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I.

See Also
A.

Obesity

B.

Obesity in Children

C.

Obesity Evaluation

D.

Obesity Measurement (or Obesity Screening)

E.

Obesity Risk (or Obesity Comorbid Conditions)

F.

Obesity Management

G.

Obesity Medication

H.

Dietary Supplements in Obesity

I.

Exercise in Obesity
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II. Resources: General


A. Shape Up America
1. http://www.shapeup.org
B. Weight Control Information Network (WIN)
1. http://www.niddk.nih.gov/health/nutrit/nutrit.htm
2. Phone: 877-946-4627
C. The North American Association for the study of Obesity
1. http://www.naaso.org
III. Resources: Weight Loss Groups
A. Weight Watchers
1. http://www.weightwatchers.com
B. TOPS (Take Off Pounds Sensibly)
1. http://www.tops.org
IV. Resources: Advocacy, Support and Lobby Groups
A. National Association to Advance Fat Acceptance
1. http://www.naafa.org

2. Phone: 916-558-6880
B. Council on Size and Weight Discrimination
1. http://www.cswd.org
2. Phone: 845-679-1209
C. American Obesity Association
1. http://www.obesity.org
2. Phone: 800-98-OBESE
V. Resources: Medical Supplies for Obese Patients
A. Amplestuff: Make your world fit you
1. http://www.amplestuff.com
2. Phone: 845-679-3316
B. Size Wise
1. http://www.sizewise.com
2. Phone: 800-238-0658

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Related Topics in Obesity
Books
Endocrinology Chapters
Endocrinology - Obesity Pages
Back Links (pages that link to this page)
Search other sites for 'Obesity Resources'

Phentermine
Aka: Phentermine, Ionamin, Fastin
Endocrinology
Pharmacology Chapter

Systemic Corticosteroid

Corticosteroid Associated Osteoporosis

Adrenal Disease

Fludrocortisone

Medication Causes of Hyperglycemia

Glucometer

GlucoWatch Biographer

Symlin

Gliptin

Incretin Mimetic

Insulin

Anologue Basal Insulin

Inhaled Insulin

Insulin Dosing

Carbohydrate Count in Insulin Dosing

Insulin Dosing in Type 1 Diabetes

Insulin Dosing in Type 2 Diabetes

Variable Rate Insulin Infusion

Hourly Subcutaneous Insulin

Insulin Sliding Scale

Dawn Phenomena

Somogyi Phenomena

Insulin Pump

Insulin Simulation

Oral Hypoglycemic

Chromium Picolinate

Diabetes Mellitus

Thiazolidinedione

Glucophage

Alpha-glucosidase Inhibitor

Sulfonylurea

Non-Sulfonylurea Insulin Secretagogues

Second Generation Sulfonylurea

Sulfonylurea Overdose

First Generation Sulfonylurea

SGLT2 Inhibitor

Medications Associated with Unintentional Weight Loss

Geriatric Medicine

Growth Disorders

Human Growth Hormone

Glucagon

Intravenous Dextrose

Hypoglycemic Disorders

Medications Associated with Weight Gain

Orlistat

Lorcaserin

Sibutramine

Dexfenfluramine

Phentermine

Phentermine and Topiramate

Obesity

Pituitary Disease

Medication Causes of Hyperprolactinemia

Dopamine Agonist in Hyperprolactinemia

Sexual Development

Medication Causes of Gynecomastia

Thyroid Disease

Medications Affecting Thyroid Function

Thyroid Hormone Replacement

Liothyronine

Antithyroid Drug

Radioiodine

Radiation-Induced Thyroiditis

From Related Chapters

Endocrine Medications in Pregnancy

I. See Also
A.

Medications Associated with Weight Gain

B.

Orlistat (Xenical)

C.

Lorcaserin (Belviq)

D.

Phentermine and Topiramate (Qsymia, Qnexa)

E.

Obesity

F.

Obesity in Children

G.

Obesity Evaluation

H.

Obesity Measurement (or Obesity Screening)

I.

Obesity Risk (or Obesity Comorbid Conditions)

Obstetrics

J.

Obesity Management

K.

Obesity Medication

L.

Dietary Supplements in Obesity

M.

Exercise in Obesity

N.

Obesity Resources
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II. Mechanism
A.

Stimulates CNS adrenergic system

B.

Reduces food seeking behavior

III. Indication
A.

Short term (12 weeks per year) Obesity Management

B.

Physician discretion for indication to continue

IV. DEA Controlled Substance


A.

Class IV (Limited dependence liability)

V. Dosing
A.

Start: 8 mg PO tid

B.

Alternative: 15 to 37.5 mg PO qd 10 hours before sleep

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images
Cost: Medications
Phentermine HCl (on 2/9/2012 at DrugStore.com)
Phentermine HCl 30mg The Pharmacy Can Fill A Maximum Of A 30 Day Supply

#10 for $19.99

($2.00

Phentermine HCl 37.5mg The Pharmacy Can Fill A Maximum Of A 30 Day Supply

#10 for $14.99

($1.50

Phentermine HCl 15mg The Pharmacy Can Fill A Maximum Of A 30 Day Supply

#10 for $24.99

($2.50

FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This
information is provided only to help medical providers and their patients see relative costs. Insurance plans
negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates.
See Needy Meds for financial assistance information.
Ontology: Phentermine (C0031447)

Definition
(NCI)

A natural monoamine alkaloid derivative and a sympathomimetic stimulant with appetite suppressant
property. Phentermine, which was part of the Fen-Phen anti-obesity medication, stimulates hypothalam
release of norepinephrine, a neurotransmitter involved in stress responses (fight-or-flight reactions), an
reduces hunger sensation. Phentermine also causes the release of epinephrine or adrenaline outside of t
brain, resulting in breakdown of stored fat.

Definition
(MSH)

A central nervous system stimulant and sympathomimetic with actions and uses similar to those of
DEXTROAMPHETAMINE. It has been used most frequently in the treatment of obesity.

Definition
(CSP)

central nervous system stimulant and sympathomimetic with actions and uses similar to dextroampheta
used in the treatment of obesity.

