Status checked on October 6, 2026 dailymed.nlm.nih.gov
Qsymia (phentermine/topiramate ER): who it is for, how it works, trial results in adults and teens, REMS and pregnancy testing, side effects, serious risks, generics and dated prices.
Fact-checked against FDA labels and official sources; not yet reviewed by a licensed clinician. This page is education, not medical advice. Talk to your doctor before starting, stopping or changing any treatment.
Key facts
- Class
- Sympathomimetic amine
- Route
- Capsule
- How often
- Daily
- Manufacturer
- Vivus
- Approved for weight
- Yes
- First approved
- 2012
- Generic available
- Yes
- Controlled substance
- Schedule IV
- Official label
- Prescribing information
Key takeaways
- Qsymia combines phentermine and extended-release topiramate and is FDA approved for long-term weight management in adults and in children 12 and older with obesity.[1]
- In one-year trials, average weight loss on the top dose was 9.8% to 10.9% vs 1.2% to 1.6% on placebo.[1]
- Topiramate can cause birth defects, so Qsymia is dispensed only by certified pharmacies (REMS), with pregnancy tests before and monthly during treatment.[1]
- Tingling, dry mouth, constipation, altered taste, insomnia and dizziness are common; mood, thinking, eye, kidney-stone and acidosis risks need monitoring, and the top dose is tapered when stopping.[1]
- The manufacturer listed $74.99 for a 30-day home-delivery prescription for cash payers on 2026-10-06; generic versions are FDA approved.[4]
In short: Qsymia is a once-daily capsule that combines low-dose phentermine (an appetite suppressant) with extended-release topiramate (a seizure and migraine medicine). It has been FDA approved since July 17, 2012 for long-term weight management with a reduced-calorie diet and more activity, in adults with obesity or with overweight and a weight-related condition, and since June 2022 in children 12 and older with obesity. Because topiramate can cause birth defects, Qsymia is only available through certified pharmacies under a safety program (REMS), and pregnancy tests are recommended before and every month during treatment for anyone who can become pregnant (label checked on DailyMed on 2026-10-06).
Qsymia is one of the more effective non-GLP-1 weight-loss pills in clinical trials, and generic versions now exist. It also has more safety steps than most: lab tests, pregnancy testing, a tapering rule when stopping, and a long list of possible side effects affecting mood, thinking, eyes and kidneys. This page explains what the official prescribing information says about all of it. It is general education, not personal medical advice. Please research your options, talk with a licensed doctor and get a full evaluation before considering it.
Qsymia at a glance
- 2012first FDA approval (July 17)Drugs@FDA, NDA 022580
- 10.9%average weight loss at one year on the top dose in Study 1 (placebo 1.6%)Qsymia label (DailyMed)
- Monthlypregnancy tests recommended during treatment for anyone who can become pregnantQsymia label (DailyMed)
- Schedule IVcontrolled substance, because it contains phentermineQsymia label (DailyMed)
Checked on October 6, 2026
What Qsymia is and how it works
Each capsule contains two medicines. Phentermine is a stimulant-type appetite suppressant; the label says its effect is likely mediated by the release of brain messengers in the hypothalamus that reduce appetite and food intake. Topiramate is an antiseizure medicine whose effect on weight “is not known” precisely; the label suggests it may both suppress appetite and increase fullness through several actions on brain chemistry. The combination is approved as its own product, which is different from combining separate phentermine and topiramate pills.
The combination matters. In a 28-week trial published in Obesity in 2013 (Aronne and colleagues), the share of adults who lost at least 5% of their weight was 15.5% on placebo, 43% to 46% on phentermine alone, 39% to 49% on topiramate alone, and 62% to 66% on the two combination doses, suggesting the pair works better together than either part alone.
FDA status and who it is labeled for
Drugs@FDA shows the original approval on July 17, 2012 (NDA 022580) and a new indication on June 24, 2022 that added children. The current label covers adults and children 12 and older with obesity, and adults with overweight plus at least one weight-related condition, always with a reduced-calorie diet and more physical activity. The label adds that its effect on heart attacks, strokes and deaths “has not been established,” and that its safety with other weight-loss products, including over-the-counter and herbal products, has not been established. Drugs@FDA also lists approved generic versions rated as therapeutically equivalent (AB). Our BMI calculator can show where you stand; whether Qsymia fits you is a decision for you and your clinician.
