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Additionally, use caution when prescribing topiramate to pregnant women (increased risk of cleft palate) and to women on birth control pills (topiramate induces the metabolism of estrogen and can diminish the efficacy of the contraceptive)

People using oral contraception should either: Switch to a non-oral method, or Use a barrier method for 4 weeks after initiation and 4 weeks after each dose escalation Given the titration schedule, that can mean several months of backup contraception

Stress management High stress and elevated cortisol can interfere with hormonal balance

So far so good, dropped 8lbs in 2 weeks

Conversely, some case reports for exenatide 181 and semaglutide 182 described onset or relapse of depressive symptoms, which resolved when the GLP-1RAs were stopped 181,182 and recurred on medication rechallenge 181