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Taking phentermine together with other diet medications such as fenfluramine (Phen-Fen) or dexfenfluramine (Redux)
can cause a rare fatal lung disorder called pulmonary hypertension. Do not take phentermine with any other diet
medications without your doctors advice.
Phentermine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything
that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of phentermine.
Phentermine may be habit-forming and should be used only by the person it was prescribed for. Keep track of how many
pills have been used from each new bottle of this medicine. Phentermine is a drug of abuse and you should be aware if any
person in the household is using this medicine improperly or without a prescription.
You may have withdrawal symptoms, such as depression and extreme tiredness, when you stop using phentermine
after using it over a long period of time. Do not stop using phentermine suddenly without first talking to your doctor.
You may need to use less and less before you stop the medication completely.
In 1959 phentermine first received approval from the FDA as an appetite suppressing drug.
Phentermine hydrochloride then became available in the early 1970s. It was previously sold as Fastin® from King
Pharmaceuticals for SmithKline Beecham, however in 1998 it was removed from the market.
Medeva Pharmaceuticals sells the name brand of phentermine called Ionamin® and Gate Pharmaceuticals
sells it as Adipex-P®. Phentermine is also currently sold as a generic. Since the drug was approved in
1959 there have been almost no clinical studies performed. The most recent study was in 1990 which
combined phentermine with fenfluramine or dexfenfluramine and became known as Fen-Phen.
Although Fen-Phen was never approved by the FDA the agency did approve of the drug. A study was published in 1992 that Fen-Phen was more effective than diet and exercise with few side effects. However, in 1997 after 24 cases of heart valve disease in Fen-Phen users, fenfluramine and dexfenfluramine were voluntarily taken off the market at the request of the FDA. Studies later proved that nearly 30% of people taking fenfluramine or dexfenfluramine had abnormal valve findings. The FDA did not ask manufacturers toremove phentermine from the market. Phentermine is still available by itself in most countries, including the U.S. However, because it is an amphetamine, individuals may develop an addiction to it. Hence, it is classified as a controlled substance in many countries. Internationally, phentermine is a schedule IV drug under the Convention on Psychotropic Substances. In the United States, it is classified as a Schedule IV controlled substance under the Controlled Substances Act. Phentermine, like many other prescription drugs, works with neurotransmitters in the brain. It is a centrally-acting stimulant and is a constitutional isomer (not to be confused with stereoisomer) of methamphetamine. It stimulates neuron bundles to release a particular group of neurotransmitters known as catecholamines; these include dopamine, epinephrine (also known as adrenalin), and norepinephrine (noradrenaline). The anorectic activity seen with these compounds would thus seem likely due to this effect on the central nervous system, which is consistent with current knowledge about central nervous system systems and feeding behavior. This is the same mechanism of action as other stimulant appetite suppressants such as diethylpropion and phendimetrazine. The neurotransmitters signal a fight-or-flight response in the body which, in turn, puts a halt to the hunger signal. As a result, it causes a loss in appetite because the brain does not receive the hunger message.
Generally, it is recommended by the Food and Drug Administration (FDA) that phentermine should be used short-term (usually interpreted as 'up to 12 weeks'), while following nonpharmacological approaches to weight loss such as healthy dieting and exercise. However, recommendations limiting its use for short-term treatment may be controversial. One reason given behind limiting its use to 12 weeks is drug tolerance, whereby phentermine loses its appetite-suppressing effects after the body adjusts to the drug. On the contrary, it has been shown that phentermine did not lose effectiveness in a 36-week trial.[2] Due to the risk of insomnia, it is generally recommended that the drug be taken either before breakfast or 1-2 hours after breakfast. Generally, phentermine appears to be relatively well tolerated.[3] It can produce side effects consistent with its catecholamine-releasing properties, e.g., tachycardia, increased heart rate, increased alertness, but the incidence and magnitude of these appear to be less than with the amphetamines. Because phentermine acts through sympathomimetic pathways, the drug may increase blood pressure and heart rate. It may also cause palpitations, restlessness, and insomnia. Additionally, individuals taking this drug on a long-term basis may develop euphoria and a psychological addiction to it. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it may do. This is a decision you and your doctor will make. For sympathomimetic appetite suppressants, the following should be considered: Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or amphetamine, dextroamphetamine, ephedrine, epinephrine, isoproterenol, metaproterenol, methamphetamine, norepinephrine, phenylephrine, phenylpropanolamine, pseudoephedrine, terbutaline, or other appetite suppressants. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Diet—You must follow a reduced-calorie diet while using an appetite suppressant in order to lose weight. Also, in order to keep the lost weight from returning, changes in diet and exercise must be continued after the weight has been lost. Pregnancy—If a pregnant woman takes this medicine in high doses or more often than the doctor has directed, it may cause withdrawal symptoms in the newborn baby. Also, medicines similar to sympathomimetic appetite suppressants can cause birth defects in the newborn baby if a pregnant woman takes them in high doses. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant. Breast-feeding—Diethylpropion and benzphetamine pass into breast milk. It is not known if other sympathomimetic appetite suppressants pass into breast milk. However, use of sympathomimetic appetite suppressants during breast-feeding is not recommended, because it may cause unwanted effects in nursing babies.
Children—Studies on these medicines have been done only in adult patients, and there is no specific information comparing use of sympathomimetic appetite suppressants in children with use in other age groups. The use of these medicines by children younger than 16 years of age is not recommended. Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of appetite suppressants in the elderly with use in other age groups. Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking appetite suppressants, it is especially important that your health care professional know if you are taking any of the following: Amantadine (e.g., Symmetrel) or Amphetamines or Caffeine (e.g., NoDoz) or Chlophedianol (e.g., Ulone) or Cocaine or Medicine for asthma or other breathing problems or Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) or Methylphenidate (e.g., Ritalin) or Nabilone (e.g., Cesamet) or Pemoline (e.g., Cylert)—Using these medicines with sympathomimetic appetite suppressants may increase the central nervous system (CNS) stimulant effects, such as irritability, nervousness, trembling or shaking, or trouble in sleeping Appetite suppressants (diet pills), other or Selective serotonin reuptake inhibitors (citalopram [e.g., Celexa], fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft])—It is not known whether using two different appetite suppressants together or using a sympathomimetic appetite suppressant with a selective serotonin reuptake inhibitor is safe and effective. There have been some serious unwanted effects on the hearts of people who used two different appetite suppressants together Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])— Do not take an appetite suppressant while you are taking or less than 14 days after taking a monoamine oxidase (MAO) inhibitor . If you do, you may develop sudden extremely high blood pressure Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])—Using these medicines with sympathomimetic appetite suppressants may cause high blood pressure or irregular heartbeat
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