Concepts

Organic Chemical (T109) , Pharmacologic Substance(T121)

MSH

D010645

SnomedCT

373343009, 53480001

English

Phentermine, Benzeneethanamine, alpha,alpha-dimethyl-, phentermine, Phentermine


[Chemical/Ingredient], 1,1-Dimethyl-2-phenylethylamine, 2-Phenyl-tert-butylamine, 2-Amino-2-meth
phenylpropane, PHENTERMINE, Phenyl-tertiary-butylamine, Phentermine (product), Phentermine
(substance)

Swedish

Fentermin

Czech

fentermin

Finnish

Fentermiini

Russian

FENTERMIN,

Japanese

, , , ,

Polish

Fentermina

Spanish

fentermina (producto), fentermina (sustancia), fentermina, Fentermina

French

Phentermine

German

Phentermin

Italian

Fentermina

Portuguese

Fentermina

Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology


Books
Endocrinology Chapters
Endocrinology - Pharmacology Pages
Back Links (pages that link to this page)
Search other sites for 'Phentermine'

V. Types: Class IV (Schedule IV Controlled Substance)


A.Limited dependence liability
B.Examples
1. Benzodiazepines (e.g. Xanax, Ativan, Valium, Klonopin)
2. Propoxyphene (e.g. Darvocet)

3.

Phentermine

PhentermineAlso Known As: Ionamin, Fastin, Adipex-P, Obe-Nix, Zantryl


currently under development

Compare

Chemical Formula: C10H15N

CSA Classification: Schedule IV

Drug Category: Stimulants

Description
Regulations

This page is

Prescription Drugs

Description
Substance

Chemical Formula

FDA/DEA Regulation

Phentermine is a Schedule IV controlled substance, which means that it has a low potential for abuse relative to substan
III. However, abuse may still lead to limited physical or psychological dependence.

Substance Effects

A central nervous system stimulant and sympathomimetic with actions and uses similar to those of DEXTROAMPHET
been used most frequently in the treatment of obesity.
As a stimulant, Phentermine enhances activity in the central nervous system and is found to be habit-forming.

US Government Regulations
GOVERNMENT REGULATIONS

DEA Number

1640

CSA Classification

Schedule IV
Compare Schedule IV Controlled Substances

Narcotic Classification

Non-Narcotic

Drug Category

Stimulants
Compare Stimulants

FDA Regulations

No legal medical use, or DEA license required

DEA Prescription
Regulation(s)

Prescription only; prescription may be refilled up to 5 times within

TRAFFICKING PENALTIES

Penalty for any amount:

Prison Time
(nonviolent / violent)
Fine Maximum
(individual / group)

First Offense

Second Offense

Max 5 years / --

Max 10 years / --

$250,000 / $1 million

$500,000 / $2 million

Prescription Drugs with Phentermine


Brand
Name

Description

Category Side Effects

Adipex-P

Phentermine HCl 37.5mg;


caps; scored tabs.

Metabolic
Disorders

CNS overstimulation, dizziness, palpitation


arrhythmias, hypertension, psychosis, dry mou
disturbances, urticaria, impotence, primary pul
hypertension, and/or regurgitant cardiac valvul

Primary pulmonary hypertension, regurgita


valvular disease, palpitation, tachycardia, eleva
pressure, overstimulation, restlessness, dizzine
euphoria, dysphoria, tremor, headache, dry mo
unpleasant taste, GI upset, constipation, urtica
impotence, changes in libido, tolerance (discon
occurs)
rare: psychotic episodes.

Phentermine HCl 15mg


(equivalent to 12mg
Phentermi
Metabolic
phentermine), 30mg
ne
Disorders
(equivalent to 24mg ...Show
More

Qsymia

Suprenza

Phentermine HCl/topiramate
extended-release;
Metabolic
3.75mg/23mg,
Disorders
7.5mg/46mg,
11.25mg/69... Show More

Paraesthesia, dizziness, dysgeusia, insomn


constipation, dry mouth
acute myopia and secondary angle closure
(discontinue if occurs), cognitive dysfunction, m
acidosis, increased serum creatinine, kidney st
oligohidrosis, hyperthermia.

Phentermine HCl *15mg,


*30mg, 37.5mg; orallydisintegrating tabs (ODT);

Cardiovascular (eg, PPH, regurgitant cardia


disease, palpitations, tachycardia, elevated blo
ischemic events, CNS (eg, overstimulation, rest

Metabolic
Disorders

Brand
Name

Description

Category Side Effects

peppermi ...Show More

dizziness, insomnia, euphoria, dysphoria, tremo


psychosis), dry mouth, unpleasant taste, GI up
constipation, urticaria, impotence, changes in l

http://controlled-substances.findthebest.com/l/383/Phentermine

phentermine (Fastin, Ionamin, Adipex- P)

http://clinicaltrials.gov/show/NCT01402674
Long-term Phentermine Pharmacotherapy: An Investigation for Symptoms of
Dependence, Cravings, or Withdrawal (PC-II)
This study has been completed.
Sponsor:

Center for Weight Management, California


Collaborator:

American Society of Bariatric Physicians


Information provided by (Responsible Party):

Ed J. Hendricks, M.D., Center for Weight Management, California


ClinicalTrials.gov Identifier:

NCT01402674
First received: July 23, 2011
Last updated: January 25, 2013
Last verified: January 2013

