Risk Mitigation
An Old Drug Might Bring New Hope for Obesity Epidemic If Used Properly
Why phentermine (well-researched medication) works for some and not for others with nuanced pros and cons based on independent research and observations
In life, risks and opportunities are intertwined. While everything we pursue carries inherent risks, the key lies in our ability to turn challenges into opportunities. We can unlock hidden potential and move forward by navigating uncertainty and welcoming calculated risks with diligence and collaboration.
In September 2023, a review paper published in the International Journal of Drug Policy informed that:
Phentermine (one of the most commonly prescribed pharmaceuticals for weight loss in the US) has appeared on toxicology and listed as a cause of death in fatal drug overdoses in the state of Tennessee.
While this paper concerned the medical community as a serious health issue, it also opened opportunities to understand the mechanisms and better use of a well-researched molecule, as I will unfold from multiple angles. I shared my observations and experiences with phentermine in a previous story for readers interested in the background and details.
This timely and comprehensive research informed that “given the lack of currently available data about non-prescribed phentermine use and its involvement in fatal drug overdoses elsewhere, a need exists to both expand surveillance capabilities and broaden research to better inform policies governing this drug in the US and internationally.”
While phentermine remains legally available with a prescription in the US, Mexico, Australia, Singapore, and many other countries, as documented in a systemic review in BMC Medicine in 2016, some countries, like Sweden, Turkey, the UK, UAE, Mauritius, Oman, and Venezuela, have banned its use, citing safety concerns, including non-prescribed use causing cardiovascular effects and death.
As my regular readers know, I always focus on healthy lifestyle approaches and professional support, including psychotherapy for weight management in my metabolic health stories.
As a personal note, I don’t use medication and only wrote about this one as one of the oldest and most researched ones as a hope-inducing weight loss drug for those struggling with obesity challenges initially, which I investigated for a long time as it relates to the brain and cognitive function. Obesity is a topic close to my heart as I struggled with abdominal obesity in my younger years. I documented the nuances of four types of obesity.
The medication phentermine has been in use for a long time in the treatment of obesity and getting started with healthy weight management as a jumpstart solution. However, like many other drugs, it can be abused and cause serious health issues if not used properly under the guidance of qualified medical professionals. So, the main problem seems to be not with the medication itself but its misuse or abuse.
I recently shared the summary of my observations to create a healthy debate on this widely prescribed medication in the US, and the story went viral due to its dual nature. While some people used it successfully to jumpstart their fat loss journey and had a positive view of it, some struggled with it and gave up before even getting the desired results.
In my observations and research, missing some nuances might be causing this old medication to lose momentum and might gain again as we learn more about it. I will present these nuances to provide an informed and independent perspective focussing on risk mitigation, as every drug or molecule we ingest comes with a risk.
As I knew, and also some readers pointed out, their doctors were hesitant to prescribe the drug for various reasons. So, while some physicians embrace it, others remain cautious, as evidenced by its acceptance and rejection in different countries.
Some readers commented that this medication took on new significance, as they felt that newer, pricier drugs overshadowed its importance despite its thorough research. Thus, some argue that the current situation is more economically motivated than healthcare-driven.
My story doesn’t promote drug use for weight loss, even though it might be necessary for some. My goal is to offer an alternative perspective for some people struggling with lifestyle changes, emphasizing the importance of expert guidance from qualified healthcare professionals and understanding nuanced pros and cons.
I aim to provide an unbiased viewpoint for awareness purposes, exploring both the advantages and drawbacks to facilitate meaningful discussions between patients and doctors amid the surrounding discourse so that we find viable ways to deal with the obesity epidemic.
What is Phentermine?
Phentermine is “a sympathomimetic amine anorectic. It has a similar mechanism of action as amphetamine in that it is an agonist at the trace amine-associated (TAAR1) receptor site, stimulating the release of norepinephrine and epinephrine. It is a central nervous system stimulant.”
By increasing the levels of these neurotransmitters, phentermine can help to reduce hunger pangs and cravings, making it easier for patients to consume fewer calories and maintain a calorie deficit necessary for weight loss.
This medication is typically prescribed as part of a comprehensive weight-loss program that includes a reduced-calorie diet, exercise, and behavioral modifications. It is a short-term treatment for obesity in conjunction with lifestyle modifications like diet and exercise. It is not a standalone solution.
When taken orally as an anorectic agent, phentermine is absorbed into the bloodstream. It reaches the brain, interacting with the hypothalamus, which regulates hunger and satiety. Phentermine can increase metabolism.
