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Most providers plan dose escalation every 4 weeks if well-tolerated

Smalley SG, Barrow PA, Foster N

Topiramate is associated with cognitive side effects including difficulty concentrating, memory problems, confusion, and slowed thinkingsometimes referred to colloquially as "Topamax fog"

various eye and vision abnormalities such as decreased blink rate, dry eyes, deficient ocular pursuit (eye tracking) and saccadic movements (fast automatic movements of both eyes in the same direction), difficulties in directing gaze upward, and blurred or double vision

Another issue is that compounded semaglutide tends to come in a vial instead of a pre-filled pen, which means patients must measure out their dose using a syringe