History of Changes

Full Text View

Tabular View

No Study Results Posted

Disclaimer

How to Read a Study Record

Purpose
Phentermine, an amphetamine congener, is the most widely used anti-obesity drug in the U.S. Although
phentermine is the agent-of-choice among physicians specializing in obesity treatment, the use of this drug for
obesity treatment by other physicians has long been curtailed because misapprehensions regarding phentermine
safety. Concerns of phentermine-induced adverse cardiovascular reactions and of phentermine-induced addiction
are two fears that have had a profound negative impact on phentermine prescribing. Although warnings of high
incidence rates of adverse cardiovascular and psychiatric effects are included in FDA labeling and are often
repeated in published reviews, the few clinical reports in the peer-reviewed medical literature of such adverse
effects are anecdotal. Fear of phentermine adverse effects does not inhibit the use of phentermine by obesity
treatment specialists. A 2008 survey of prescribing practices found that 98% of bariatric medicine specialists used
pharmacotherapy in treating obesity and that 97% of those prescribed phentermine as their first choice.
The fear that phentermine has addiction potential appears to be a factor influencing curtailment of use. At the
time that phentermine was approved in 1959 the expectations were that it would prove to be addicting, although
perhaps less so than amphetamine. These expectations were based on the chemical structural similarities
between phentermine and amphetamine and on evidence in rats that phentermine stimulated spontaneous
activity. No evidence suggesting the drug had human addiction potential appeared in clinical trials conducted
prior to approval.
After 52 years of use there is no evidence in the peer-reviewed medical literature to support the hypothesis that
phentermine has significant human addiction potential. Research in addiction medicine has undergone significant
development in the last 50 years. Concepts of addiction have shifted from an early focus on tolerance and
withdrawal to a current emphasis on the psychological components of dependence. Drug addiction has been
redefined as drug dependence and standardized diagnostic criteria have been adopted for drug abuse,
dependence and withdrawal. Psychometric testing methods have been developed, validated, and applied
clinically for measurements of dependence, drug craving, and withdrawal for a wide variety of substances of
abuse including cocaine, heroin, and amphetamine.
Until recently, none of these addiction medicine metrics had been used to study the addiction potential of
phentermine. Presumably, since phentermine is an amphetamine congener, any clinical characteristics of
dependence or withdrawal should mimic those of amphetamine dependence or withdrawal. One recent
retrospective study investigated symptoms occurring when patients treated with long-term phentermine in a

weight management program abruptly ceased taking phentermine. The study found that patients on long-term
phentermine who ceased phentermine abruptly by their choice did not have an amphetamine-like withdrawal
symptom complex. Significantly there was no evidence of phentermine cravings. Further investigation is
warranted.
The addiction potential of a drug may be investigated by measuring the drug's propensity to induce dependence,
to induce cravings for the drug, and for cessation of the drug to induce characteristic withdrawal symptoms. In the
case of amphetamine withdrawal symptoms appear very quickly reaching a maximum at 48 hours after drug
cessation.
In this prospective study the addiction potential of phentermine will be assessed with validated psychometric
scales to examine patients who have taken phentermine long-term for two years or more. Patients who have
taken phentermine for 7 to 14 days will also be assessed. Participating patients who have taken phentermine
long-term in this study will be asked to interrupt phentermine therapy for 48 hours to participate in the study.
Scale examinations will be conducted at 24 and at 48 hours after drug cessation.
Hypotheses
1. Long-term phentermine-treated (LPT) patients do not develop phentermine dependence or cravings.
2. LPT patients who cease taking phentermine abruptly do not experience amphetamine-like withdrawal
symptoms.
Specific Aims
1. To compare the severity of phentermine dependence and craving between LPT patients and acute
phentermine-treated (APT) patients
2. To compare the severity of stimulant withdrawal symptoms before and after phentermine cessation in LPT
patients.
3. To examine the prevalence of phentermine dependence in LPT patients

Condition
Obesity

Intervention
Drug: Abrupt cessation of phentermine pharmacotherapy

Phentermine Withdrawal

Study Type:

Interventional

Study

Allocation: Non-Randomized

Design:

Endpoint Classification: Safety Study


Intervention Model: Single Group Assignment
Masking: Open Label

Primary Purpose: Treatment

Official Title:

Long-term Phentermine Pharmacotherapy: An Investigation for Symptoms of Dependence,


Cravings, or Withdrawal

Resource links provided by NLM:


MedlinePlus related topics: Obesity
Drug Information available for: Phentermine Phentermine hydrochloride
U.S. FDA Resources

Further study details as provided by Center for Weight Management, California:


Primary Outcome Measures:

Signs or symptoms of phentermine dependence (addiction) [ Time Frame: Long-term cohort subjects on
phentermine 2 years or more. ] [ Designated as safety issue: No ]
Psychometric scales will be used for assessment of signs or symptoms of phentermine dependence,
phentermine withdrawal, or phentermine cravings

Signs or symptoms of phentermine dependence (addiction) [ Time Frame: Short-term cohort subjects on
phentermine (APT) for 7 to 14 days. ] [ Designated as safety issue: No ]
Psychometric scales will be used for assessment of signs or symptoms of phentermine dependence, or
phentermine cravings.

Enrollment:

269

Study Start Date:

August 2011

Study Completion Date:

November 2012

Primary Completion Date:

November 2012 (Final data collection date for primary outcome measure)

Arms

Assigned Interventions

Active Comparator: LPT

Drug: Abrupt cessation of phentermine pharmacotherapy

Subjects treated with

Patients will be asked to cease taking phentermine, then to complete

phentermine for 2 years

psychometric scales 24 and 48 hours later. Patients will be examined at 48 hours

or more.

by physician who will determine if phentermine should be continued or


discontinued.
Other Name: Phentermine-HCL, generic

No Intervention: APT
Patients treated with
phentermine for 7 to 14
days.

Eligibility

Ages Eligible for Study:

18 Years and older

Genders Eligible for Study:

Both

Accepts Healthy Volunteers:

No

Criteria
Inclusion Criteria:
1. Aged 18 years or older.
2. Duration of phentermine treatment
a. For LPT patients, on phentermine pharmacotherapy consecutively for 2 years or more and willing
to take a drug holiday for 48 to 72 hours.
b. LPT Patients who have taken drug holidays on their own during the most recent 2 years may be
included provided there has not been a holiday in the 90 days prior to matriculation in this study.
c. For APT patients, on phentermine pharmacotherapy for 7 to 14 days at 37.5 mg/day or less.
Exclusion Criteria:
1. Patients with confirmed Axis I psychiatric conditions including depression, ADHD, SAD, bipolar disorder,
substance abuse disorders (except caffeine and nicotine) and patients taking drugs for any of these
conditions, including anti-depressant drugs, drugs for ADHD and lithium.
2. Patients who were taking phentermine in combination with any other anti-obesity drug.
3. Patients who are taking medications such as beta-blockers, which may modulate the stimulant effect of
phentermine.