Who should not take Qsymia
- Anyone who is pregnant
- People with glaucoma
- People with hyperthyroidism (an overactive thyroid)
- Anyone taking an MAOI, or within 14 days of stopping one
- Anyone with a known allergy to phentermine, topiramate or any ingredient, or sensitivity to stimulant amines
The label also says to avoid it in people with a history of suicide attempts or active suicidal thoughts, to avoid it with end-stage kidney disease on dialysis or severe liver impairment, and to limit the dose with moderate or severe kidney impairment or moderate liver impairment. It contains the dye FD&C Yellow No. 5 (tartrazine), which can cause allergic-type reactions in some people, particularly those sensitive to aspirin.
The safety steps: REMS, pregnancy tests and labs
What the label asks for before and during treatment
- Pregnancy test firstA negative pregnancy test before starting, for anyone who can become pregnant, plus effective contraception.
- Monthly testsPregnancy tests every month during treatment.
- Blood chemistryBicarbonate, creatinine and potassium before starting and periodically, plus glucose for people with type 2 diabetes on medicines.
- Certified pharmacyQsymia is dispensed only by pharmacies certified in the Qsymia REMS program.
- Taper to stopThe top dose is stopped gradually, every other day for at least a week, because sudden withdrawal of topiramate can trigger seizures.
The reason for these steps is embryo-fetal toxicity. Data from pregnancy registries and studies show that babies exposed to topiramate in the first trimester have a higher risk of major birth defects, including cleft lip and cleft palate, and of being small for gestational age. Under the REMS (Risk Evaluation and Mitigation Strategy), only certified pharmacies may distribute Qsymia; more information is at QSYMIAREMS.com. Qsymia can cause irregular bleeding with combined birth control pills, but the label says this is not expected to raise the risk of pregnancy; do not stop the pill if spotting occurs, and tell your clinician.
How it is taken, in general
Qsymia is taken once a day in the morning, with or without food; evening doses can cause insomnia. The label describes starting at the lowest strength for 14 days, then a standard dose. After 12 weeks, if an adult has not lost at least 3% of their weight (or a teen has not reduced BMI by at least 3%), the dose can be stepped up through a transition strength to the highest dose. After 12 weeks on the highest dose, if at least 5% has not been lost, Qsymia should be stopped gradually, because further benefit is unlikely. For teens, the label also says to consider a lower dose if weight loss exceeds 2 lb (0.9 kg) a week. Your prescriber chooses the strength and timing; never adjust it yourself.
What the trials showed in adults
Two one-year trials, each with a reduced-calorie diet and lifestyle advice, are summarized in the label. Study 1 (NCT00554216) enrolled 1,267 adults with a BMI of 35 or more (average starting weight 116 kg) and no diabetes. Study 2 (NCT00553787) enrolled 2,487 adults with a BMI of 27 to 45 and at least two weight-related conditions, including 388 with type 2 diabetes. About 40% (Study 1) and 31% (Study 2) left before the end.
| Item | Placebo | Standard dose 7.5-46 mg | Top dose 15-92 mg |
|---|---|---|---|
| Study 2, lost 5% or more | 21% | 62% | 70% |
| Study 2, lost 10% or more | 7% | 37% | 48% |
Study 2: 2,487 adults with overweight or obesity and two or more weight-related conditions. In Study 1, 67% on the top dose lost 5% or more, vs 17% on placebo.
Source: Qsymia prescribing information, Table 10 (DailyMed) (checked on October 6, 2026)
Waist size fell by 10.9 cm on the top dose versus 3.1 cm on placebo in Study 1, and blood pressure, triglycerides and HDL cholesterol improved modestly. In people with type 2 diabetes in Study 2 (starting HbA1c 6.8%), HbA1c fell by 0.4 points on Qsymia versus 0.1 on placebo. Resting heart rate rose slightly, by 1 to 2 beats per minute on average.
