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The standard justification requires a documented medical need, such as a verified allergy to an inactive ingredient in the brand-name formulation, that makes the FDA-approved version unsuitable for that specific patient

For many individuals, topiramate helps reduce food cravings and makes it easier to resist the urge to binge eat

Patients with a history of severe gastrointestinal disease, particularly those with inflammatory bowel disease, severe gastroesophageal reflux disease, or history of pancreatitis, require careful evaluation before considering this therapy

In March 2026, Lilly also reported positive Phase 3 data for retatrutide in type 2 diabetes