4. Pregnant patients, nursing mothers, patients with uncontrolled hypertension, hyperthyroidism, severe
cardiovascular disease, glaucoma, and known hypersensitivity to phentermine -

Contacts and Locations


Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or
friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study
research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01402674

Locations

United States, California


Center for Weight Management
Roseville, California, United States, 95661
Center for Weight Management
Sacramento, California, United States, 95816

Sponsors and Collaborators


Center for Weight Management, California
American Society of Bariatric Physicians

Investigators
Principal Investigator:

Ed J Hendricks, MD

Center for Weight Management

More Information
Publications:
Hendricks EJ, Greenway FL. A study of abrupt phentermine cessation in patients in a weight management
program. Am J Ther. 2011 Jul;18(4):292-9.
Hendricks EJ, Greenway FL, Westman EC, Gupta AK. Blood Pressure and Heart Rate Effects, Weight Loss and
Maintenance During Long-Term Phentermine Pharmacotherapy for Obesity. Obesity (Silver Spring). 2011 Apr 28;
[Epub ahead of print]
Hendricks EJ, Rothman RB, Greenway FL. How physician obesity specialists use drugs to treat obesity. Obesity
(Silver Spring). 2009 Sep;17(9):1730-5. Epub 2009 Mar 19.
Kampman KM, Volpicelli JR, McGinnis DE, Alterman AI, Weinrieb RM, D'Angelo L, Epperson LE. Reliability and
validity of the Cocaine Selective Severity Assessment. Addict Behav. 1998 Jul-Aug;23(4):449-61.
McGregor C, Srisurapanont M, Jittiwutikarn J, Laobhripatr S, Wongtan T, White JM. The nature, time course and
severity of methamphetamine withdrawal. Addiction. 2005 Sep;100(9):1320-9.
McGregor C, Srisurapanont M, Mitchell A, Longo MC, Cahill S, White JM. Psychometric evaluation of the
Amphetamine Cessation Symptom Assessment. J Subst Abuse Treat. 2008 Jun;34(4):443-9. Epub 2007 Jul 13.

Srisurapanont M, Jarusuraisin N, Jittiwutikan J. Amphetamine withdrawal: I. Reliability, validity and factor


structure of a measure. Aust N Z J Psychiatry. 1999 Feb;33(1):89-93.
Tiffany ST, Singleton E, Haertzen CA, Henningfield JE. The development of a cocaine craving questionnaire.
Drug Alcohol Depend. 1993 Dec;34(1):19-28.

Responsible Party:

Ed J. Hendricks, M.D., Medical Director, Center for Weight Management, California

ClinicalTrials.gov Identifier:

NCT01402674

Other Study ID Numbers:

11061-01

Study First Received:

July 23, 2011

Last Updated:

January 25, 2013

Health Authority:

United States: Institutional Review Board

History of Changes

Keywords provided by Center for Weight Management, California:


Obesity treatment
Phentermine
Withholding treatment
Phentermine dependence
Additional relevant MeSH terms:
Obesity

Central Nervous System Agents

Overnutrition

Therapeutic Uses

Nutrition Disorders

Appetite Depressants

Overweight

Anti-Obesity Agents

Body Weight

Sympathomimetics

Signs and Symptoms

Autonomic Agents

Phentermine

Peripheral Nervous System Agents

Central Nervous System Stimulants

Adrenergic Agents

Physiological Effects of Drugs

Neurotransmitter Agents

Pharmacologic Actions

Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 27, 2014

http://www.ncbi.nlm.nih.gov/pubmed/20592662?dopt=Abstract

A study of abrupt phentermine cessation in patients in a weight management program.


Hendricks EJ1, Greenway FL.

Author information

Abstract
Phentermine is the most widely used antiobesity drug in the United States. Although no evidence of phentermine
addiction has been published, fear that phentermine has addiction potential has contributed to curtailment of its
worldwide use in clinical practice. The aim of this study was to evaluate the abuse and addiction potential of long-term
phentermine pharmacotherapy in patients in a weight management program. Thirty-five patients in a weight
management program who abruptly stopped taking prescribed phentermine on their own initiative were examined using
the 18-item Kampman Cocaine Selective Severity Assessment scale modified for phentermine. The Kampman Cocaine
Selective Severity Assessment scale has also been modified by McGregor for amphetamines to assess withdrawal
from amphetamine in amphetamine-addicted subjects. For comparison, 35 new patients were examined with the same

scale before any treatment was initiated. Data from the treated and untreated groups were compared by t test with
each other and with published data from amphetamine-addicted subjects. There were no significant differences in
individual items or total scores between the patients who stopped phentermine abruptly and the patients who had
never taken phentermine. There was a striking and significant difference in individual and total scores between the
phentermine-treated subjects and the amphetamine-dependent subjects. Cravings for the substance abused, the
hallmark characteristic of substance dependence and withdrawal, were entirely absent in the phentermine-treated
subjects. Abrupt cessation of long-term phentermine therapy does not induce amphetamine-like withdrawal. Long-term
phentermine therapy does not induce phentermine cravings. Symptoms observed after abrupt phentermine cessation
represent loss of therapeutic effect and are not withdrawal.
PMID:

20592662

[PubMed - indexed for MEDLINE]

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http://www.ncbi.nlm.nih.gov/pubmed/21527891?dopt=Abstract

Blood pressure and heart rate effects, weight loss and maintenance during
long-term phentermine pharmacotherapy for obesity.
Hendricks EJ1, Greenway FL, Westman EC, Gupta AK.
Author information

Abstract
There is a perception that phentermine pharmacotherapy for obesity increases blood pressure and heart rate (HR),
exposing treated patients to increased cardiovascular risk. We collected data from phentermine-treated (PT) and
phentermine-untreated (P0) patients at a private weight management practice, to examine blood pressure, HR, and
weight changes. Records of 300 sequential returning patients were selected who had been treated with a lowcarbohydrate ketogenic diet if their records included complete weight, blood pressure, and HR data from seven office
examinations during the first 12 weeks of therapy. The mean time in therapy, time range, and mode was 92 (97.0), 12624, and 52 weeks. 14% were normotensive, 52% were prehypertensive, and 34% were hypertensive at their first visit

or had a previous diagnosis of hypertension. PT subjects systolic blood pressure/diastolic blood pressure (SBP/DBP)
declined from baseline at all data points (SBP/DBP -6.9/-5.0 mm Hg at 26, and -7.3/-5.4 at 52 weeks). P0 subjects'
declines of SBP/DBP at both 26 and 52 weeks were -8.9/-6.3 but the difference from the treated cohort was not
significant. HR changes in treated/untreated subjects at weeks 26 (-0.9/-3.5) and 52 (+1.2/-3.6) were not significant.
Weight loss was significantly greater in the PT cohort for week 1 through 104 (P = 0.0144). These data suggest
phentermine treatment for obesity does not result in increased SBP, DBP, or HR, and that weight loss assisted with
phentermine treatment is associated with favorable shifts in categorical blood pressure and retardation of progression
to hypertension in obese patients.