What the trial showed in teens
In a 56-week trial of 223 adolescents aged 12 to 17 with obesity (NCT03922945; average BMI 38, about 81% with severe obesity), BMI rose by 3.3% on placebo and fell by 4.8% on the standard dose and 7.1% on the top dose. A BMI drop of at least 10% was reached by 4.5% on placebo, 33.5% on the standard dose and 44.4% on the top dose. The label notes slower growth in height in teens on Qsymia (1.3 to 1.4 cm a year less than placebo), one hospitalization for suicidal thoughts, and more mood and sleep side effects, so height and mood should be monitored. A pediatric specialist should be involved.
Side effects
The most characteristic side effects are tingling in the hands, feet or face (paraesthesia), dry mouth, constipation, a metallic or altered taste (dysgeusia), insomnia and dizziness. They become more common as the dose rises:
| Item | Placebo | Lowest dose 3.75-23 mg | Standard dose 7.5-46 mg | Top dose 15-92 mg |
|---|---|---|---|---|
| Tingling (paraesthesia) | 2% | 4% | 14% | 20% |
| Dry mouth | 3% | 7% | 14% | 19% |
| Constipation | 6% | 8% | 15% | 16% |
| Altered taste | 1% | 1% | 7% | 9% |
| Insomnia | 5% | 5% | 6% | 9% |
| Dizziness | 3% | 3% | 7% | 9% |
| Headache | 9% | 10% | 7% | 11% |
Doses are phentermine/topiramate ER in mg. 1,561 adults on placebo and 2,318 on Qsymia across doses.
Source: Qsymia prescribing information, Table 1 (DailyMed) (checked on October 6, 2026)
Other side effects listed at 2% or more include upper respiratory infections, blurred vision, fatigue, depression, anxiety, irritability, hair loss, problems with attention, low potassium and dry eyes. Mood and sleep side effects affected 15% (standard dose) and 21% (top dose) versus 10% on placebo, and thinking-related side effects (attention, memory, word-finding) affected 5.0% and 7.6% versus 1.5%. Heart rate rose by more than 20 beats per minute at some point in 19.6% of adults on the top dose versus 11.9% on placebo.
Serious risks
- Birth defects (see the REMS section above).
- Suicidal thoughts and behavior. Antiseizure medicines, including topiramate, roughly doubled the risk in a pooled analysis of 199 trials (0.43% vs 0.24%).
- Eye problems: acute myopia with secondary angle-closure glaucoma, and visual field defects.
- Mood, sleep and thinking problems, including depression, anxiety, trouble concentrating and word-finding difficulty; caution with driving until you know how it affects you, and with alcohol.
- Metabolic acidosis (low bicarbonate), lower kidney function, kidney stones and low potassium; drink plenty of fluids.
- Seizures if the top dose is stopped suddenly.
- Decreased sweating and overheating, mostly reported in children, especially in hot weather.
- Serious skin and allergic reactions (DRESS, Stevens-Johnson syndrome, anaphylaxis and angioedema).
- Abuse and dependence potential from the phentermine component (Schedule IV).
Interactions
The label lists: MAOIs (contraindicated, risk of hypertensive crisis); combined birth control pills (irregular bleeding); alcohol and sedatives (more dizziness, drowsiness and thinking problems); non-potassium-sparing diuretics such as hydrochlorothiazide (low potassium); other antiseizure drugs such as phenytoin, carbamazepine and valproic acid; other carbonic anhydrase inhibitors (more acidosis and kidney stones); pioglitazone (closer glucose monitoring); and amitriptyline. A ketogenic diet may add to the acidosis and kidney-stone risk. Ask your pharmacist to review everything you take.
Cost, generics and insurance
Prices on the manufacturer’s site, checked on 2026-10-06: cash-paying patients can get 30-day prescriptions through Qsymia’s home-delivery pharmacy for $74.99 (about $2.50 a day), or $70 a month with a 90-day prescription where allowed; at retail pharmacies the site lists a manufacturer discount of $75 for a 30-day prescription. Commercially insured patients with coverage pay the first $70 of the copay and can then receive $65 off. Generic phentermine/topiramate ER is also approved; Medicaid’s NADAC benchmark (what pharmacies pay, not your price) works out to about $85 to $93 for 30 capsules depending on strength.
