Best Weight Loss Pills Phentermine – Phentermine is an oral sympathomimetic amine used as an adjunct to exogenous short-term (eg, 8-12 weeks) treatment of obesity. The pharmacological effects of phentermine are similar to those of amphetamines. Phentermine resin complex was approved by the FDA in 1959 but is no longer sold in the US. Phentermine hydrochloride was approved by the FDA in 1973. In the mid-1990s, there was renewed interest in phentermine in combination with another anorectic, fenfluramine, for the treatment of obesity and substance abuse, but little scientific data supports this practice. On July 8, 1997, the FDA issued a Dear Healthcare Professional letter alerting physicians to the development of valvular heart disease and pulmonary hypertension in women receiving a combination of fenfluramine and phentermine; Fenfluramine was subsequently withdrawn from the US market in the fall of 1997. The use of phentermine with other anorectic agents for obesity has not been evaluated and is not recommended. In May 2011, the FDA approved phentermine hydrochloride orally disintegrating tablet (Suprenza) for the treatment of exogenous obesity.
There are limited data on the mechanism of action of this drug in the reference texts. Phentermine is an analogue of methamphetamine. Like amphetamines, phentermine increases the release of norepinephrine and dopamine from nerve terminals and inhibits their reuptake. Thus, phentermine is classified as an indirect sympathomimetic. 2 Other effects include a weak ability to increase serotonin levels in a dose-dependent manner, although the effects on serotonin are less potent than those of methamphetamine itself. 3 Clinical effects include central nervous system stimulation and elevation of blood. pressure. Appetite suppression is thought to occur through direct stimulation of the satiety center in the hypothalamic and limbic regions.
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Tolerance to the anorexic effects of phentermine usually develops within a few weeks of starting therapy. The mechanism of tolerance appears to be pharmacodynamic in nature. Higher doses of phentermine are required to produce the same response. When tolerance develops to the anorexic effects, it is usually recommended that phentermine be discontinued rather than the dose increased.
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Phentermine is administered orally. The rate and magnitude of effect of phentermine under fasting conditions are equivalent regardless of the oral formulation taken.
There are limited data on the pharmacokinetics of phentermine. Phentermine is primarily excreted by the kidneys. The elimination half-life ranges from 19-24 hours and is affected by urinary pH. Since the pKa of phentermine is 9.84, the elimination half-life is reduced to about 7-8 hours under acidic urinary conditions.
Oral route. After oral administration, most of phentermine is absorbed from the small intestine. The duration of action after taking 8 mg capsules or tablets is about 4 hours and 12-14 hours after taking 30 mg capsules or 37.5 mg tablets.
Phentermine orally disintegrating tablet (ODT) reaches maximum concentrations (Cmax) 3-4.4 hours after administration. Water intake prior to ODT ingestion did not affect AUC. Although Cmax (approximately 5%) and AUC (approximately 12%) were decreased when phentermine ODT was administered after a high-fat/high-calorie breakfast, phentermine ODT may be administered with or without food. Cmax and AUC decreased by approximately 7% and 8%, respectively, when ODT was ingested without predissolution.1
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Renal failure. use with caution in patients with renal failure. Cumulative urinary excretion of phentermine under uncontrolled urinary pH conditions is 62-85%, and increased exposure can be expected in patients with renal impairment.
According to the manufacturers of phentermine capsules and tablets, its product is contraindicated in patients with heart disease, advanced arteriosclerosis, moderate to severe hypertension, agitated states, or glaucoma. disease, including coronary artery disease, stroke, cardiac arrhythmia, heart failure, and uncontrolled hypertension. 5 Valvular heart disease has been reported in women receiving a combination of fenfluramine and phentermine; The safety and efficacy of combination therapy with phentermine and any other weight loss medication, including selective serotonin reuptake inhibitors (eg, fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, the combined use of these drugs for weight loss is not recommended. Furthermore, primary pulmonary hypertension (PPH) has been reported to occur in patients receiving the combination of phentermine with fenfluramine or dexfenfluramine. The possibility of an association between phentermine use alone and PPH or valvular heart disease cannot be excluded. The first symptom of PPH is usually shortness of breath. Other initial symptoms include angina pectoris, syncope, or swelling of the lower extremities. Patients should be advised to promptly report any deterioration in exercise tolerance. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope, or lower extremity edema.