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?
setid=02b8f684-b1ca-4ab7-9567-bcacc6a92779
PHENTERMINE HYDROCHLORIDE tablet
[Mutual Pharmaceutical Company, Inc.]

Permanent Link:
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=02b8f684-b1ca-4ab7-9567-bcacc6a92779

Category
HUMAN PRESCRIPTION DRUG LABEL

Drug Label Sections


Description
Clinical Pharmacology
Indications & Usage
Contraindications

DEA Schedule
CIV

Marketing Status
Abbreviated New Drug Application

Warnings
Precautions
Adverse Reactions
Overdosage
Dosage & Administration
How Supplied
Patient Counseling Information
Supplemental Patient Material
Boxed Warning
Patient Package Insert
Highlights
Full Table of Contents
Medication Guide

HIGHLIGHTS OF PRESCRIBING INFORMATION


These highlights do not include all the information needed to use phentermine hydrochloride tablets USP safely and effectively. See full
prescribing information for phentermine hydrochloride tablets USP.
PHENTERMINE Hydrochloride Tablets USP CIV for oral use
Initial U.S. Approval: 1959
INDICATIONS AND USAGE
Phentermine hydrochloride is a sympathomimetic amine anorectic indicated as a short-term adjunct (a few weeks) in a regimen of weight
reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial
body mass index 30 kg/m2, or 27 kg/m2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia). (1)
The limited usefulness of agents of this class, including phentermine hydrochloride, should be measured against possible risk factors inherent in
their use. (1)
DOSAGE AND ADMINISTRATION

Dosage should be individualized to obtain an adequate response with the lowest effective dose. (2)

Late evening administration should be avoided (risk of insomnia). (2)

Phentermine hydrochloride tablets can be taken with or without food. (12.3)

DOSAGE FORMS AND STRENGTHS


Tablets containing 37.5 mg phentermine hydrochloride. (3)

CONTRAINDICATIONS
History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled
hypertension) (4)

During or within 14 days following the administration of monoamine oxidase inhibitors (4)

Hyperthyroidism (4)

Glaucoma (4)

Agitated states (4)

History of drug abuse (4)

Pregnancy (4, 8.1)

Nursing (4, 8.3)

Known hypersensitivity, or idiosyncrasy to the sympathomimetic amines (4)

WARNINGS AND PRECAUTIONS


Coadministration with other drugs for weight loss is not recommended (safety and efficacy of combination not established). (5.1)

Rare cases of primary pulmonary hypertension have been reported. Phentermine should be discontinued in case of new, unexplained
symptoms of dyspnea, angina pectoris, syncope or lower extremity edema. (5.2)
Rare cases of serious regurgitant cardiac valvular disease have been reported. (5.3)
Tolerance to the anorectic effect usually develops within a few weeks. If this occurs, phentermine should be discontinued. The
recommended dose should not be exceeded. (5.4)
Phentermine may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or driving

a motor vehicle. (5.5)

Risk of abuse and dependence. The least amount feasible should be prescribed or dispensed at one time in order to minimize the
possibility of overdosage. (5.6)

Concomitant alcohol use may result in an adverse drug reaction. (5.7)

Use caution in patients with even mild hypertension (risk of increase in blood pressure). (5.8)

A reduction in dose of insulin or oral hypoglycemic medication may be required in some patients. (5.9)

ADVERSE REACTIONS
Adverse events have been reported in the cardiovascular, central nervous, gastrointestinal, allergic, and endocrine systems. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Mutual Pharmaceutical Company, Inc. at 1-888-351-3786 or
drugsafety@urlpharma.com or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
DRUG INTERACTIONS

Monoamine oxidase inhibitors: Risk of hypertensive crisis. (4, 7.1)

Alcohol: Consider potential interaction. (7.2)

Insulin and oral hypoglycemics: Requirements may be altered. (7.3)

Adrenergic neuron blocking drugs: Hypotensive effect may be decreased by phentermine. (7.4)

USE IN SPECIFIC POPULATIONS


Nursing mothers: Discontinue drug or nursing taking into consideration importance of drug to mother. (4, 8.3)

Pediatric use: Safety and effectiveness not established. (8.4)

Geriatric use: Due to substantial renal excretion, use with caution. (8.5)

Use caution when administering phentermine to patients with renal impairment. (8.6)

See 17 for PATIENT COUNSELING INFORMATION.

http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?
archiveid=18677
WARNINGS

Phentermine hydrochloride tablets are indicated only as short-term monotherapy for the
management of exogenous obesity. The safety and efficacy of combination therapy with
phentermine and any other drug products for weight loss, including selective serotonin reuptake
inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established.
Therefore, coadministration of these drug products for weight loss is not recommended.
Primary Pulmonary Hypertension (PPH) a rare frequently fatal disease of the lungs has been
reported to occur in patients receiving a combination of phentermine with fenfluramine or
dexfenfluramine. The possibility of an association between PPH and the use of phentermine
alone cannot be ruled out; there have been rare cases of PPH in patients who reportedly have
taken phentermine alone. The initial symptom of PPH is usually dyspnea. Other initial symptoms
include: angina pectoris, syncope or lower extremity edema. Patients should be advised to report
immediately any deterioration in exercise tolerance. Treatment should be discontinued in patients
who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower
extremity edema.
Valvular Heart Disease: Serious regurgitant cardiac valvular disease, primarily affecting the
mitral, aortic and/or tricuspid valves, has been reported in otherwise healthy persons who had
taken a combination of phentermine with fenfluramine or dexfenfluramine for weight loss. The
etiology of these valvulopathies has not been established and their course in individuals after the
drugs are stopped is not known. The possibility of an association between valvular heart disease
and the use of phentermine alone cannot be ruled out; there have been rare cases of valvular heart
disease in patients who reportedly have taken phentermine alone.
Tolerance to the anorectic effect usually develops within a few weeks. When this occurs, the
recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug
should be discontinued.

