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Across the SURPASS trials, gastrointestinal symptoms occurred in 3744% of patients depending on the dose
However, their effectiveness and risks have not yet been systematically evaluated in a comprehensive set of possible health outcomes
4-chloro-3-hydroxybutyronitrile is synthesized from epichlorohydrin in an aqueous hydrogen cyanide solution 4-chloro-3-hydroxy butyric acid alkyl ester is then synthesized from the 4-chloro-3-hydroxybutyronitrile in the presence of an alcohol and a sulfuric acid catalyst the racemic 4-chloro-3 -hydroxy butyric acid alkyl ester is hydrolyzed in an aqueous solution using an enzyme, thereby preparing (R)-4-chloro-3-hydroxy butyric acid alkyl ester
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Because this side effect occurs consistently, it has led to interest in topiramate for obesity, but the risks associated with the drug make off-label use for weight loss inappropriate outside specialist settings
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