Online Weight Loss Programs Phentermine – Phentermine is an oral sympathomimetic amine used as an adjunct for short-term (e.g., 8–12 weeks) external obesity treatment. The pharmacological effects of phentermine are similar to those of amphetamine. Phentermine resin complex was approved by the FDA in 1959; However, it is no longer sold 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, although little scientific data supports this practice. July 8 In 1997, the FDA warned physicians about the development of valvular heart disease and pulmonary hypertension in women receiving a combination of fenfluramine and phentermine; Fenfluramine was withdrawn from the US market in the fall of 1997. The use of phentermine with other anorectic agents for obesity has not been evaluated. In May 2011, the FDA approved phentermine hydrochloride orally disintegrating tablet (Suprenza) for the treatment of exogenous obesity.1
Limited data are available in reference literature on the mechanism of action of this drug. Phentermine is an analogue of methamphetamine. Similar to amphetamines, phentermine increases the release of norepinephrine and dopamine from nerve terminals and inhibits their reuptake. Therefore, phentermine is classified as an indirect sympathomimetic.2 Other effects include a weak ability to dose-dependently raise serotonin levels, although the effect on serotonin happens is less potent than that of methamphetamine itself.3 Clinical effects include CNS stimulation and elevation of blood Pressure. The reduction of appetite is thought to occur by direct stimulation of the satiety center in the hypothalamic and limbic regions.
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Tolerance to the anorexiant 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 anorexiant effects, it is generally recommended that phentermine be discontinued rather than increasing the dose.
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Phentermine is administered orally. The rate and extent of phentermine exposure under fasting conditions were equivalent to that observed without administration of the oral formulation.1
There are limited data on the pharmacokinetics of phentermine. Phentermine is primarily excreted by the kidneys. The elimination half-life is 19-24 hours and is influenced by urine pH. Since the pKa of phentermine is 9.84; The elimination half-life decreases to about 7-8 hours under acidic urine.
Oral Route: After oral administration; Most of the absorption of phentermine occurs 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 oral disintegrating tablet (ODT) reaches peak concentration (Cmax) 3-4.4 hours after administration. Consuming water before swallowing ODT does not affect AUC. Cmax (approximately 5%) and AUC (approximately 12%) when phentermine ODT was administered after a high fat/high calorie breakfast, phentermine ODT can be administered with or without food. When ODT was swallowed without predegradation, Cmax and AUC decreased by approximately 7% and 8%, respectively.
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Renal Impairment – Use with caution in patients with renal impairment. Urinary excretion of phentermine under uncontrolled urinary pH conditions is 62–85%, and increased exposure can be expected in patients with renal impairment.1
The produces of phentermine capsules and tablets, its products are contraindicated in patients with cardiac disease, advanced arteriosclerosis, moderate to severe hypertension, agitated states, or glaucoma.6 Likewise, orally disintegrating tablets, are contraindicated in a patient with a history of heartiac vascular disease. stroke Irregular heartbeat Decreased heart rate and controlled hypertension.5 Valvular heart failure has been reported in women receiving a combination of fenfluramine and phentermine. The safety and efficacy of combination therapy with phentermine for weight loss, including selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, the combined use of these medicinal products for weight loss is not recommended. In addition, primary pulmonary hypertension (PPH) has been reported in patients receiving fenfluramine or dexfenfluramine and the combination of phentermine. The possibility of an association between the use of phentermine alone and PPH or valvular heart disease cannot be determined. The initial symptom of PPH is usually dyspnea. Other early symptoms include: angina pectoris; including syncope or lower extremity edema. Any deterioration in exercise tolerance should be advised to report the patient immediately. shortness of breath angina pectoris syncope Treatment should be discontinued in patients who develop new unexplained symptoms of or lower extremity edema.
Because phentermine is a sympathomimetic agent, it is contraindicated in patients with hyperthyroidism. Caution should also be exercised in patients with thyroid disease.
Phentermine is contraindicated for use during or 14 days after the use of MAOI therapy or other drugs with MAO-inhibiting activity. Monoamine oxidase inhibitors (MAOIs) or drugs with MAO-inhibiting activity such as furazolidone or procarbazine may prolong and intensify the cardiostimulatory and vasopressor effects of phentermine.
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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 are insomnia, Irritability Personality changes and psychotic symptoms cannot be separated from other mental disorders such as schizophrenia. Phentermine is psychological; It may worsen certain psychiatric conditions, such as in patients who exhibit severe nervousness or agitated behavior, including mania or severe anxiety.
Using phentermine can cause dizziness; It may 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 not to drive or operate machinery or perform other tasks that require mental alertness until you know how the therapy affects their mental and/or motor performance. In general, Consumption 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 diabetes medication requirements may result from altered dietary regimens using phentermine during weight loss. Patients should check their blood sugar regularly and follow their healthcare provider’s recommendations.5
Appetite suppression therapy is not recommended for use in patients with 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 the amphetamines which have been widely abused. The possibility of abuse of phentermine should be a mind when evaluating the desirability of including a drug as part of a weight reduction program. A reasonable minimum dose should be prescribed or dispensed at one time to limit the possibility of overdose or drug diversion.5
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Phentermine products are now classified as FDA pregnancy risk types X, as are many anorexiants used for weight loss, and are contraindicated during pregnancy.56 Safe use of phentermine during pregnancy has not been established; There are no known indications for the use of phentermine during pregnancy. Phentermine should not be taken by pregnant women or by women who may become pregnant unless, in the physician’s opinion, the potential benefits outweigh the possible hazards.6
Abrupt discontinuation of phentermine after long-term high doses may result in severe psychotic depression or extreme fatigue; Sleep EEG changes were also observed. A gradual withdrawal of therapy is recommended. If immediate discontinuation is medically necessary. Careful monitoring and management of symptoms is warranted.4
Phentermine is contraindicated during breast-feeding.5 It is not known whether phentermine and its metabolites are excreted in human milk. However, Due to the potential for serious adverse effects in infants; Breastfeeding while taking phentermine is not recommended.76
The safety and efficacy of phentermine in children are not established. Phentermine is not recommended for children or adolescents 16 years of age or younger. There is no established use of phentermine in infants or young children.45
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A debilitated or elderly patient may experience more CNS and sympathomimetic side effects of phentermine; Use with caution in elderly patients. Patients with renal impairment may also experience more side effects. Exposure may be increased in patients with renal impairment or renal impairment. Use caution when administering phentermine to patients with renal impairment.4
Use of inhaled anesthetics during surgery may sensitize the myocardium to the effects of sympathomimetic drugs. Because of this, and its effect on blood pressure, in general, phentermine should be discontinued several days before surgery. Avoid hiatus.
Phentermine products are now classified as FDA pregnancy risk types X, as are many anorexiants used for weight loss, and are contraindicated during pregnancy.55 Safe use of phentermine during pregnancy has not been established; There are no known indications for the use of phentermine during pregnancy. If Phentermine is not to be taken by pregnant women or by women, in the opinion of the physician, the possible risks outweigh the potential benefits.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 concurrent use should be avoided. The role of phentermine in production
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