Phentermine hydrochloride may impair the ability of the patient to engage in potentially
hazardous activities such as operating machinery or driving a motor vehicle; the patient should
therefore be cautioned accordingly.
Usage with Alcohol: Concomitant use of alcohol with phentermine hydrochloride may result in
an adverse drug interaction.
PRECAUTIONS

General
Caution is to be exercised in prescribing phentermine hydrochloride for patients with even mild
hypertension.

Insulin requirements in diabetes mellitus may be altered in association with the use of
phentermine hydrochloride and the concomitant dietary regimen.
Phentermine hydrochloride may decrease the hypotensive effect of guanethidine.
The least amount feasible should be prescribed or dispensed at one time in order to minimize the
possibility of overdosage.
Carcinogenesis, Mutagenesis, Impairment of Fertility: Studies have not been performed with
phentermine hydrochloride to determine the potential for carcinogenesis, mutagenesis or
impairment of fertility.
Pregnancy Teratogenic Effects: Pregnancy Category C. Animal reproduction studies have not
been conducted with phentermine hydrochloride. It is also not known whether phentermine
hydrochloride can cause fetal harm when administered to a pregnant woman or can affect
reproductive capacity. Phentermine hydrochloride should be given to a pregnant woman only if
clearly needed.
Nursing Mothers
Because of the potential for serious adverse reactions in nursing infants, a decision should be
made whether to discontinue nursing or to discontinue the drug, taking into account the
importance of the drug to the mother.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
ADVERSE REACTIONS

Cardiovascular: Primary pulmonary hypertension and/or regurgitant cardiac valvular disease


(see WARNINGS), palpitation, tachycardia, elevation of blood pressure.

Central Nervous System: Overstimulation, restlessness, dizziness, insomnia, euphoria, dysphoria,


tremor, headache; rarely psychotic episodes at recommended doses.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other
gastrointestinal disturbances.
Allergic: Urticaria.
Endocrine: Impotence, changes in libido.
DRUG ABUSE AND DEPENDENCE: Phentermine hydrochloride is related chemically and
pharmacologically to the amphetamines. Amphetamines and related stimulant drugs have been
extensively abused, and the possibility of abuse of phentermine hydrochloride should be kept in
mind when evaluating the desirability of including a drug as part of a weight reduction program.
Abuse of amphetamines and related drugs may be associated with intense psychological
dependence and severe social dysfunction. There are reports of patients who have increased the
dosage to many times that recommended. Abrupt cessation following prolonged high dosage
administration results in extreme fatigue and mental depression; changes are also noted on the
sleep EEG. Manifestations of chronic intoxication with anorectic drugs include severe
dermatoses, marked insomnia, irritability, hyperactivity and personality changes. The most
severe manifestation of chronic intoxications is psychosis, often clinically indistinguishable from
schizophrenia.
OVERDOSAGE

Manifestations of acute overdosage with phentermine include restlessness, tremor, hyperreflexia,


rapid respiration, confusion, assaultiveness, hallucinations, panic states. Fatigue and depression
usually follow the central stimulation. Cardiovascular effects include arrhythmia, hypertension or
hypotension, and circulatory collapse. Gastrointestinal symptoms include nausea, vomiting,
diarrhea and abdominal cramps. Fatal poisoning usually terminates in convulsions and coma.
Management of acute phentermine intoxication is largely symptomatic and includes lavage and
sedation with a barbiturate. Experience with hemodialysis or peritoneal dialysis is inadequate to
permit recommendations in this regard. Acidification of the urine increases phentermine
excretion. Intravenous phentolamine (Regitine, CIBA) has been suggested for possible acute,
severe hypertension, if this complicates phentermine overdosage.
DOSAGE AND ADMINISTRATION

Exogenous Obesity: Dosage should be individualized to obtain an adequate response with the
lowest effective dose.
The usual adult dose is one tablet (37.5 mg) daily, administered before breakfast or 1 2 hours
after breakfast. The dosage may be adjusted to the patient's need. For some patients 1/2 tablet

(18.75 mg) daily may be adequate, while in some cases it may be desirable to give 1/2 tablet
(18.75 mg) two times a day.
Late evening medication should be avoided because of the possibility of resulting insomnia.
Phentermine is not recommended for use in patients sixteen (16) years of age and under

POSTED ON APRIL 28, 2013 IN PRESCRIPTION DRUG ADDICTION

For some 50 years the American medical community has been on a quest for the Holy Grail of
Medicines: a safe effective pill for weight loss. In the 1990s, doctors and scientists thought they had
found it in Fen-Phen, a combination of two drugs fenfluramine and phentermine. Neither drug could
produce significant weight loss on its own, but when used together, the effect was golden. Weight loss
clinics sprung up all over the United States, where you could undergo a cursory physical examination
from a physician who would hand you a diet and prescribe Fen-Phen. Some clinics were treating people
who were only slightly overweight and selling them to try at ten times its retail price.
By 1996, over 6.6 million people had taken Fen-Phen. As one doctor put it, Fen-Phen was a cash
register. People were demanding it and doctors were devoting their practices to it.
The Fen-Phen craze fell apart because of a single study of 121 women ages 30 to 72 years old who had
taken the drug for one to 28 months. Thirty-three percent had developed heart valve abnormalities. The
United States Food and Drug Administration asked doctors to report any other cases, and soon a pattern
became clear: one in three Fen-Phen users developed heart abnormalities. The drug was promptly
removed from the market.
Today phentermine remains the most popular diet drug, representing half of all sales of such products.
Americans now spend $60 billion a year on weight-loss measures, and yet they keep getting fatter.
Treating their obesity-related conditions costs $147 billion a year or 9% of the total healthcare bill.
Meanwhile, the quest for the Holy Grail of Medicine is ongoing.

