Diet Pills Similar To Phentermine – Phentermine is an oral sympathomimetic amine used as an adjunct for short-term (eg, 8-12 weeks) treatment of exogenous obesity. The pharmacologic effects of phentermine are similar to amphetamines. Phentermine resin complex was approved by the FDA in 1959, but is no longer marketed in the US. Phentermine hydrochloride was FDA approved in 1973. In the mid-90s, there was renewed interest in phentermine in combination with another anorectic, fenfluramine, for the treatment of obesity and substance abuse, however, little scientific data supports this practice. On July 8, 1997, the FDA issued a ‘Dear Health Care Professional’ letter warning doctors about 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pulmonary hypertension in women receiving a combination of fenfluramine and phentermine; fenfluramine was subsequently withdrawn from the US market in the fall of 1997.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 tablets (Suprenza) for the treatment of exogenous obesity.1
Limited data are available in the reference text on the mechanism of action of this drug. Phentermine is an analogue of methamphetamine. Similar to the amphetamines, phentermine increases the release of norepinephrine and dopamine from the nerve terminals and prevents their reuptake. Thus, phentermine is classified as an indirect sympathomimetic. 2 other effects include a strong ability to dose-dependently increase serotonin levels, although the effect on serotonin occurs less strongly than that of methamphetamine itself. 3 clinical effects include CNS stimulation and blood elevation. pressure. Appetite suppression is believed to occur through direct stimulation of the satiety center in the hypothalamus and limbic regions.
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Tolerance to the anorexiant effect 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 anorexiant effect, it is generally recommended that the phentermine is reduced instead of increased doses.
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Phentermine is administered orally. The level and extent of exposure to phentermine in fasting conditions are the same regardless of the oral formulation administered.1
Limited data exist on the pharmacokinetics of phentermine. Phentermine is mainly excreted by the kidneys. The elimination half-life is 19-24 hours and is influenced by urine pH. Because the pKa of phentermine is 9.84, the elimination half-life decreases to about 7-8 hours in acidic urine conditions.
Oral Route: Following oral administration, most absorption of phentermine occurs from the small intestine. The duration of action after administration of capsules or tablets of 8 mg is approximately 4 hours and 12-14 hours after administration of capsules of 30 mg or tablets of 37.5 mg.
Phentermine orally disintegrating tablet (ODT) reaches its peak concentration (Cmax) 3-4.4 hours after administration. Ingestion of water before swallowing ODT does not affect AUC. Despite the decrease in Cmax (approximately 5%) and AUC (approximately 12%) when this phentermine ODT is administered after a high-fat/high-calorie breakfast, phentermine ODT can be administered with or without food. Cmax and AUC were reduced by approximately 7% and 8%, respectively, when ODT was swallowed without prior disintegration.1
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Renal failure: Use with caution in patients with renal impairment. The cumulative urinary excretion of phentermine under uncontrolled urinary pH conditions is 62-85%, and an increase in exposure can be expected in patients with renal impairment.1
According to manufacturers of phentermine capsules and tablets, the product is contraindicated in patients with heart disease, advanced arteriosclerosis, moderate to severe hypertension, agitated state, or glaucoma.6 Also, oral disintegrating tablets, which are contraindicated in patients with a history of heart disease. diseases 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; safety and efficacy of combination therapy with phentermine and other drug products for weight loss, including selective serotonin reuptake inhibitors (eg, fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, coadministration of drug products for weight loss is not recommended. Moreover, primary pulmonary hypertension (PPH) has been reported to occur in patients receiving a combination of phentermine with fenfluramine or dexfenfluramine. The possibility of an association between phentermine use alone and PPH or valvular heart disease cannot be ruled out. The initial symptom of PPH is usually dyspnea. Other early symptoms include: angina pectoris, syncope, or lower extremity edema. Patients should be advised to report any deterioration in exercise tolerance immediately. Treatment should be discontinued in patients who develop symptoms of dyspnea, angina pectoris, syncope, or unexplained 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 during or within 14 days after using MAOI therapy or other drugs with MAO-inhibiting activity. Monoamine oxidase inhibitors (MAOIs), or drugs with MAO inhibitory activity such as furazolidone or procarbazine, can prolong and amplify the cardiac stimulation and vasopressor effects of phentermine.4
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Phentermine is contraindicated in patients with agitated states. aggravate these effects or cause an adverse drug reaction. 4 Symptoms of chronic intoxication include insomnia, irritability, change in personality, and psychotic symptoms that may be clinically indistinguishable from other psychotic disorders, like schizophrenia. Phentermine can aggravate certain mental conditions, such as those patients who show highly nervous or agitated behavior, including psychosis, mania, or severe anxiety.
The use of phentermine can cause dizziness, mask signs of fatigue or the need for others, or impair the ability of the patient to participate in activities that require mental alertness. Advise patients to be careful when driving or operating machinery, or performing other tasks that require mental alertness until they understand how therapy will affect mental and/or motor performance. In general, ethanol ingestion can aggravate this effect or cause adverse drug reactions.4 Advise patients to avoid alcohol while taking phentermine.
Use phentermine with caution in patients with diabetes mellitus. Insulin or other antidiabetic medication requirements can be changed in these patients when using phentermine during weight loss and because the diet regimen changes. Patients should monitor their blood glucose regularly and follow the recommendations of their healthcare providers.5
Appetite suppressant therapy is not recommended for use in patients with a history of anorexia nervosa or other eating disorders. The use of 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 possibility of phentermine abuse should be kept in mind when evaluating the desirability of including the drug as part of a weight reduction program. The minimum amount should be administered or distributed 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, as are many anorexiants used for weight loss, and are contraindicated during pregnancy.56 The safety of using phentermine during pregnancy has not been established; There are known indications for using phentermine during pregnancy. Phentermine should not be taken by pregnant women or by women who may become pregnant unless, in the opinion of the doctor, the potential benefits outweigh possible hazards.6
Sudden discontinuation of phentermine after a prolonged high dose can result in severe mental depression or severe fatigue; sleep EEG changes have also been noted. A gradual withdrawal of therapy is recommended. If immediate discontinuation is medically necessary, careful monitoring and symptom management is recommended.4
Phentermine is contraindicated during breastfeeding.5 It is not known whether phentermine and its metabolites are excreted in breast milk; However, because of the potential for serious adverse effects in nursing infants, breastfeeding while taking phentermine is not recommended.76
The safety and effectiveness of phentermine in children has not been established. Phentermine is not recommended for children or adolescents 16 years and under. There is no use of phentermine in infants or neonates.45
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The debilitated or geriatric patient is also more susceptible to CNS and sympathomimetic side effects of phentermine; use with caution in elderly patients. Patients with kidney disorders may also be more susceptible to side effects. Increased exposure can be expected in patients with renal impairment or kidney failure. Use caution when administering phentermine to patients with renal impairment.4
The use of inhalation anesthesia during surgery can cause sensitization of the myocardium to the effects of sympathomimetic drugs. Because of this, and the effect on blood pressure, in general, phentermine should be discontinued a few days before surgery. Do not stop abruptly.
Phentermine products are now classified as FDA pregnancy risk category X, as are many anorexiants used for weight loss, and are contraindicated during pregnancy.55 The safety of using phentermine during pregnancy has not been established; There are known indications for using phentermine during pregnancy. Phentermine should not be taken by pregnant women or by women who may become pregnant unless, in the opinion of the doctor, the potential benefits outweigh possible hazards.5
The safety of phentermine when used with other anorexiant agents such as amphetamine, benzphetamine, dexfenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine8 is controversial and simultaneous use should be avoided. The role of phentermine in production
