts.

This drug may prevent other drugs taken by mount from getting into the body. If you take other medications by mouth, you may need to stagger the timing with this drug.

As with other medications, semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with other drugs that may lower blood sugar, such as insulin or insulin secretagogues, such as sulfonylureas. Semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, before starting semaglutide, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it, as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (i.e., warfarin) should be monitored closely while on semaglutide. If you are taking levothyroxine, talk to your health care provider before starting semaglutide. 

Vitamin B-6 can interact with some medications, including cycloserine, antiepileptic drugs, and theophylline. 

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions, and additional information.

To report suspected adverse reactions to compounded semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Mounjaro® pen with other people

SIDE EFFECTS INFORMATION

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Mounjaro® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Mounjaro® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Mounjaro®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Mounjaro®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Mounjaro® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Wegovy® pen with other people

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Wegovy® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Wegovy® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Wegovy®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Wegovy®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Wegovy® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Ozempic® pen with other people

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Ozempic® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Ozempic® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Ozempic®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Ozempic®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Ozempic® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Trulicity® pen with other people

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Trulicity® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Trulicity® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Trulicity®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Trulicity®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Trulicity® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Saxenda® pen with other people

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Saxenda® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Saxenda® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Saxenda®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Saxenda®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Saxenda® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your health care provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Victoza® pen with other people

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Victoza® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Victoza® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Victoza®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Victoza®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Victoza® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with Type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality

SIDE EFFECTS

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with Type 2 diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

DRUG INTERACTIONS

As with other medications, Rybelsus® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Rybelsus® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Rybelsus®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Rybelsus®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Rybelsus® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Do not use this medication if you are or suspect you may be allergic to any of the ingredients in Contrave® including naltrexone and bupropion.

Notify your doctor if you experience:

• Anxiety
• Buzzing or ringing in ears
• Chest discomfort
• Confusion or trouble concentrating
• Depression
• Dry mouth
• Fainting
• Hallucinations
• Headaches
• Hyperventilation
• Impulsivity
• Irregular heartbeats
• Irritability
• Lightheadedness
• Mood or mental changes
• Restlessness
• Seizures
• Shaking
• Skin hives, rashes, or itching
• Suicidal thoughts
• Sweating
• Trouble sleeping
• Unusual tiredness
• Vision changes or eye pain

Stop using Contrave® and get medical help immediately if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat. 

Tell your health care provider about your medical history. You should not take Contrave® if you:

• Have uncontrolled high blood pressure
• Have anorexia or bulimia
• Have or have had seizures
• Use other medicines that contain bupropion such as Wellbutrin®, Wellbutrin® SR, Wellbutrin® XL, Aplenzin®, or Zyban®
• Are undergoing an abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs 
• Drink a lot of alcohol and abruptly stop drinking
• Have kidney disease
• Have liver disease (it may cause liver dysfunction or hepatitis)
• Are depressed or have suicidal feelings
• Have current or recent (within the past 7-14 days) use of opioids or opiate drugs

You should not take Contrave® under these circumstances either:

• If you’re pregnant, breastfeeding, or planning to become pregnant
• If you’ve taken an MAOI (monoamine oxidase inhibitor), such as Nardil®, Parnate®, or Marplan® in the past 14 days
• If you’re taking any opioids or opiate drugs
• If you’re dependent on opioids or using methadone or buprenorphine
• If you are in opioid withdrawal

If you take opioids or opiates right after stopping Contrave®, you may be more sensitive to them and require lower doses—which poses a risk of overdose. Please talk to your provider before initiating any opioids or opiates after stopping Contrave®.

