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Combines phentermine (appetite suppressant) with topiramate (antiepileptic) to reduce hunger and enhance satiety through complementary mechanisms European Medicines Agency refused marketing authorisation citing cardiovascular safety, psychiatric adverse effects, cognitive impairment, and teratogenic risks Clinical trials showed 911% mean weight loss at one year, but no head-to-head comparisons with UK-licensed medications or cardiovascular outcomes trials exist Contraindicated in pregnancy due to significant risk of orofacial clefts

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Prominent ketosteroid isomerase activity is displayed by HsaGST A3-3, and approximately 10-fold lower by HsaGST A1-1, but not by the other alpha class GSTs (Johansson and Mannervik, 2001)