Phentermine: 6 things you should know
Medically reviewed by C. Fookes, BPharm. Last updated on Sep 14, 2018.
1. How it works
- Phentermine is a central nervous stimulant that may be used in the treatment of obesity.
- Experts aren't exactly sure how phentermine works but it appears to have multiple actions including stimulating neurons to release the neurotransmitters dopamine and norepinephrine, which may account for its appetite-suppressing effects. Phentermine also appears to increase levels of norepinephrine, dopamine, and serotonin by inhibiting their reuptake, and inhibit monoamine oxidase enzymes. It possibly also indirectly raises leptin levels in the brain (leptin is a hormone that tells us we feel full), and reduces the effects of neuropeptide Y - a chemical messenger that initiates eating, decreases energy expenditure, and increases fat storage.
- Phentermine belongs to the class of drugs known as anorectics or anorexigenics.
- May be used short-term as an aid to weight-loss in addition to exercise, behavioral modification, and caloric restriction. Recommended only for people with an initial BMI of equal or more than 30 kg/m2, or 27 kg/m2 with risk factors for a cardiovascular event (such as controlled high blood pressure, diabetes, or high cholesterol).
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- High blood pressure and other adverse cardiovascular effects. Restlessness, insomnia, headache, psychosis, dry mouth, rash, sexual dysfunction, an unpleasant taste and gastrointestinal disturbances may also occur.
- Treatment of more than a few weeks increases the risk of addiction and dependence on phentermine. Abrupt cessation following prolonged dosing may cause a withdrawal effect (symptoms include extreme fatigue and depression).
- May impair judgment and affect a person's ability to drive or operate machinery. Alcohol should be avoided.
- Tolerance may develop to the weight-loss effects of phentermine, rendering it less effective. The dosage of phentermine should not be increased in this situation, rather the drug may need to be discontinued under medical advice.
- Should not be used in children aged 16 or less.
- The dosage of phentermine requires reducing in people with severe kidney impairment and it should be avoided in people with end-stage kidney disease. Phentermine is not suitable for people with a history of cardiovascular or valvular heart disease, glaucoma, hyperthyroidism, a history of drug abuse, who are pregnant or breastfeeding, or with agitation.
- May interact with a number of other drugs including other medications used for weight loss (includes other prescribed products, over-the-counter preparations, or herbal supplements), antidepressants, antipsychotics, antidiabetic drugs, and other central nervous system stimulants. Some interactions may be potentially fatal, such as primary pulmonary hypertension (PPH), a frequently fatal lung disease which can occur if phentermine is taken with fenfluramine or dexfenfluramine.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Administer before breakfast or one-to-two hours after breakfast. Avoid late evening administration as this may cause insomnia. Some people may benefit from a twice-daily dosage regimen.
- Dosage must be tailored to different individuals. Take exactly as directed and for the duration intended. If you find yourself gaining weight while taking phentermine see your doctor.
- Phentermine should be used alongside dietary changes, exercise, and behavioral modification as discussed with your doctor.
- Do not drive or operate machinery if this medicine impairs your judgment.
- Do not drink alcohol while taking phentermine as it may increase the risk of side effects and further impair your judgment.
- Should not be used at the same time as other medications used for weight loss.
- Recommended only for people with an initial BMI of equal or more than 30 kg/m2, or 27 kg/m2 with risk factors for a cardiovascular event (such as controlled high blood pressure, diabetes, or high cholesterol). Do not share your phentermine with anybody else (this is also illegal).
- Report any new shortness of breath, angina pain, fluid retention in legs or feet, or a decrease in your ability to exercise (not attributable to any other cause) to your doctor immediately.
- Phentermine may be sought out by drug users and one accidental dose may be fatal to children or pets. Keep supplies out of reach and sight of others.
6. Response and Effectiveness
Peak concentrations of phentermine are reached within three to four hours. Studies have shown that, on average, phentermine helps people lose approximately one extra pound per week. The rate of weight loss is greatest in the first few weeks of therapy.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use phentermine only for the indication prescribed.
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