‍

While some people experience no side effects while taking Contrave®. Some of the most common side effects are:

• Nausea
• Constipation
• Headache
• Vomiting
• Dizziness
• Insomnia
• Dry mouth
• Diarrhea
• Anxiety
• Hot flushes
• Fatigue
• Tremors
• Upper abdominal pain
• Viral gastroenteritis
• Influenza (flu) 
• Tinnitus (ringing in the ears) 
• Urinary tract infection 
• Excessive sweating
• Irritability
• Increased blood pressure
• Changes in taste and smell 
• Rashes 
• Muscle strains
• Palpitations (heart racing)  

Additional but less common side effects may include:

Fast heart rate, heart attack, dizziness, motion sickness, lower abdominal pain, gas, lip swelling, rectal bleeding, hernia, inflamed gallbladder, pneumonia, staph infection, kidney infection, increased blood creatinine, increased hepatic enzymes, decreased hematocrit, feeling jittery, feeling abnormal, feeling weak or a loss of energy, thirst, feeling hot, disturbance in attention, feeling sleepy, tremors, balance disorder, impaired memory, amnesia, abnormal dreams, nervousness, feeling spacey, tension, agitation, mood swings, abnormal and frequent urination, dehydration, bulging or herniated discs, jaw pain, feeling faint, hair loss, erectile dysfunction, vaginal dryness, and irregular menstrual cycles (periods).

These symptoms often subside as your body adjusts to the medication. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

‍

If you take diabetes medications, please discuss this with your prescribing clinician before taking Contrave® since your diabetes medications may need to be adjusted as you lose weight. 

As with other medications, Contrave® can interact with alcohol and certain prescription and OTC medications and herbal products. Some drugs and other substances can interact with Contrave®, including alcohol, MAOIs (like isocarboxazid, linezolid, phenelzine, selegiline, or tranylcypromine), drugs that increase dopamine levels in your system (like levodopa and amantadine), drugs that affect the central nervous system (like antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medication), drugs for depression or anxiety, antipsychotics, theophylline, systemic corticosteroids, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder (ADHD), medicine for seizures or barbiturates, muscle relaxants, anesthetics, including some dental anesthetics, dextromethorphan, diarrhea medication (such as diphenoxylate), disulfiram, opioid pain or cough relievers (such as codeine and hydrocodone), thioridazine.

Avoid drinking alcohol while taking Contrave®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions, and additional information.

To report suspected adverse reactions to Contrave®, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Before using metformin, tell your health care provider about your medical history, especially if you have:

• kidney disease
• heart disease or congestive heart failure
• liver disease
• metabolic acidosis or diabetic ketoacidosis
• high ketone levels in your blood or urine
• you use insulin or other diabetes medications

Talk to your health care provider if you are planning to become pregnant or if pregnant or breastfeeding. Avoid alcohol while taking this medication. Talk to your health care provider about discontinuing metformin prior to a surgical procedure or an iodinated contrast imaging procedure. Stop metformin and notify your health care provider immediately if you have an illness with severe diarrhea and/or vomiting resulting in dehydration.

SIDE EFFECTS

Many people experience no side effects while taking metformin. The most common side effects of metformin include:

• diarrhea
• nausea/vomiting
• upset stomach (gas, bloating, and stomach cramps)

These symptoms may subside after the body adjusts to the medication. Taking your medicine with the evening meal can help reduce these side effects.

Additional but rare side effects include:

• low blood sugar (hypoglycemia)
• feeling cold
• unusual muscle pain
• dizziness
• slow or irregular heart rate
• trouble breathing
• metallic taste
• changes to nails on fingers and toes
• Low b12 levels

DRUG INTERACTIONS

As with other medications, metformin can interact with alcohol and certain medications, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, corticosteroids, hormone replacement therapy and estrogens, oral contraceptives, carbonic anhydrase inhibitors, nifedipine, thiazides or furosemide and other diuretics, phenothiazines, phenytoin, nicotinic acid (niacin), multidrug and toxin extrusion inhibitors, sympathomimetics, calcium channel blockers, isoniazid (antibiotic for tuberculosis), insulin and glyburide or other medications for diabetes, and medications for thyroid disease.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to metformin contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

DO NOT take zonisamide if you have an allergy to sulfa drugs. A potentially fatal reaction can occur including a life threatening skin rash or a blood cell condition.