Medicare is prohibited by law from covering drugs used specifically for weight loss, and Qsymia is not part of the 2026-2027 Medicare GLP-1 Bridge. Commercial coverage varies. The manufacturer also offers an online doctor consultation for a fee; whichever route you use, make sure the prescriber reviews your full history and arranges the recommended tests. Our insurance guide and weight-loss costs hub explain coverage and appeals.
Pregnancy and breastfeeding
Qsymia is contraindicated in pregnancy because of the birth-defect risk described above, and effective contraception is advised for anyone who can become pregnant. The Medication Guide says that anyone who becomes pregnant while taking Qsymia should stop it immediately and tell their health care provider right away. Topiramate and phentermine are present in human milk; diarrhea and sleepiness have been reported in breastfed infants with topiramate, and the label warns of possible effects from phentermine such as irritability, sleep changes and weight loss, so it says breastfeeding is not recommended during treatment.
Qsymia and Contrave at a glance
| Qsymia | Contrave | |
|---|---|---|
| How often | Once a day, in the morning | Twice a day, morning and evening |
| Average weight loss at about one year (label trials) | 9.8% to 10.9% on the top dose (placebo 1.2% to 1.6%) | 3.7% to 8.1% at 56 weeks (placebo 1.3% to 4.9%) |
| Ages | Adults; children 12+ with obesity | Adults only |
| Main safety program or warning | REMS for birth-defect risk; monthly pregnancy tests | Boxed warning on suicidal thoughts and behaviors |
| Controlled substance | Schedule IV | No |
| Generic | Yes (FDA approved) | Not listed when checked |
These are summaries of each label, checked on 2026-10-06. The trials enrolled different people, so the numbers are not a head-to-head comparison.
Alternatives and comparisons
Qsymia is often compared with Contrave, the other combination pill; Contrave vs Qsymia sets them side by side. Other options include short-term phentermine alone, orlistat, the GLP-1 pills (Wegovy pill, Foundayo) and weekly injections. See weight-loss pills by evidence and the medications hub for the full list with FDA status badges. People with PCOS often ask about weight medicines; our PCOS page covers what helps, and pregnancy planning deserves extra attention with Qsymia. The everyday foundations in how to lose weight stay the base of any plan.
FDA status and approved uses
| Indication | Labeled population | For weight | Approved | Source |
|---|---|---|---|---|
| Reduce excess body weight and maintain weight reduction long term, with a reduced-calorie diet and increased physical activity | Adults with obesity, or adults with overweight in the presence of at least one weight-related comorbid condition | Yes | July 17, 2012 | Source |
| Reduce excess body weight and maintain weight reduction long term | Pediatric patients aged 12 years and older with obesity | Yes | June 24, 2022 | Source |
From the FDA label. Who a medicine is labeled for is not the same as whether it fits you; only a clinician can decide that.
How it is taken (in general)
Once daily in the morning, with or without food; avoid evening doses (insomnia). Starts at the lowest strength for 14 days, then a standard dose. Evaluated at 12 weeks (3% weight loss in adults, 3% BMI reduction in teens) to decide on escalation, and at 12 weeks on the top dose (5%) to decide whether to continue. Taper the top dose every other day for at least a week when stopping. Dose limits with kidney or liver impairment. Follow your prescriber.
This is what the label describes in general, never a personal dose or schedule. Follow your prescriber.
What studies showed
| Trial | Population | Duration | Outcome as reported |
|---|---|---|---|
| Label Study 1 NCT00554216 | 1,267 adults with BMI 35+, no type 2 diabetes | 56 weeks (4-week titration + 52 weeks) | Weight -10.9% (15/92 mg) and -5.1% (3.75/23 mg) vs -1.6% placebo; 67% vs 17% lost 5% or more on the top dose.[1] |
| Label Study 2 NCT00553787 | 2,487 adults with BMI 27-45 and 2+ comorbidities | 56 weeks | Weight -9.8% (15/92 mg) and -7.8% (7.5/46 mg) vs -1.2% placebo; 10% or more loss 48% and 37% vs 7%.[1] |
| Label Study 3 (adolescents) NCT03922945 | 223 adolescents 12 to 17 with obesity | 56 weeks | BMI -7.1% (15/92 mg) and -4.8% (7.5/46 mg) vs +3.3% placebo.[1] |
| Aronne 2013 (combination vs components) | Adults with obesity, 7 arms | 28 weeks | Weight -9.2% (15/92 mg) and -8.5% (7.5/46 mg) vs -1.7% placebo, greater than either component alone.[3] |
Average results from trials; individual results vary. Results from different trials cannot be compared directly.
