Weight Loss Doctors Phentermine Near Me – Phentermine is an oral sympathomimetic amine used as an adjunct for the short-term (eg, 8-12 weeks) treatment of exogenous obesity. The pharmacological effects of phentermine are similar to amphetamines. 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-1990s, 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 Healthcare Professional letter warning physicians 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pulmonary hypertension in women receiving a combination of fenfluramine and phentermine; fenfluramine was subsequently withdrawn from the US market in the fall of 1997.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 tablet (Suprenza) for the treatment of exogenous obesity.1
Limited data are available in reference texts regarding 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. Thus, phentermine is classified as an indirect sympathomimetic.2 Other effects include a weak ability to dose-dependently increase serotonin levels, although the effect on serotonin that occurs is less strong than that of methamphetamine itself.3 Clinical effects include CNS stimulation and elevation of blood pressure. Appetite suppression is believed to occur through direct stimulation of the satiety center in the hypothalamus and limbic region.
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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 administered orally. The rate and extent of exposure to phentermine under fasting conditions are equivalent regardless of the oral formulation administered.1
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 influenced 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 the absorption of phentermine occurs from the small intestine. The duration of action after administration of 8 mg capsules or tablets is about 4 hours and 12-14 hours after administration of 30 mg capsules or 37.5 mg tablets.
Phentermine oral disintegrating tablet (ODT) reaches maximum concentrations (Cmax) 3-4.4 hours after administration. Swallowing water before swallowing ODT did not affect AUC. Despite a decrease in Cmax (approximately 5%) and AUC (approximately 12%) when 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 ingested without prior dissolution.1
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Renal impairment: Use with caution in patients with renal impairment. 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 the manufacture of phentermine capsules and tablets, its products are contraindicated in patients with heart disease, advanced arteriosclerosis, moderate to severe hypertension, anxiety states, or glaucoma. disease including coronary artery disease, stroke, cardiac arrhythmias, 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 medications, including selective serotonin reuptake inhibitors (eg, fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, the simultaneous administration of these drugs for weight loss is not recommended. Furthermore, 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 the use of phentermine alone and PPH or valvular heart disease cannot be excluded. The initial symptom of PPH is usually dyspnea. Other initial symptoms include: angina pectoris, syncope, 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.
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 of the use of MAOI therapy or other drugs with MAOI-inhibiting activity. 4
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Phentermine is contraindicated in patients with anxiety states. worsen these effects or cause an adverse drug reaction.4 Symptoms of chronic intoxication include insomnia, irritability, personality change, and psychotic symptoms that may be clinically indistinguishable from other psychotic disorders, such as schizophrenia. Phentermine may worsen certain mental conditions, such as those 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 the therapy will affect their mental and/or motor performance. In general, ingestion of ethanol may worsen 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. Insulin or other antidiabetic drug requirements may change in these patients when using phentermine during weight loss and due to altered dietary regimens. Patients should monitor their blood glucose regularly and follow their healthcare provider’s recommendations. 5
Appetite suppression therapy is not recommended for use in those 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 the heavily abused amphetamines. The potential for abuse of phentermine should be kept in mind when evaluating the desirability of including the drug as part of a weight loss program. The smallest reasonable amount should be prescribed or dispensed at one time in order to limit the potential for overuse or diversion of the medication.5
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Phentermine products are now classified as pregnancy risk category X by the FDA, 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 is no known indication for the use of phentermine during pregnancy. Phentermine should not be taken by women who are pregnant or who may become pregnant unless, in the doctor’s opinion, the potential benefits outweigh the possible dangers.6
Abrupt discontinuation of phentermine after prolonged high doses may result in severe mental depression or extreme fatigue; Changes in the EEG during sleep have also been observed. A gradual withdrawal 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 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 have not been established. Phentermine is not recommended for children or adolescents 16 years of age and younger. The use of phentermine in infants or neonates has not been established.45
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The debilitated or geriatric patient may be more susceptible to the CNS and sympathomimetic side effects of phentermine; use with caution in elderly patients. Patients with renal impairment may also be more susceptible to side effects. An increase in exposure can be expected in patients with renal impairment or renal insufficiency. Use caution when administering phentermine to patients with renal impairment.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 abrupt termination.
Phentermine products are now classified as pregnancy risk category X by the FDA, 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 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 opinion of the physician, the potential benefits outweigh the possible dangers.5
The safety of phentermine when used with other anorexic agents such as amphetamine, benzamphetamine, dexfenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine8 is controversial and concomitant use should be avoided. The role of phentermine in production
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