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Topiramate is not a controlled substance, but it carries its own regulatory requirements, including the REMS (Risk Evaluation and Mitigation Strategy) program that Qsymia must follow due to the risk of birth defects

In obese patients, acipimox can inhibit adipose tissue lipolysis by activating protein upregulated in macrophage by INF- (PUMA-G) (also known as the hydroxycarboxylic acid receptor 2 [HCA2] and GPR109a) receptors

Clinically, PCOS patients exhibit reduced gut microbial -diversity, an elevated Bacteroidetes-to-Firmicutes ratio, and decreased abundance of beneficial bacteria such as Akkermansia muciniphila

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In comparison to placebos, these adverse effects were reported more frequently in several trials clinically, although not always markedly different from active comparator groups [77]