Side effects
| Common side effect | How often (label) |
|---|---|
| Paraesthesia (tingling) | 14% (7.5/46 mg) and 20% (15/92 mg) vs 2% placebo |
| Dry mouth | 14% and 19% vs 3% placebo |
| Constipation | 15% and 16% vs 6% placebo |
| Dysgeusia (altered taste) | 7% and 9% vs 1% placebo |
| Insomnia | 6% and 9% vs 5% placebo |
| Dizziness | 7% and 9% vs 3% placebo |
| Headache | 7% and 11% vs 9% placebo |
Serious risks
- Embryo-fetal toxicity (oral clefts, small for gestational age); REMS with certified pharmacies
- Suicidal behavior and ideation
- Acute myopia and secondary angle-closure glaucoma; visual field defects
- Mood and sleep disorders
- Cognitive impairment
- Slowing of linear growth in pediatric patients
- Metabolic acidosis
- Decrease in renal function
- Seizures with abrupt withdrawal
- Kidney stones
- Oligohidrosis and hyperthermia
- Hypokalemia
- DRESS, serious skin reactions (SJS/TEN), anaphylaxis and angioedema
- Allergic reactions to FD&C Yellow No. 5 (tartrazine)
- Abuse and dependence (phentermine, Schedule IV)
Warnings and who should not use it
Who should not use it (per the label)
- Pregnancy
- Glaucoma
- Hyperthyroidism
- Taking or within 14 days of stopping a monoamine oxidase inhibitor (MAOI)
- Known hypersensitivity to phentermine, topiramate or any excipient, or idiosyncrasy to sympathomimetic amines
Interactions, pregnancy and breastfeeding
| Drug or class | What the label says |
|---|---|
| MAOIs | Contraindicated during and within 14 days: risk of hypertensive crisis. |
| Combined oral contraceptives | Irregular bleeding possible; not expected to increase pregnancy risk. Do not stop the pill; tell the clinician. |
| Alcohol and CNS depressants | May potentiate dizziness, cognitive effects and drowsiness. |
| Non-potassium-sparing diuretics | May worsen hypokalemia; check potassium. |
| Antiepileptic drugs (phenytoin, carbamazepine, valproic acid) | Lower topiramate levels; valproate combination linked to hyperammonemia and hypothermia. |
| Carbonic anhydrase inhibitors | Avoid: more metabolic acidosis and kidney stones. |
| Pioglitazone | Lower pioglitazone exposure; monitor glucose. |
| Amitriptyline | Levels may rise substantially; adjust by clinical response. |
Pregnancy and breastfeeding
Contraindicated in pregnancy: topiramate exposure in the first trimester increases the risk of major congenital malformations, including oral clefts, and of being small for gestational age. Negative pregnancy test before starting and monthly during treatment for patients who can become pregnant; effective contraception advised. Available only through certified pharmacies under the Qsymia REMS. Breastfeeding is not recommended during treatment (both components are present in human milk).
Cost, insurance and savings
| Price | Amount | Basis | Checked on |
|---|---|---|---|
| Self-pay / cash | 74.99 USD | 30-day prescription, Qsymia home-delivery pharmacy, cash payers | October 6, 2026 |
| Self-pay / cash | 70 USD | per month with a 90-day prescription (not available in all states) | October 6, 2026 |
| With savings program | 75 USD | 30-day prescription at retail with the manufacturer discount | October 6, 2026 |
| Other | 85.42-92.72 USD | NADAC pharmacy acquisition cost, 30 generic capsules depending on strength (rates effective 2026-09-23) | October 6, 2026 |
Prices change often and depend on pharmacy, plan and location. Insurance can change what you pay. Every price shows the date we checked it.