What Is Phentermine?
Phentermine hydrochloride is a stimulant chemically similar but not identical to amphetamine. Its
systemic name is 2-methyl-1-phenylpropan-2-amine.
Phentermine is sold as a generic capsule and pill from Sandoz, but it is also the main active ingredient in
several trademarked products. Apidex made by Teva comes as blue and white tablets or in capsule form
and is the most popular form of this drug. Duromine made by 3M Pharmacies comes in grey and green
capsules in either 15mg, 30mg or 40mg; Ionamine is a slow release generic phentermine; Suprenza is
an orally disintegrating tablet in 15mg, 30mg or 37.5mg that went on the market in 2012.It comes as a
white powder that is soluble in water.

In September 2012 the United States Food and Drug Administration approved Qsymia, later called
Qnexia, a combination of phentermine and topamirate, a drug typically used to treat seizures. Vivus is
the manufacturer of Qnexia.
Fastin was a phentermine product discontinued in the United States in 1999. Hi-Tech Pharmacies sells a
weight loss drug called Fastin but it does not contain phentermine. Phentremine is a non-prescription
weight loss product that contains various herbal remedies but not phentermine.
Phentermine works as an appetite suppressant in the hypothalamus of the brain to stimulate the
adrenal glands to release a neurotransmitter called norepinephrine. The drug affects the central nervous
system and functions such as sleep and the rates of breathing and heartbeat.
The United States government classifies Phentermine is classified as a Controlled Schedule IV
substance, which means it has potential for addiction. You can become physically and psychologically
dependent on phentermine and develop withdrawal symptoms when you stop using it.

What Are the Medical Uses of Phentermine?


Phentermine is prescribed to people with BMIs over 27 as a weight loss aid. It is only supposed to be
used for a short time, and if the person has not lost any weight within the first three months, the drug
should be withdrawn. It is for someone seriously overweight and not for the person who wants to lose a
few pounds for a special occasion, etc. Phentermine is sometimes prescribed to people who have had
bariatric surgeries.
The typical dosage for people 17 years old and older is 15mg to 30mg once a day. Some people take
half a tablet or 18mg twice a day.
The FDA recommends that you start Qnexia with a middle-level dosage and increase it only if you have
not lost 3% of your body weight in three months. If you do not lose 5% within 12 months, you should
stop taking Qnexia.
Phentermine is sometimes prescribed off-label to people with autism, but it is only effective for a very
small percentage. One study done by its manufacturer found that Qnexia may help patients with sleep
apnea.
Phentermine seems to work better and for a longer period when it is used in combination with certain
other drugs. A 2009 survey of doctors who are members of the American Association of Bariatric
Physicians found that 65% were prescribing phentermine in combinations not approved by the FDA. The
most common drugs prescribed with phentermine are Prozac, Zoloft, Celexa, Effexor, Trazodone, and
Luvox. Some of them are SSRI antidepressants, which as a general rule should not be used with
phentermine because both drugs increase serotonin levels.

How Effective is Phentermine?


In order to lose weight, you have to eat less and/or exercise more. Phentermine can help some people
feel less hungry, and that in turn makes them eat less food. However, when you stop taking
phentermine, you may regain the weight you lost. The big challenge in long-term weight loss is
maintaining it, because the body becomes metabolically programmed to return to its original weight.
Most studies of phentermine are short-term and many participants drop out or are eliminated before
completing it. For example, a 2006 study in Korea started with 94 obese people but only 48 completed
the 12-week study.
Phentermine is probably only modestly effective on its own. No studies can prove that it prolongs lives,
and Medicare, Medicaid and most insurance companies do not cover it. Phentermine along with calorie
restriction seems to help people lose weight quickly in the first few months of usage, but then their rate
of loss usually tapers off. In the Korean study, people taking phentermine group lost 13 pounds
compared to the seven pounds lost by the placebo group. In a 1968 study published in the British
Medical Journal, over a nine-month period women on the drug lost an average of 3.7 pounds a month,
using phentermine along with a 1200 calorie diet.

What Side Effects Does Phentermine Cause?


The most common side effects are dry mouth, unpleasant taste, diarrhea, constipation, or vomiting.
Others can be depression, drowsiness, increased blood pressure, irritability, nervousness, increased
sense of well-being, fatigue, headaches, shaking of the extremities, fainting, and trouble thinking.
If you experience serious side effects, you should stop taking phentermine and call your doctor. But
these might be chest pain, fainting, swelling of the lower legs or feet, trouble breathing, inability to
exercise, heart palpitations, tremors, insomnia, and extreme dizziness.
Rare side effects can be blurred vision, change in sex drive, confusion, clumsiness, irregular heartbeat,
nausea, psychosis, skin rashes, and stomach pain.
Qnexia contains topamirate, which can cause changes in concentration.
People call it the stupid pill, said Dr. Paul Ernsberger, a professor at Case Western University. They go
around in a fog.

Does Phentermine Show up on Routine Urine Tests at


School or Work?
Phentermine as a stimulant similar to amphetamines so it will show up on urine tests. It has a half-life of
16 to 31 hours, which means it can take almost a week to clear the body.

What Drugs Interact with Phentermine?


Adverse reactions can occur if you drink alcohol while taking phentermine.
Phentermine should not be taken with other stimulants, including caffeine, ephedrine, amphetamine,
cocaine, dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine, Dextrostat, Adderall, Adderall
XR), methamphetamine (Desoxyn), doxapram (Dopram), methylphenidate (Concerta, Metadate CD,
Metadate ER, Methylin, Ritalin, Ritalin LA, Ritalin SR), modafinil (Provigil), and pemoline (PemADD), and
decongestants that contain phenylephrine or pseudoephedrine (Sudafed).
Do not combine phentermine products with selective serotonin uptake inhibitors or tricyclic
antidepressants including amitriptyline, bupropion (Wellbutrin), doxepin, duloxetine (Cymbalta),
escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox CR), imipramine (Tofranil), nefazodone,
nortriptyline (Pamelor), paroxetine (Paxil), sertraline (Zoloft), trazodone, and venlafaxine (Effexor). Do
not use phentermine within fourteen days of taking an MAO inhibitor antidepressant such as
isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine
(Parnate).
Do not mix phentermine with drugs for mental illnesses such as chlorpromazine, prochlorperazine
(Compro), perphenazine, thioridazine, and trifluoperazine; or with drugs for diabetes, including glipizide
(Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab), insulin, metformin (Glucophage),
pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia).
Do not use phentermine with herbal supplements or over-the-counter drugs for dieting such as green
tea, and phretermine or guarana.
Do not take phentermine with medications used to treat high blood pressure such as acebutolol
(Sectral), amlodipine (Norvasc), atenolol (Tenormin), benazepril (Lotensin), betaxolol (Kerlone),
bisoprolol (Zebeta), captopril, carteolol, carvedilol (Coreg), diltiazem (Cardizem, Dilacor, Tiamate,
Tiazac), doxazosin (Cardura), enalapril (Vasotec), felodipine, fosinopril, isradipine (DynaCirc), labetalol
(Normodyne, Trandate), lisinopril (Prinivil, Zestril), metoprolol (Lopressor, Toprol XL), nadolol (Corgard),
nicardipine (Cardene), nifedipine (Procardia, Adalat), pindolol, prazosin (Minipress), propranolol (Inderal),
quinapril (Accupril), ramipril (Altace), sotalol (Betapace), timolol, and verapamil (Calan, Isoptin, Verelan).
Do not combine phentermine products with meperidine, carbidopa/levodopa (Sinemet), Tramaol
(Ultram) or Linezolid.

