Drug & supplement interaction

1,4-butanediol + Phentermine, Topiramate

Phentermine, Topiramate brand name: Qsymia.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Phentermine, Topiramate falls into 3 drug categories that 1,4-butanediol can interact with; the most serious is rated major. Theoretically, concomitant use of 1,4-butanediol with CNS depressants may potentiate respiratory and CNS depression.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

1,4-butanediol and Phentermine, Topiramate

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

1,4-butanediol interacts with whole categories of medication. Phentermine, Topiramate falls into 3 of those categories, so it can interact with 1,4-butanediol in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

CNS DEPRESSANTS

1 of 3

Why this applies to Phentermine, Topiramate

Phentermine, Topiramate falls under CNS DEPRESSANTS — the group 1,4-butanediol interacts with.

Theoretically, concomitant use of 1,4-butanediol with CNS depressants may potentiate respiratory and CNS depression.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of CNS depressants with GHB may cause serious CNS and respiratory depression.
Severity Major Likelihood Probable Evidence D

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

First, the big picture: 1,4-butanediol is not a real supplement. Your body turns it into GHB, a heavy-duty sedative that slows your brain and your breathing. That alone can cause coma or death, so this is something to avoid entirely, not just pair carefully.

Now, with Qsymia (phentermine/topiramate), the topiramate piece can already make some people feel drowsy, foggy, dizzy, or slow to think. Stacking it with a powerful CNS depressant like GHB could deepen that sedation and, more importantly, blunt your drive to breathe. This warning is based mostly on anecdotal reports, but the concern is real and serious. Please don't combine these, and talk with your pharmacist or doctor if you have any questions.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  2. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
Moderate

ANTICONVULSANTS

2 of 3

Phentermine, Topiramate also falls under ANTICONVULSANTS.

Theoretically, concomitant use of 1,4-butanediol with certain anticonvulsants may potentiate respiratory and central nervous system (CNS) depression or increase the risk of seizures.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of anticonvulsants that have sedative effects with GHB may cause serious CNS and respiratory depression. GHB might also reduce the effectiveness of anticonvulsants since it also can cause seizures.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

First things first: 1,4-butanediol is not a real supplement. It's a toxic industrial chemical that your body turns into GHB, a strong sedative that slows the brain and breathing. So my honest advice is to steer clear of it entirely, no matter what else you take.

Now, about Qsymia (phentermine and topiramate). The topiramate part can cause its own drowsiness, dizziness, and slowed thinking. Pairing that with something that already depresses the brain could deepen sedation and make breathing dangerously slow. There's also a theoretical concern that GHB could trigger seizures and work against topiramate. This warning is based mainly on anecdotal reports, not solid studies, but the safest move is simply to never combine them. Please talk with your pharmacist or doctor with any worries.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  2. Carotenuto A, De Feo V, Fattorusso E, et al. The flavonoids of Allium ursinum. Phytochem 1996;41:531-6. PubMed
  3. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
Moderate

TOPIRAMATE (Topamax)

3 of 3
Concomitant use of 1,4-butanediol with topiramate may potentiate adverse effects.
1,4-Butanediol is metabolized to gamma-hydroxybutyrate (GHB). Concomitant use of topiramate with GHB may increases blood levels of GHB. In one case report, a patient regularly taking GHB 4.5 grams twice nightly was hospitalized after initiating treatment with topiramate 25 mg daily. Symptoms included confusion, muscle jerking, miosis, and coma. Plasma levels of GHB were 2.5-fold higher than when GHB was given alone. Potential mechanisms might include decreased GHB breakdown, increased absorption, and/or increased activity.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

First, the most important thing: 1,4-butanediol is not a real supplement. It's a toxic industrial chemical that your body turns into GHB, a powerful sedative that can cause coma, dangerously slow breathing, and death on its own. So my honest advice is to steer clear of it entirely, no matter what else you take.

Now, about the Qsymia angle. Your Qsymia contains topiramate, and there's a case report where adding topiramate to GHB pushed GHB blood levels about 2.5 times higher, leading to confusion, muscle twitching, pinpoint pupils, and coma. So the concern is that topiramate may make GHB hit harder, not weaker. This is based on a single anecdotal report, so the evidence is thin, but the danger is serious enough that I wouldn't risk it. Please talk with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Weiss T, Müller D, Marti I, Happold C, Russmann S. Gamma-hydroxybutyrate (GHB) and topiramate--clinically relevant drug interaction suggested by a case of coma and increased plasma GHB concentration. Eur J Clin Pharmacol. 2013 May;69(5):1193-4. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

1,4-butanediol Also Interacts With Other Medications

1,4-butanediol has 249 major, 21 moderate known drug interactions in our database — the Phentermine, Topiramate one above is among them. If you take anything else, check it against the full list below.

Major 249 Moderate 21 No known interaction 2,560 (incl. Phentermine, Topiramate)
Taking anything else?

Check Another of Your Medications Against 1,4-butanediol

Covers the 2,830 medications we’ve checked against 1,4-butanediol. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Phentermine, Topiramate

This page covers 1,4-butanediol only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Phentermine, Topiramate page lists 125 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Gamma-hydroxybutyrate (ghb) (major), Kava (major) and L-tryptophan (major).

By severity: 7 major · 101 moderate · 17 minor.

From our pharmacist’s overview on the Phentermine, Topiramate page

“Alcohol is the single biggest hazard on this page. Beer and wine both carry major-rated interactions with Qsymia (phentermine and topiramate), because topiramate already slows the nervous system and drinking deepens that sedation.”

Reviewed by 2 · Jul 18, 2026

Open the Phentermine, Topiramate interaction page

How much people look this up

Where 1,4-butanediol and Phentermine, Topiramate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement 1,4-butanediol
Steady interest

#847 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Phentermine, Topiramate
Top 25%

#335 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About 1,4-butanediol

What is 1,4-butanediol?

  • Marketed illegally as a 'recreational' or party substance
  • Falsely sold as a sleep aid
  • Falsely promoted for bodybuilding or muscle growth
  • Industrial solvent and chemical manufacturing

1,4-butanediol is a toxic industrial chemical, not a safe dietary supplement. Once swallowed, the body converts it into GHB, a powerful central nervous system depressant that can cause coma, dangerous breathing problems, addiction, and death. It should never be taken as a supplement or recreational substance.

Read the full 1,4-butanediol monograph & all interactions
Keep checking

Other Drugs & 1,4-butanediol

Browse every other medication we’ve checked against 1,4-butanediol — both the ones with a known interaction and the ones without. Select any drug for the full detail.

249Major
21Moderate
0Minor
2,559No known interaction
249 Major 21 Moderate 2,559 No interaction
Major

249 interactions

Showing 60 of 249 major interactions — see all 249 on the 1,4-butanediol page.

Moderate

21 interactions

No interaction 2,559 drugs checked — show the list

We also checked 1,4-butanediol against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,559 medications checked with no known interaction — see the full 1,4-butanediol list.

See the full 1,4-butanediol interactions page
See every supplement checked against Phentermine, Topiramate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
1,4-butanediol monograph › Uses, safety, and every drug interaction in one place Phentermine, Topiramate supplement interactions › Every supplement checked against Phentermine, Topiramate, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking 1,4-butanediol and Phentermine, Topiramate Together: Common Questions

Can you take 1,4-butanediol with Phentermine, Topiramate?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for 1,4-butanediol and Phentermine, Topiramate?
Phentermine, Topiramate belongs to more than one drug category, and 1,4-butanediol interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the 1,4-butanediol and Phentermine, Topiramate interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.