Diet Pills That Work Like Phentermine – Phentermine is an oral sympathomimetic amine used as an adjunct in the short-term (eg, 8-12 weeks) treatment of obesity. The pharmacological effects of phentermine are similar to those of amphetamine. The phentermine resin compound 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 along with another anorectic, fenfluramine, for the treatment of obesity and substance abuse, but little scientific evidence supports this practice. . On July 8, 1997, the FDA issued a Dear Healthcare Professional letter warning physicians about the development of cardiovascular disease and pulmonary hypertension in women receiving a combination of fenfluramine and phentermine; Fenfluramine was later removed from the US market in the summer of 1997. The use of phentermine and other anorectic agents for the treatment of obesity has not been evaluated and is not recommended. In May 2011, the FDA approved phentermine hydrochloride orally disintegrating tablets (Suprenza) for the treatment of obesity.1
Little data on the mechanism of action of this drug is available in reference literature. Phentermine is an analog of methamphetamine. Like amphetamine, phentermine increases the release of norepinephrine and dopamine from nerve endings and inhibits their reuptake. Therefore, 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 weaker than methamphetamine itself.3 Clinical effects include central nervous system stimulation central nervous system and blood pressure. standards. pressure. It is believed that appetite suppression occurs by direct stimulation of the satiety center in the hypothalamic and limbic regions.
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Tolerance to phentermine anorexia usually develops within a few weeks of starting treatment. The mechanism of tolerance appears to be pharmacodynamic in nature; higher doses of phentermine are needed to produce the same response. When tolerance to anorexic effects develops, it is usually recommended to stop phentermine instead of increasing the dose.
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Phentermine is used orally. The rate and extent of exposure to phentermine in the fasting state are the same regardless of the oral form administered.
There is limited data on the pharmacokinetics of phentermine. Phentermine is mainly excreted by the kidneys. The elimination half-life is 19-24 hours and depends on the pH of the urine. Since the pKa of phentermine is 9.84, the half-life is reduced to approximately 7-8 hours under acidic conditions of the urine.
Oral route: After oral administration, most of the absorption of phentermine occurs from the small intestine. The duration of action after taking 8 mg tablets or tablets is about 4 hours and 12-14 hours after taking 30 mg tablets or 37.5 mg tablets.
Phentermine orally disintegrating tablet (ODT) reaches maximum levels (Cmax) 3-4.4 hours after administration. Drinking water before taking ODT does not affect AUC. Although Cmax (approximately 5%) and AUC (approximately 12%) were decreased when phentermine ODT was 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 impaired renal function. Urinary excretion of phentermine under uncontrolled urinary pH conditions is 62-85%, and increased exposure can be expected in patients with impaired renal function.
According to the manufacturers of phentermine pills and tablets, its products are contraindicated in patients with heart disease, advanced arteriosclerosis, moderate to severe hypertension, shock, or glaucoma.6 Similarly, oral disintegrating tablets are contraindicated for patients with a history of heart disease. conditions, including heart disease, stroke, cardiac arrhythmias, heart failure, and uncontrolled high blood pressure.5 Heart valve disease has been reported in women treated with a combination of fenfluramine and phentermine; The safety and effectiveness of combination therapy with phentermine and any other weight loss medication, including selective serotonin reuptake inhibitors (for example, fluoxetine, sertraline, fluvoxamine, paroxetine), has 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 treated with a combination of phentermine and fenfluramine or dexfenfluramine. The possibility of an association between the use of phentermine alone and PRK or valvular heart disease cannot be excluded. Shortness of breath is usually the first symptom of PRK. Other early symptoms include: angina pectoris, syncope, or lower extremity edema. Patients should be advised to immediately report deterioration of exercise tolerance. Treatment should be stopped 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 MAO inhibitory activity. Monoamine oxidase (MAO) inhibitors or drugs with MAO inhibitory activity, such as furazolidone or procarbazine, may prolong and increase the cardiac excitability and vasopressor effects of phentermine.4
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Phentermine is contraindicated in agitated patients. It increases these effects or causes an adverse effect of the medication.4 Symptoms of chronic alcoholism include insomnia, irritability, personality changes, and psychotic symptoms that are clinically indistinguishable from other mental illnesses such as schizophrenia. Phentermine may worsen certain mental conditions, such as patients who exhibit fearful or agitated behavior, including psychosis, mania, or severe anxiety.
The use of phentermine can cause dizziness, masking signs of fatigue or the need to rest, or impair the patient’s ability to participate in activities that require mental focus. Advise patients to exercise caution when driving or operating machinery or performing other tasks that require mental alertness until they are aware of the effect of treatment on their mental and/or motor performance. In general, drinking ethanol can increase 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. Insulin or other antidiabetic drug requirements may be altered in these patients when phentermine is used during weight loss and due to changes in dietary patterns. Patients should monitor their blood glucose levels regularly and follow their healthcare provider’s recommendations
Appetite suppressant therapy is not recommended for patients with a history of anorexia nervosa or other eating disorders. Phentermine is contraindicated in patients with a known history of drug or drug abuse. Phentermine is chemically and pharmacologically related to the widely abused amphetamines. The potential for phentermine abuse should be considered when evaluating the possibility of including the drug in a weight loss program. A reasonably small amount should be administered or given at one time to minimize the possibility of overdose or drug withdrawal.5
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Phentermine products are now classified as FDA Pregnancy Hazard Category, as are many anorectic drugs used for weight loss, and are restricted 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 women who are pregnant or who may become pregnant, unless, in the doctor’s opinion, the potential benefits outweigh the potential risks.6
Abrupt discontinuation of phentermine after long-term high doses may cause severe mental depression or extreme fatigue; EEG changes during sleep were also observed. It is recommended to stop treatment slowly. If immediate cessation is necessary for treatment, careful monitoring and treatment of symptoms is necessary
Phentermine is contraindicated during breast-feeding.5 It is not known whether phentermine and its metabolites are excreted in human milk; however, because of the potential for serious side effects in nursing infants, breastfeeding while taking phentermine is not recommended.76
The safety and efficacy of phentermine in children has not been established. Phentermine is not recommended for children or adolescents under the age of 16. There is no established use of phentermine in infants or young children.45
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The debilitated or elderly patient may be more sensitive to the central nervous system and sympathomimetic effects of phentermine; use with caution in elderly patients. Patients with impaired renal function may also be more sensitive to side effects. Increased exposure can be expected in patients with impaired renal function or renal failure. Use caution when prescribing phentermine to patients with impaired renal function
The use of inhalation anesthetics during surgery can increase the sensitivity of the myocardium to the action of sympathomimetic agents. Because of this and its effects on blood pressure, phentermine should be stopped a few days before surgery. Avoid abrupt termination.
Phentermine products are now classified as a pregnancy risk category by the FDA, as are many anorexics used for weight loss, and are not approved 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 women who are pregnant or who may become pregnant unless, in the doctor’s opinion, the potential benefits outweigh the potential risks.5
The safety of phentermine with other anorectic agents such as amphetamine, benzamphetamine, dexphenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine8 is controversial, and simultaneous use should be avoided. The role of phentermine in production
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