Adverse effects
In clinical trials, the most common adverse events which occurred at a rate ≥5% and ≥1.5 times placebo included paraesthesia (tingling in fingers/toes), dizziness, altered taste, insomnia, constipation, and dry mouth.In the U.S., the drug label contains warnings for increased heart rate, suicidal behavior and ideation, glaucoma, mood and sleep disorders, creatine elevation, and metabolic acidosis. Some of these warnings are based on historical observations in epilepsy patients taking topiramate. The FDA is requiring the company to perform a post-approval cardiovascular outcomes trial, due in part to the observation of increased heart rate in some people taking the drug in clinical trials. Pregnancy
Phentermine and topiramate can cause fetal harm. Data from pregnancy registries and epidemiology studies indicate that a fetus exposed to topiramate in the first trimester of pregnancy has an increased risk of oral clefts (cleft lip with or without cleft palate). If a patient becomes pregnant while taking phentermine/topiramate ER, treatment should be discontinued immediately, and the patient should be apprised of the potential hazard to a fetus. Females of reproductive potential should have a negative pregnancy test before starting phentermine/topiramate ER and monthly thereafter during phentermine/topiramate ER therapy. Females of reproductive potential should use effective contraception during phentermine/topiramate ER therapy. Risk evaluation and mitigation strategy
Phentermine and topiramate was approved with a risk evaluation and mitigation strategy (REMS) program to ensure that benefits of treatment outweigh the risks. Because of the teratogenic risk associated with phentermine/topiramate ER therapy, phentermine/topiramate ER is distributed via certified pharmacies.
Extremities may refer to:

Anatomy
The distal limb (forearm or lower leg) of a tetrapod animal, more specifically its distalmost portion, including:
Hand, a prehensile, multi-digited organ at the distal end of upper limb (arm) of bipedal primates (especially humans) that is highly adapted for grasping and fine manipulation of objects
Foot, the terminal portion of a quadruped tetrapods limb that mainly bears weight and allows terrestrial locomotion. In toe-walking ungulates, the term typically refers to the hoofed portion of the foot. Paw, a furry, padded foot with claws, common in many quadruped animals
Appendage, any external body part that protrudes outwards from an organisms core, such as a limb, tail, ear, nose, horn/antler, external genitalia, antenna, tusk/mouthpart or raptorial

Other
Extremities (play), a 1982 play by William Mastrosimone
Extremities (film), a 1986 film based on the play

See also
Extreme (disambiguation)