Phentermine is a medication used for a limited period to accelerate weight loss in individuals with overweight who are also engaged in exercise and a reduced-calorie diet. It belongs to a class of medications known as anorectics and functions by curbing appetite. While phentermine can be a useful tool in managing obesity, it is crucial to understand both its benefits and potential risks.
What is Phentermine?
Phentermine is a prescription weight-loss drug known as an anorectic, which reduces a person’s appetite. It is similar to an amphetamine and stimulates the central nervous system, increasing heart rate and blood pressure while decreasing appetite. It is available as tablets and extended-release capsules and is typically taken once daily in the morning or three times a day, 30 minutes before meals. The medication is usually prescribed for 3 to 6 weeks, but the duration of treatment depends on individual response.
How Phentermine Works
Phentermine affects the brain’s neurotransmitters and is believed to cause weight loss by suppressing appetite. The exact mechanism by which phentermine leads to weight loss is not fully understood. It belongs to the class of drugs known as sympathomimetic amines.
Dosage and Administration
Phentermine is available in both tablet and extended-release capsule form. It is usually taken as a single daily dose in the morning or three times a day 30 minutes before meals. Most people take phentermine for 3 to 6 weeks, and the length of treatment depends on how you respond to the medication.
- Tablets: Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine exactly as directed. There are some tablets that can be crushed and mixed with food.
- Extended-Release Capsules: If you are taking the extended-release (long-acting) tablets, do not split, chew, or crush them tablet.
Benefits of Phentermine
Weight Loss
Phentermine is used to speed weight loss in overweight people who are exercising and eating a low-calorie diet. It can be an effective tool for individuals with a body mass index (BMI) of 30 kg/m2 or greater, or a BMI of 27 kg/m2 or greater if they have co-existing conditions such as hypertension or type 2 diabetes mellitus.
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Improved Cardiometabolic Variables
Studies have shown that phentermine can improve cardiometabolic variables, including body fat, visceral fat, systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose.
Potential for Long-Term Use
While initially approved for short-term use (12 weeks or less), some studies suggest that longer-term use of phentermine may be safe and effective for certain patients. A study using electronic health records found evidence of better weight loss with longer-term use of phentermine, up to 2 years’ follow-up.
Risks and Side Effects of Phentermine
Common Side Effects
Phentermine may cause side effects, including:
- Dry mouth
- Unpleasant taste
- Diarrhea
- Constipation
- Vomiting
Serious Side Effects
Some side effects can be serious and require immediate medical attention:
- Increased blood pressure
- Heart palpitations
- Restlessness
- Dizziness
- Tremor
- Insomnia
- Shortness of breath
- Chest pain
- Swelling of the legs and ankles
- Difficulty doing exercise that you have been able to do
Potential for Overdose
It is possible to overdose on phentermine, which is a stimulant drug similar to amphetamine. Symptoms of an overdose include:
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- Bigger, dilated, or enlarged pupils (black part of the eye)
- Confusion
- Increased sensitivity of the eyes to light
- Overactive reflexes
- Panic states
- Physical attempt to injure
- Restlessness
- Seeing, hearing, or feeling things that are not there
- Shakiness in the legs, arms, hands, or feet
- Trembling or shaking of the hands or feet
- Violent actions
If you suspect an overdose, call 911 immediately.
Risk of Addiction
Phentermine can be habit-forming, especially if used for an extended period of time. Chronic phentermine use can lead to dependence and addiction, especially if you’re misusing it or continue to increase your dose as time goes on.
Mental Health Risks
Taking an appetite suppressant like phentermine may not only cause many physical adverse effects but it can also lead to disordered eating behaviors like caloric restriction and skipping meals and even clinical eating disorders like anorexia nervosa (AN).
Cardiovascular Risks
Concerns have been raised about cardiovascular side effects due to phentermine's stimulant properties, which could potentially raise blood pressure.
Pulmonary Hypertension
This medicine may cause pulmonary hypertension (increased blood pressure in the lungs). Serious heart or blood vessel problems (eg, valvular heart disease) may also occur if you take more of it, if you take it for a longer time, or if you are taking other medicine that reduces appetite (eg, dexfenfluramine (Redux®), fenfluramine (Fintepla®)). Check with your doctor right away if you have chest pain, decreased ability to exercise, fainting, swelling of the feet or lower legs, or trouble breathing.
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Precautions and Contraindications
Before taking phentermine, it is crucial to inform your doctor and pharmacist about any allergies, medications you are taking, and medical conditions you have or have had.
Drug Interactions
Tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan®), phenelzine (Nardil®), selegiline (Eldepryl®, Emsam®, Zelapar®) and tranylcypromine (Parnate®).
Do not use phentermine if you are also using similar medicines such as benzphetamine, diethylpropion, mazindol, phendimetrazine, Bontril®, or Didrex®.
Medical Conditions
Tell your doctor if you have or have ever had heart disease, high blood pressure, arteriosclerosis (narrowing of the arteries), hyperthyroidism (overactive thyroid gland), diabetes, glaucoma, or a history of drug abuse.
Pregnancy and Breast-feeding
Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.
Older Adults
Talk to your doctor about the risks and benefits of taking phentermine if you are 65 years of age or older. Older adults should not usually take phentermine because it is not as safe as other medications that can be used to treat the same condition.
Alcohol and Other Medications
Ask your doctor about the safe use of alcohol while you are taking phentermine. Alcohol can make the side effects of phentermine worse.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription and nonprescription (over-the-counter) medicines, dietary supplements, herbal remedies, or medicines for appetite control, asthma, colds, cough, hay fever, and sinus problems.
Diabetes
If you have diabetes, you may need to decrease your dose of insulin while taking phentermine. Call your doctor if you have questions or problems.
Lifestyle Changes are Essential
Follow the diet and exercise program your doctor has given you. Phentermine works best in combination with a diet program.
What to do if you Miss a Dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Long-Term Studies
A study in Mexico evaluated the efficacy and safety of phentermine over a 6-month period. The results indicated that while a higher dose (30 mg) was more effective than a lower dose (15 mg) in the first 3 months, the difference was not significant after 6 months. The study also found that a significant number of patients could benefit from continuing the therapy from 3 to 6 months.
Important Considerations
- Regular Monitoring: It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and does not cause any unwanted effects.
- Controlled Substance: Phentermine is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist any questions you have about refilling your prescription.
- Individual Response: It’s important to monitor patients for their response to phentermine treatment. About a third of people prescribed phentermine lost less than 3 percent of their weight within the first 3 months of starting the drug. These “non-responders” should not continue phentermine treatment, as they are unlikely to experience clinical benefit from it.
Alternative Approaches
It's crucial to recognize that relying solely on medications like phentermine for weight loss can be risky. A comprehensive approach that addresses the underlying issues related to eating behaviors and body image is essential. This may include therapy, nutritional counseling, and lifestyle modifications.
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