Obesity is one of the most perplexing problems we treat as internists. The condition is associated with high morbidity and mortality, and yet the cause is one of the most basic of all human pleasures: eating. No wonder we are all hoping for a magic bullet.
Zonisamide at a daily dose of 400 mg, combined with diet and lifestyle counseling, provided moderately successful weight loss in this trial (7.3 kg [3.3 kg more than placebo] at 1 year) as it did in prior trials. The problem is that the adverse effects at this dose are substantial: 18.7% of patients experienced headache, 13.3% experienced nausea/vomiting, 9.3% experienced anxiety, and 10.7% experienced impaired memory.
Katz MH. ZonisamideComment on “Zonisamide for Weight Reduction in Obese Adults: A 1-Year Randomized Controlled Trial”. Arch Intern Med. 2012;172(20):1565. doi:10.1001/2013.jamainternmed.108