Phentermine Weight Loss Clinic Online – Phentermine is an oral sympathomimetic amine used adjunctively for the short-term (eg, 8-12 weeks) treatment of exogenous obesity. The pharmacological effects of phentermine are similar to amphetamines. The Phentermine resin complex was approved by the FDA in 1959, but is no longer sold in the United States. Phentermine hydrochloride was approved by the FDA in 1973. In the mid-90s, interest in phentermine along with another anorexic, fenfluramine, for the treatment of obesity and substance abuse was renewed, but little scientific data supports this practice. On July 8, 1997, the FDA issued a ‘Dear Healthcare Professional’ letter warning physicians about the development of valvular heart disease and pulmonary hypertension in women taking the combination of fenfluramine and phentermine; fenfluramine was withdrawn from the US market in the fall of 1997.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 and is not recommended. In May 2011, the FDA approved phentermine hydrochloride orodispersible tablet (Suprenza) for the treatment of exogenous obesity.1
There is limited information on the mechanism of action of this drug in reference texts. Phentermine is an analogue of methamphetamine. Similar to 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 effect on serotonin is less potent than that of methamphetamine itself.3 Clinical effects include central nervous system stimulation and elevation of blood levels. pressure. Appetite suppression is believed 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 to the anorexic effects develops, it is generally recommended to discontinue phentermine rather than increase the dose.
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Phentermine is taken orally. The rate and extent of exposure to phentermine under fasting conditions are equivalent regardless of oral administration.1
There is limited information on the pharmacokinetics of phentermine. Phentermine is mainly excreted by the kidneys. The elimination half-life is 19-24 hours and is affected by urinary pH. Since the pKa value of phentermine is 9.84, the elimination half-life is reduced to approximately 7-8 hours under acidic urinary conditions.
Oral Route: After oral administration, most absorption of phentermine occurs through the small intestine. The duration of action is about 4 hours after taking an 8 mg capsule or tablet and 12-14 hours after taking a 30 mg capsule or 37.5 mg tablet.
Phentermine orally disintegrating tablet (ODT) reaches peak concentration (Cmax) 3-4.4 hours after administration. Water intake prior to ODT ingestion did not affect AUC. Phentermine ODT may be taken with or without food, although Cmax (approximately 5%) and AUC (approximately 12%) are decreased when phentermine ODT is administered after a high-fat/high-calorie breakfast. Cmax and AUC were reduced by approximately 7% and 8%, respectively, when ODT was absorbed without prior breakdown.1
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Renal impairment: Use with caution in patients with renal impairment. Under conditions of uncontrolled urinary pH, the total urinary excretion of phentermine is 62-85%, and increased exposure can be expected in patients with renal impairment.1
According to the manufacturers of Phentermine capsules and tablets, its products are contraindicated in patients with heart disease, advanced arteriosclerosis, moderate or severe hypertension, anxiety states, or glaucoma.6 Likewise, orally disintegrating tablets are contraindicated in patients with heart disease. diseases including coronary artery disease, stroke, cardiac arrhythmias, heart failure, and uncontrolled hypertension.5 Valvular heart disease has been reported in women taking the combination of fenfluramine and phentermine; The safety and efficacy of combination therapy with phentermine and any other medication for weight loss, including selective serotonin reuptake inhibitors (eg, fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, the simultaneous use of these drugs for weight loss is not recommended. In addition, primary pulmonary hypertension (PPH) has been reported in patients receiving the combination of phentermine and 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 early symptoms include: angina pectoris, fainting, or edema of the lower extremities. Patients should be advised to report any deterioration in exercise tolerance immediately. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope, or lower extremity edema.
Since 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 of the use of 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 stimulatory and vasopressor effects of phentermine.
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Phentermine is contraindicated in patients with anxiety states. Exacerbate these effects or cause an adverse drug reaction.4 Symptoms of chronic intoxication include insomnia, irritability, personality changes, and psychotic symptoms that are clinically indistinguishable from other psychotic disorders such as schizophrenia. Phentermine may aggravate certain mental conditions, such as in patients who exhibit high nervousness or agitated behavior, including psychosis, mania, or severe anxiety.
Phentermine use may cause dizziness, mask symptoms of fatigue or the need for rest, or impair the patient’s ability to participate in activities that require mental alertness. Advise patients to exercise 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 function. In general, 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 mellitus. In these patients, insulin or other antidiabetic drug requirements may be altered when using phentermine during weight loss and due to changes in dietary patterns. Patients should monitor their blood glucose regularly and follow the doctor’s recommendations. 5
Appetite suppressant therapy is not recommended for use in patients with anorexia nervosa or other eating disorders. Phentermine use is contraindicated in patients with a history of drug or substance abuse. Phentermine is chemically and pharmacologically related to the widely abused amphetamines. The potential for abuse of Phentermine should be considered when evaluating the desirability of including the drug as part of a weight loss program. The lowest acceptable amount should be prescribed or given at the same time to limit the potential for drug abuse or diversion.5
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Phentermine products are now classified as FDA pregnancy risk category X, as are many anorexics used for weight loss, and are contraindicated during pregnancy.56 The 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 women who may become pregnant unless, in the physician’s opinion, the potential benefits outweigh the possible 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. A gradual discontinuation of therapy is recommended. If immediate discontinuation is medically necessary, careful monitoring and symptom management are warranted.4
Phentermine is contraindicated during breastfeeding.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 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 under 16 years of age. There are no established uses of phentermine in infants or neonates.45
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A debilitated or elderly patient may be more sensitive to the CNS and sympathomimetic side effects of phentermine; use with caution in elderly patients. Patients with kidney failure may also be more susceptible to side effects. An increase in exposure can be expected in patients with renal insufficiency or renal insufficiency. Use caution when administering phentermine to patients with renal insufficiency.4
The use of inhalation anesthetics during surgery can sensitize the myocardium to the effects of sympathomimetic drugs. Because of this and its effects on blood pressure, phentermine should generally be stopped a few days before surgery. Avoid sudden stops.
Phentermine products are now classified as FDA pregnancy risk category X, as are many anorexics used for weight loss, and are contraindicated during pregnancy.55 The 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 women who may become pregnant unless, in the doctor’s opinion, the potential benefits outweigh the possible risks.
The safety of phentermine when used with other anorexic agents such as amphetamine, benzphetamine, dexfenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine8 is controversial and concomitant use should be avoided. The role of phentermine in production
