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When added to metformin, the GLP-1 receptor agonists achieve a mean HbA1c reduction of 0.99%,28 together with a significant weight loss (expected 2.9kg on average).40 The GLP-1 receptor agonists do not induce hypoglycemia when administered in monotherapy

Therefore, women of childbearing age should be advised that significant weight loss may increase fertility, requiring effective contraception

Healthcare providers may avoid prescribing topiramate for individuals with: A history of suicidal thoughts or behaviors A history of kidney stones Metabolic acidosis Bone conditions like osteopenia, osteomalacia, or osteoporosis Glaucoma Respiratory issues like asthma or COPD Depression or mood disorders Growth problems Thyroid disease Liver disease Kidney diseases Topiramate can increase the risk of kidney stones, so it's essential to stay well-hydrated while taking the medication