The combination of metformin and phentermine is sometimes explored as a weight loss strategy. Each medication has its own mechanism of action and potential side effects. This article will provide a comprehensive overview of metformin and phentermine, their individual effects, and the risks and benefits associated with their combined use for weight loss.
Understanding Metformin
Metformin is a medication primarily prescribed to manage type 2 diabetes. It functions by improving the body's response to insulin, a hormone that regulates blood sugar levels. While not specifically a weight loss drug, metformin is often associated with moderate weight loss in some individuals.
How Metformin Works
Metformin's mechanism of action involves:
- Improving insulin sensitivity: This allows the body to use insulin more effectively, lowering blood sugar levels.
- Decreasing glucose production in the liver: Metformin reduces the amount of glucose produced by the liver, further contributing to lower blood sugar levels.
Side Effects of Metformin
Common side effects of metformin include:
- Taste disturbances
- Diarrhea
- Other stomach-related issues
Metformin and Lac-Phe
According to a new study in mice and humans, an "anti-hunger" molecule produced after vigorous exercise is responsible for the moderate weight loss caused by the diabetes medication metformin. The finding further cements the critical role the molecule, called lac-phe, plays in metabolism, exercise, and appetite.
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The researchers found that obese laboratory mice given metformin had increased levels of lac-phe in their blood. They also analyzed stored blood plasma samples from people with Type 2 diabetes before and 12 weeks after they had begun taking metformin to control their blood sugar, seeing significant increases in the levels of lac-phe in people after metformin compared with their levels before treatment.
Understanding Phentermine
Phentermine is a stimulant medication approved for short-term use as an adjunct to diet and exercise for weight loss in individuals with obesity or who are overweight with at least one weight-related condition. It works by suppressing appetite.
How Phentermine Works
Phentermine is thought to work by:
- Suppressing appetite: Phentermine affects neurotransmitters in the brain to reduce hunger.
- Increasing energy expenditure: As a stimulant, it can slightly increase metabolism.
Side Effects and Risks of Phentermine
Phentermine carries a number of potential side effects and risks, including:
- Addiction and Tolerance: Phentermine may be used short-term as an aid to weight loss; however, it can be addictive, and tolerance may develop to its weight-losing effects, rendering it less effective with time.
- Cardiovascular Effects: Like other sympathomimetic amines, amphetamines may cause cardiovascular adverse effects such as palpitation, tachycardia, cardiac arrhythmias, and elevation of blood pressure. Rarely, cardiomyopathy manifested as ventricular hypertrophy and/or congestive heart failure has been reported during chronic amphetamine use. In addition, sudden death has been reported in association with amphetamine therapy at usual dosages in children with structural cardiac abnormalities. In general, amphetamines should not be used in patients with structural cardiac abnormalities.
- Central Nervous System Effects: Some CNS stimulants are contraindicated in patients with marked agitation and/or anxiety since these symptoms may be aggravated. CNS stimulants may also exacerbate symptoms of behavior disturbance and thought disorder in psychotic patients, particularly children.
- Risk of Abuse and Misuse: CNS stimulants (especially amphetamines) have a high potential for abuse and misuse, which can lead to development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants can result in overdose and death; this risk is increased with higher doses or unapproved methods of administration (e.g., snorting, injection). Before prescribing a CNS stimulant, each patient's risk for abuse, misuse, and addiction should be assessed. Throughout therapy, it is recommended to reassess each patient's risk and frequently monitor for signs/symptoms of abuse, misuse, and addiction. Therapy with CNS stimulants should be administered cautiously, if at all, in patients with a history of alcohol or substance abuse.
Potential Interactions and Considerations When Combining Metformin and Phentermine
Combining metformin and phentermine requires careful consideration due to potential interactions and overlapping side effects.
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Blood Sugar Monitoring
As you lose weight during treatment with phentermine, your dosage requirement of metFORMIN or any other diabetic medications you are receiving may change. You may need more frequent monitoring of your blood sugar and adjustment of your diabetic regimen both during and after treatment with phentermine. Let your doctor know if you experience hypoglycemia, or low blood sugar. Symptoms of hypoglycemia include headache, dizziness, drowsiness, nervousness, confusion, tremor, nausea, hunger, weakness, perspiration, palpitation, and rapid heartbeat.