Before using zonisamide, tell your health care provider about your medical history, especially if you have:

• kidney disease
• liver disease
• long-term diarrhea
• lung or breathing problems
• metabolic acidosis or diabetic ketoacidosis
• high ketone levels in your blood or urine
• you use insulin or other diabetes medications
• history of psychiatric disorders or suicidal thoughts
  

Talk to your health care provider if you are planning to become pregnant or if pregnant or breastfeeding. Avoid alcohol and stay well hydrated while taking this medication. Do not drive, operate heavy machinery or perform any hazardous task until the effects of this medication are known to you. Tell your health care provider right away if you experience eye pain, changes in vision, eye swelling or redness, yellowing of the eyes, confusion, difficulty concentrating, suicidal thoughts, memory problems, trouble thinking clearly, agitation, irritability, speech problems, decreased sweating, sudden flank pain, painful urination, dark urine, increased fatigue, skin rash, faintness, easy bruising, irregular or fast heartbeat, bone pain, rapid breathing, dizziness, or stomach pain that is severe or that lasts more than a few days.

SIDE EFFECTS

Many people experience no side effects while taking zonisamide. The most common side effects of zonisamide include:

• dizziness and lightheadedness
• fatigue and drowsiness
• language and speech difficulty
• metallic taste
• nausea

Other possible side effects include:

• trouble sleeping
• lack of coordination
• loss of appetite and weight loss
• diarrhea
• double vision
• mood changes such as depression or irritability
• difficulty concentrating

These symptoms may subside after your body adjusts to the medication.

DRUG INTERACTIONS

As with other medications, zonisamide can interact with certain medications, including carbonic anhydrase inhibitors (such as acetazolamide), orlistat (if using zonisamide for a seizure disorder), phenobarbital, primidone, rifamycins, glucocorticoids, and St. John's wort.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. Do not stop taking this medication without consulting your healthcare provider because some conditions may become worse when the drug is suddenly stopped.

To report suspected adverse reactions to zonisamide contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

WARNING

Before using topiramate, tell your health care provider about your medical history, especially if you have:

• narrow angle glaucoma and nearsightedness
• kidney problems, such as kidney stones
• liver problems
• depression or thoughts of suicide
• lung or breathing problems
• metabolic acidosis
• high blood ammonia levels
• long-term diarrhea
• low body temperature
• a diet high in fat and low in carbohydrates, aka a ketogenic diet
• brittle bones

Topiramate may cause some people to sweat less. It is recommended to avoid alcohol and stay well hydrated while taking this medication.This drug may make you dizzy or drowsy or impair your judgment. Please do not drive, operate heavy machinery, or perform any hazardous task until the effects of topiramate are known to you. For anyone taking diabetes medications, please have a discussion with your prescribing clinician prior to taking topiramate as your diabetes medications may need to be adjusted as you lose weight.

Topiramate may also cause birth defects (particularly there is a risk of cleft lip and/or palate and low birth weight). Topiramate may cause breakthrough bleeding. DO NOT take topiramate if you are planning to become pregnant or if pregnant or breastfeeding.

SIDE EFFECTS

Many people experience no side effects while taking topiramate. Some of the most common side effects (but not extremely frequent) are:

• anorexia
• weight loss
• dizziness
• fatigue or drowsiness
• difficulty with concentration and psychomotor slowing
• speech difficulty
• nervousness
• tingling or prickling sensations
• abnormal vision
• fever

Additional side effects include:

• difficulty with memory
• changes in taste
• diarrhea
• numbness
• nausea
• abdominal pain
• upper respiratory tract infection
• hair loss
• changes in mood/suicidal thoughts

These symptoms may subside after the body adjusts to the medication.

DRUG INTERACTIONS

As with other medications, topiramate can interact with alcohol, marijuana and certain medications, including antiepileptic drugs, CNS depressants, oral contraceptives, lithium, other carbonic anhydrase inhibitors, hydrochlorothiazide, pioglitazone and amitriptyline. Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to topiramate contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.