Because phentermine is a sympathomimetic agent, it is contraindicated in patients with hyperthyroidism. It should also be used with caution in patients with thyroid disease.
Phentermine is contraindicated for use after or within 14 days of taking MAOI therapy or other drugs with MAO-inhibitory activity. Monoamine oxidase inhibitors (MAOIs) or drugs with MAO-inhibitory activity, such as furazolidone or procarbazine, may prolong and potentiate the cardiac stimulation and vasopressor effects of phentermine.
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Phentermine is contraindicated in patients with agitated states. exacerbate this effect or cause an adverse drug reaction. Phentermine may worsen certain mental conditions, such as in patients who exhibit highly nervous or agitated behavior, including psychosis, mania, or severe anxiety.
Use of phentermine may cause dizziness, mask signs of fatigue or the need for rest, or impair the patient’s ability to participate in activities that require mental alertness. Advise patients to use caution when driving or operating machinery or performing other tasks that require mental alertness until they are aware of how therapy will affect their mental and/or motor performance. In general, the ingestion of ethanol may exacerbate these effects or cause an adverse drug reaction. 4 Advise patients to avoid alcohol while taking phentermine.
Use phentermine with caution in patients with diabetes. Insulin or other antidiabetic medication requirements may be altered in these patients when using phentermine during weight loss and because of a modified diet. Patients should monitor their blood glucose regularly and follow their healthcare provider’s recommendations.5
Appetite suppressant therapy is not recommended for use in patients who have had anorexia nervosa or other eating disorders. Phentermine is contraindicated in patients with a known history of drug or substance abuse. Phentermine is chemically and pharmacologically related to amphetamines, which have been widely abused. The abuse potential of phentermine should be kept in mind when evaluating the desirability of including the drug as part of a weight loss program. The lowest reasonable dose should be prescribed or given at one time to limit the potential for overuse or drug diversion.5
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Phentermine products are now classified as FDA pregnancy risk category X, along with many anorexics used for weight loss and are contraindicated during pregnancy.56 The safe use of phentermine during pregnancy has not been established; There is no known indication for the use of phentermine during pregnancy. Phentermine should not be taken by pregnant women or women who may become pregnant unless, in the physician’s opinion, the potential benefits outweigh the potential risks.6
Abrupt discontinuation of phentermine after long-term high doses may result in severe mental depression or extreme fatigue; Sleep EEG changes were also noted. Gradual discontinuation of therapy is recommended. If immediate discontinuation is medically necessary, careful monitoring and symptom management is warranted.4
Phentermine is contraindicated during breast-feeding.5 It is not known whether phentermine and its metabolites are excreted in breast milk; however, because serious adverse effects may occur in nursing infants, breastfeeding while taking phentermine is not recommended.76
The safety and efficacy of phentermine in children have not been established. Phentermine is not recommended for children or adolescents 16 years of age and younger. There is no approved use of phentermine in neonates and infants.45
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The debilitated or elderly patient may be more sensitive to the central nervous system and sympathomimetic side effects of phentermine; use with caution in elderly patients. Patients with kidney failure may also be more prone to side effects. Increased exposure can be expected in patients with renal insufficiency or renal insufficiency. Use caution when prescribing phentermine to patients with renal impairment.4
The use of inhaled anesthetics during surgery can sensitize the myocardium to the effects of sympathomimetic drugs. Because of this and its effect on blood pressure, phentermine should generally be stopped a few days before surgery. Avoid abrupt termination.
Phentermine products are now classified as FDA pregnancy risk category X, along with many anorectics used for weight loss and contraindicated during pregnancy.55 The safe use of phentermine during pregnancy has not been established; There is no known indication for the use of phentermine during pregnancy. Phentermine should not be taken by pregnant women or women who may become pregnant unless, in the physician’s opinion, the potential benefits outweigh the potential risks.5
The safety of phentermine when used with other anorexic agents such as amphetamine, benzamphetamine, dexphenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine8 is controversial, and concomitant use should be avoided. The role of phentermine in production
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