Alcohol Consumption
MetFORMIN should be taken with meals, and excessive alcohol intake (either short-term binge drinking or frequent consumption) should be avoided during treatment. Taking metFORMIN with alcohol may increase the risk of a rare but serious and potentially life-threatening condition known as lactic acidosis, which is a buildup of lactic acid in the blood that can occasionally occur during treatment with metformin-containing products. Lactic acidosis is more likely to occur if you have kidney or liver disease, acute or unstable congestive heart failure, or dehydration. You should seek immediate medical attention if you develop potential signs and symptoms of lactic acidosis such as fatigue, weakness, muscle pain, increasing drowsiness, abdominal pain or discomfort, slow or irregular heartbeat, breathing difficulty, chills, and other unusual symptoms.
Alcohol may also affect blood glucose levels in patients with diabetes. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may occur, depending on how much and how often you drink. You should avoid using alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or pancreatitis. Moderate alcohol consumption generally does not affect blood glucose levels if your diabetes is under control. However, you should limit your alcohol intake due to the risk of lactic acidosis with metformin. Avoid drinking alcohol on an empty stomach or following exercise, as it may increase the risk of hypoglycemia.
Using phentermine with alcohol can increase the risk of cardiovascular side effects such as increased heart rate, chest pain, or blood pressure changes. In addition, you may also be more likely to experience nervous system side effects such as dizziness, drowsiness, depression, and difficulty concentrating. You should avoid or limit the use of alcohol while being treated with phentermine. Do not use more than the recommended dose of phentermine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you.
Contraindications for Metformin
Metformin is contraindicated in patients with acute or chronic metabolic acidosis (including diabetic ketoacidosis) with or without coma. Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Risk factors include renal dysfunction, age 65 years and older, hypoxic states, excessive alcohol intake, and liver dysfunction. Lactic acidosis has been associated with metformin accumulation in plasma at levels generally exceeding 5 mcg/mL. The risk of metformin-associated lactic acidosis increases with the patient's age because patients 65 years and older have a greater likelihood of having hepatic, renal, or cardiac impairment. Renal function should be assessed more frequently in older adult patients.
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Several postmarketing cases of metformin-associated lactic acidosis occurred in the setting of acute congestive heart failure, especially when accompanied by hypoperfusion and hypoxemia; cardiovascular collapse (shock), acute myocardial infarction, sepsis, and other conditions associated with hypoxemia (e.g., severe anemia, asphyxia) have been associated with lactic acidosis and may cause prerenal azotemia. When such an event occurs, metformin should be discontinued.
Dehydration (e.g., severe diarrhea or vomiting) may increase the risk for volume depletion, hypotension, and renal impairment; such patients may be at increased risk for lactic acidosis. Alcohol potentiates the effect of metformin on lactate metabolism; patients should be advised against excessive alcohol intake while receiving metformin. All patients treated with metformin should have renal function monitored regularly (at least annually or more frequently if necessary).
If metformin-associated lactic acidosis is suspected, general supportive measures should be instituted promptly in a hospital setting, as well as immediate discontinuation of metformin. If lactic acidosis is diagnosed or strongly suspected, prompt hemodialysis is recommended to correct the acidosis and remove accumulated metformin.
Contraindications for Phentermine
Many amphetamines and amphetamine-like drugs are contraindicated in patients with advanced arteriosclerosis, symptomatic or unstable cardiac or cerebrovascular disease, moderate to severe hypertension, or hyperthyroidism.
Important Considerations
It is important to tell your doctor about all other medications you use, including vitamins and herbs.
Individual Assessment
The decision to use metformin and phentermine together should be made on a case-by-case basis, considering the individual's overall health, potential risks, and potential benefits.
Lifestyle Modifications
Weight loss medications are most effective when combined with lifestyle modifications, including a healthy diet and regular exercise.
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