I agree Topamax can cause cognitive effects in some people - I can personally attest to that because I tried it for migraine prophylaxis. I stopped taking it because of word finding difficulties - sometimes couldn't think of simple words. The issue cleared up as soon as I stopped the drug. I consistently lost weight on the drug - just felt full and stopped eating sooner than normal.
But the doses here are much lower than for migraine or epilepsy, and it looks like cognitive AE's are in the 1% range for the low and mid dose. That's certainly acceptable. Ditto for the parathesias. But the key is that virtually all the side effects stop if you stop the drug. (Topamax does have a few more serious, albeit rare, side effects, including increased numbers of kidney stones).
In the 1-year studies, completion rates were higher on the drug than on placebo. That speaks to overall tolerability. Certainly the side effects in the low and mid-range doses are acceptable, and both of those give better weight loss than Arena's drug.
Ultimately I would expect to see Arena's drug used with phentermine. That would make it more comparable to Qnexa and Contrave in terms of efficacy.
Peter
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