What Is a Phentermine Overdose?


Symptoms of a phentermine overdose include blurred vision, confusion, diarrhea, dizziness, fainting,
sadness, irritability, lightheadedness, loss of consciousness, nausea, nervousness, panic attack, too slow
or too fast heartbeat, sweating, insomnia, weakness, tiredness, vomiting, overactive reflexes,

hallucinations, stomach cramps, and fainting. The person can go into convulsions or a coma and suffer
circulatory collapse if he or she does not receive emergency medical treatment.

Who Should Not Take Phentermine?


Phentermine is usually not prescribed to people under 16 years old or the very elderly. It is not for
people with allergies to similar drugs, arteriosclerosis, diabetes, histories of drug abuse or alcoholism,
glaucoma, heart or blood vessel diseases, high blood pressure, overactive thyroid, heart valve disease,
or kidney diseases. Because it is a stimulant, it can increase your risk for stroke.
One problem with phentermine is that it affects the heart as well as blood sugar levels. Many obese
people who could benefit from the drug cannot take it because they run the risk of complicating their
diabetes or cardiovascular systems two serious conditions that linked to obesity. However, sometimes
doctors prescribe it anyway because sometimes the risks of being obese outweigh the risks of taking
phentermine.
Pregnant women who take Qnexia have double to triple the risk of giving birth to a child with cleft lip.
Phentermine is classified as an addictive drug.

What Is Phentermine Withdrawal?


Phentermine withdrawal syndrome occurs when you stop taking the drug. The manufacturer suggests
that you withdraw gradually from the drug by tapering off your dosage under your doctors supervision.
Symptoms of phentermine withdrawal can be personality changes, excited activity, irritability, tiredness,
depression, nausea, vomiting, skin disease, stomach cramps, trembling, and nightmares.
Scientists at Louisiana State University compared 35 people who abruptly stopped taking phentermine
with another group who stopped taking amphetamine. The phentermine group did not develop cravings
for their drugs and did not experience withdrawal symptoms as severely as the group was stopped
taking amphetamine; however, they did experience a loss of the therapeutic effect of phentermine.

What Is Phentermine Abuse?


Phentermine can be addictive. People can develop a strong desire (cravings) to take the drug, and a
need to increase their dosages to achieve the effects they want. They also avoid stopping the drug
because every time they try to stop, they go into withdrawal. For this reason the FDA advises that
phentermine should not be used by people with histories of drug abuse or alcoholism, and should only
be used for short periods of time. People are abusing phentermine if they remain on it longer than
medically recommended or if they stay on it when they are not losing weight.
If you go on Internet forums designed for people who abuse drugs, you will find directions on how to
crush phentermine capsules to snort the drug through your nose, and how to separate the contents of

capsules, mix it with liquid, and inject for a high that feels like a million bucks. Although it is a
prescription drug, phentermine is available through illegal Internet pharmacies. People who abuse
phentermine are usually addicted to stronger stimulants such as methamphetamine, and use the diet
drug only when their drug of choice is not available.

Signs That You Might Be Abusing Phentermine


If you can answer yes to any of the following questions, you might want to seek help for your problem
with abusing stimulants.

Are you using phentermine even though its not making you lose weight?

Are you using phentermine to maintain your weight?

Are you using phentermine because it makes you feel alert and energized?

Do you experience worrisome side effects, such as hostility and irritability, that interfere with
your relationships or obligations at work or school, and yet you continue to use the drug?

Are you using phentermine in amounts not medically recommended?

Are you using phentermine when your stimulant of choice is not available?

Are you using phentermine as a study aid?

Are you obtaining phentermine from illegal sources?

Do you crush the contents of the capsules to enable a better high?

Have you tried unsuccessfully to quit using phentermine and failed?

Do your friends and/or family members criticize you for abusing diet pills?

Do you feel guilty or embarrassed about using phentermine?

Do you worry that your supply of phentermine will run out?

What Treatments Are Available for Phentermine Abuse?


If you are abusing phentermine along with alcohol and/or other drugs, you may want to consider getting
help for your addictions. If you enter a residential treatment center, you will need a few months to
devote to completing a four-step program to help you become drug free.
The first step is evaluation. A physician and a psychologist or psychiatrist will provide complete mental
and physical examinations in order to determine what program is best for you as an individual. The
second step is detoxification or the process by which you go through physical withdrawal from drugs or
alcohol. A doctor at your treatment center can monitor your progress and ease your symptoms as you
go through detoxification. The third step is working through a behavioral change therapeutic program
that will involve one-on-one therapy with a licensed psychologist, group therapy, classes in drug
addiction, journaling and other therapies to help you get in touch with your emotions, career planning,
family or couples counseling, and recreational activities. During the fourth step, you return home and
receive continued support in an aftercare program that usually includes continued therapy and
attendance at support meetings.
If you have been taking phentermine for years and not achieving a permanent weight loss, it is time to
consider the damage the drug might be doing to your long-term health. You might want to consult a

medical professional specializing in weight control who can design an individualized program of diet and
exercise for you, and help you find the support you need to achieve your goal.

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