Savings programs
- Qsymia home delivery and manufacturer discount: Cash payers or commercial plans without coverage ($75 off 28-30 day fills); covered commercial patients pay the first $70, then $65 off; some states excluded (checked October 6, 2026)
Same class
Compare with
Non-drug approaches
FDA approved for weight managementPrescriptionPillContrave (naltrexone/bupropion): how it works and its warningsPill (tablet) · Daily
FDA approved for weight managementPrescriptionPillPhentermine: short-term weight-loss pill, risks and rulesPill (tablet) · Daily
FDA approved for weight managementPrescriptionPillOrlistat (Xenical and Alli): how the fat-blocker worksCapsule · Daily
FDA approved for weight managementPrescriptionPillWegovy Pill (oral semaglutide): status, how it is taken, how it comparesSemaglutide: one ingredient, several brands · Pill (tablet) · DailyConditions
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- Given my mood, eye, kidney-stone and heart history, is Qsymia a safe option for me?
- What contraception plan and pregnancy testing schedule do you recommend?
- Which blood tests will we do before starting and how often during treatment?
- How will we decide at 12 weeks whether to step up the dose or stop?
- Is the brand or a generic the better value for me, and is it covered by my plan?
Frequently asked questions
How much weight do people lose on Qsymia?
In the label's one-year trials, average weight loss was 7.8% on the standard dose and 9.8% to 10.9% on the top dose, vs 1.2% to 1.6% on placebo. About two thirds on the top dose lost at least 5%.
What is the Qsymia REMS?
A Risk Evaluation and Mitigation Strategy required by the FDA because topiramate can cause birth defects. Under it, only certified pharmacies may dispense Qsymia, and patients who can become pregnant are counseled on testing and contraception.
Do I need pregnancy tests on Qsymia?
The label recommends a negative pregnancy test before starting and monthly during treatment for anyone who can become pregnant, plus effective contraception. Qsymia is contraindicated in pregnancy.
Is there a generic Qsymia?
Yes. Drugs@FDA lists approved generic phentermine/topiramate extended-release capsules rated as therapeutically equivalent. Ask your pharmacist which version you receive.
Can teenagers take Qsymia?
Since June 2022 the label includes children 12 and older with obesity. In the teen trial, BMI fell 7.1% on the top dose vs a 3.3% rise on placebo. Height growth was slightly slower, so growth and mood should be monitored by a pediatric specialist.
What are the most common side effects of Qsymia?
Tingling in the hands, feet or face, dry mouth, constipation, altered taste, insomnia, dizziness and headache; they are more common at higher doses.
Can I stop Qsymia suddenly?
Not the top dose. The label says to taper it by taking it every other day for at least a week before stopping, because sudden withdrawal of topiramate can cause seizures. Plan any change with your prescriber.
Is Qsymia a controlled substance?
Yes, Schedule IV, because it contains phentermine. Topiramate itself is not controlled.
How much does Qsymia cost?
On 2026-10-06 the manufacturer listed $74.99 for a 30-day prescription through its home-delivery pharmacy for cash payers, $70 a month with a 90-day prescription where available, and $75 at retail with its discount. Insurance coverage varies.
Official sources
References
- QSYMIA (phentermine and topiramate) extended-release capsules: prescribing information. Vivus, via DailyMed, 2026. (accessed October 6, 2026) Drug label
- Drugs@FDA: Qsymia, NDA 022580 (original approval 2012-07-17). U.S. Food and Drug Administration. (accessed October 6, 2026) Government page
- Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity (Silver Spring), 2013. doi:10.1002/oby.20584 · PMID 24136928 (accessed October 6, 2026) Randomized trial
- Qsymia pricing and home delivery. Vivus. (accessed October 6, 2026) Other
- Qsymia REMS (Risk Evaluation and Mitigation Strategy). VIVUS LLC. (accessed October 6, 2026) Other
- NADAC (National Average Drug Acquisition Cost) 2026. Centers for Medicare and Medicaid Services (data.medicaid.gov). (accessed October 6, 2026) Government page
- Grunvald E, Shah R, Hernaez R, et al.. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology, 2022. doi:10.1053/j.gastro.2022.08.045 · PMID 36273831 (accessed October 6, 2026) Guideline
- Medicare GLP-1 Bridge: information for providers. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
- A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People with Obesity. KFF, 2024. (accessed October 6, 2026) Other
- 988 Suicide and Crisis Lifeline. 988 Lifeline. (accessed October 6, 2026) Other
Facts checked on October 6, 2026
Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.