Phentermine: availability, use, risks, and precautionsPhentermine is a controlled substance used for short-term weight loss. Read our article to discover why phentermine is not widely available and the risks and benefits of phentermine therapy.

Phentermine and what you need to know about it

Phentermine was first introduced in the USA and FDA-approved in 1959. It is a sympathomimetic amine anorectic (hunger-suppressing drug). Chemically, the substance is known as α-methyl-amphetamine and is essentially a substituted amphetamine. In the States, phentermine is a controlled Schedule IV substance. This means it is available only with a prescription, and the patient may get a refill prescription only up to 5 times in a six-month period. Some of its trade names are:

• Adipex-P;
• Suprenza;
• Duromine;
• Metermine.

How it works

The pharmacologic activity of phentermine is similar to its parent compound: it is a CNS stimulant. While the exact mechanism of hunger suppression has not yet been explained, it is suggested that the drug increases levels of norepinephrine, serotonin, and dopamine in the brain, thus altering brain state and behavioral patterns. Outside the brain, norepinephrine helps break down fat cells which contributes to faster fat burning.

Indication, administration, dosages

Phentermine is a drug for the treatment of exogenous obesity in combination with SOC lifestyle modification therapy (that includes exercise, behavioral modification, and limitation of caloric intake). It is indicated for patients who have a body mass index over or equal to 30 kg/m² or 27 kg/m² and higher with other risk factors present. These risk factors could be a chronic condition, such as hyperlipidemia, hypertension, or diabetes. Combined with obesity, they pose a higher threat to patients’ well-being. The drug is administrated orally (per mouth). It is manufactured in the form of tablets or pills that contain 15 mg, 30 mg, or 37.5 mg phentermine hydrochloride. They could also be ODT tablets that dissolve in your mouth and thus are absorbed more quickly. The dosage is to be selected respectively to the patient’s response to treatment so that the lowest possible dosage will cause the desired effect. Phentermine can be used with or without food, preferably in the morning, as it can cause insomnia. The drug labels suggest that it should not be used in teens under the age of 16. While there is at least one study focused on the use of phentermine in the pediatric population, it included participants with a mean age of 16.1±1.3 years.

Risks, warnings, and controversy

Due to the aforementioned chemical and pharmacological relation between phentermine and amphetamine, the former can become a subject of abuse and dependence. The possibility of this should be taken into account by a doctor who develops a weight reduction therapy for their patient. Moreover, the drug is contraindicated for patients with a known history of drug abuse. On the other side, there is a 2013 study that included 269 participants who had undergone long-term or short-term phentermine treatment. According to the conclusions, there were no cases of abuse and dependence. Another possible issue with the medication is tolerance: when the patient’s organism does not react to the medication as it used or intended to. If this occurs, the dosage of phentermine should not be increased, and the treatment is to be fully discontinued. Phentermine therapy, both sole and combined, has been linked to the development of cardiac valvular disease and primary pulmonary hypertension (PPH) in otherwise healthy patients. The drug should not be combined with alcohol and other products intended for weight loss.

Side effects and contraindications

Reportedly, phentermine can cause the following side effects:

• Cardiovascular: heart palpitation, ischemization, hypertension, tachycardia.
• CNS: impaired ability to engage in activities that require focus, restlessness, insomnia, overstimulation, euphoria, dizziness, psychosis, headache, dysphoria, tremor.
• GI: mouth dryness, constipation, diarrhea, and other GI disorders.
• Allergic: urticaria (also called hives, skin rash with red and splotchy areas).
• Erectile dysfunction, changes in sex drive.

It is also impossible to rule out cardiac valvular disease and primary pulmonary hypertension as severe adverse reactions to phentermine. The medication is contraindicated to patients who:

• are pregnant or nursing;
• have a history of cardiovascular conditions (such as stroke, congestive heart failure, uncontrolled hypertension, etc.);
• have hyperthyroidism
• have glaucoma;
• are prone to agitated states;
• have history of drug abuse;
• have known intolerance or hypersensitivity to sympathomimetic amines.

Summary

Phentermine is an amphetamine derivative used for weight reduction in patients with obesity. Nevertheless, the medication has dangerous side effects and poses risks of abuse and dependence. Phentermine is a controlled substance in a majority of countries where it is used.

Medical Weight Loss

Medical weight loss programs combine guidance and support with comprehensive tools and proven strategies to help people lose weight and maintain that weight loss long-term.

Conventional weight loss programs encourage temporary changes to diet and exercise habits. While this can encourage short-term weight loss, it is not often enough for long-term change.

Your weight is affected by more than your diet and exercise habits. To lose weight and maintain that weight loss, you need to understand the reason you gained weight in the past, and make long-term changes to your health and lifestyle.

In addition to diet and exercise, weight loss is affected by:

• Hormone Balance. Our ability to lose weight is influenced by sex hormones, adrenal hormones, thyroid hormones, insulin and human growth hormone. Balanced levels of these hormones are important for successful weight loss.
• Lifestyle Habits. Behaviors like sleep and stress management influence our ability to lose weight. It is also important to remain physically active and eat a diet that provides proper nutrition.
• Body composition. To achieve and maintain weight loss, it is important to lose fat while maintaining lean muscle mass. This is because muscle mass increases your metabolism, helping you burn more calories each day.

Many weight loss products and programs focus primarily on diet and physical activity. Medical weight loss programs incorporate additional resources to help you reach your weight loss goal and maintain a healthier lifestyle.

Benefits of medical weight loss include:

• Ongoing guidance and support
• Nutritional counseling
• Weight loss supplements like HCG
• Behavior modification and education

The Consequences of Excess Weight

Being overweight or obese increases your risk for a collection of chronic and severe health conditions, including:

• Type 2 diabetes
• Hypertension
• Hyperlipidemia
• Sleep apnea
• Osteoarthritis
• Certain forms of cancer

When we gain weight, our bodies store more fat, and this effects hormone production. When you become overweight, excess fat can cause hormone fluctuations and imbalance. Fat can also prompt inflammation throughout the body. As you age, increased levels of fat can make you more susceptible to many common health conditions associated with growing older.

Medical weight loss programs incorporate healthy lifestyle changes and supported weight loss strategies that can reduce your risk for developing obesity-related conditions. In some circumstances, weight loss can even reverse the onset of chronic disease.