The key mechanism of phentermine is serving as a sympathomimetic amine medication that works as an appetite suppressant. It acts on the central nervous system to reduce hunger cravings, making it easier for obese people to consume fewer calories and lose weight rapidly.
As documented in this NIH book chapter, “phentermine has two metabolic pathways: hydroxylation and oxidation. Cytochrome P450 (CYP) 3A4 primarily metabolizes phentermine. The phentermine terminal half-life is about 20 hours.”
Coming from the amphetamine family of drugs, phentermine may inhibit the activity of the monoamine oxidase (MAO) enzyme. This enzyme can break down neurotransmitters like norepinephrine, dopamine, and serotonin. By inhibiting MAO, phentermine could increase the levels of these neurotransmitters and improve mood.
A Brief Historical Background to Phentermine
According to this NIH book chapter, phentermine was first introduced in 1959 as part of an anti-obesity combination drug. As it stimulates the release of neurotransmitters, it can suppress appetite, create a feeling of fullness and happiness, and increase metabolism. It is sold under brand names like Adipex-P, Ionamin, Suprenza, Qsymia, and many more.
“FDA approved Qsymia (phentermine) in July 2012 for chronic weight management in adults with an initial BMI of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia, as an adjunct to a reduced-calorie diet and increased physical activity.”
Phentermine has been used for a long time in treating obesity and getting started with healthy weight management. Despite its challenges (when used with other drugs), phentermine itself offers promising prospects with healthy lifestyle adjustments in several countries for addressing obesity-related challenges as a short-term use. However, its misuse and overlooked side effects make the medication problematic for some patients in some countries.
The Key Considerations for Practitioners While Prescribing Phentermine
In this section, I will summarize the critical points documented in this NIH book chapter in March 2023, covering kidney, liver, pregnancy, and breastfeeding issues while prescribing it for patients.
“For patients with severe renal impairment, it is recommended that the clinician not prescribe more than 7.5 mg/46 mg phentermine mg/topiramate mg ER per day.
No dosage adjustment is essential for patients with mild hepatic impairment. The maximum recommended daily dose for patients with moderate hepatic impairment is phentermine 7.5 mg/topiramate 46 mg per day. Phentermine/topiramate has not been studied in patients with severe hepatic impairment.
Phentermine with topiramate is teratogenic with a category X classification. Data has indicated that users who become pregnant have an increased risk of oral clefts due to exposure to topiramate in the first trimester. Topiramate has been shown to cause metabolic acidosis, leading to fetal growth restriction and hypoxic events.
Phentermine with topiramate is distributed in breast milk. There is a potential for adverse effects like hypertension and weight loss in breastfeeding; therefore, breastfeeding is contraindicated on phentermine with topiramate.”
As informed by the FDA, phentermine carries safety considerations, particularly for pregnant women, as it can cause fetal harm and an increased risk of oral clefts. Therefore, professionals ask patients to “undergo pregnancy testing before starting treatment, use effective contraception during treatment, and have regular pregnancy tests. Due to the risk of birth defects, Qsymia is only available through a restricted program called the Qsymia Risk Evaluation and Mitigation Strategy.”
As with any medication, phentermine might have numerous side effects, and they can vary from person to person. Thus, it should be used under the supervision of a healthcare professional. Following the prescribed dosage and recommendations is crucial to ensure safety and effectiveness.
What are the documented side effects of phentermine?
In this section, I will summarize commonly cited side effects of phentermine in the literature. The paper citations are provided for interested practitioners at the end of this NIH Book chapter.
“These side effects also include topiramate, as it is sometimes prescribed with phentermine. Topiramate is an anticonvulsant medication primarily used to treat epilepsy and prevent migraines. It works by modulating neurotransmitter activity in the brain.
As I also observed with people using it, the essential points of the adverse effects of phentermine include dry mouth, constipation, and paresthesia (tingling). Severe hypohidrosis (reduced sweating) and hyperthermia (overheating) may occur, especially when combined with anticholinergics.
Some patients may experience an increased resting heart rate and should be monitored, particularly those with a history of heart disease or stroke.
Psychiatric and cognitive disturbances like mood disorders, insomnia, and cognitive impairment are possible. Acute myopia and secondary angle-closure glaucoma may develop, necessitating monitoring for increased intraocular (eye) pressure.
In extreme cases, elevated serum creatinine may lead to hypokalemia and metabolic acidosis, with a risk of nephrolithiasis. Hypoglycemia may occur due to decreased appetite, especially in patients with type-2 diabetes.
Central nervous system depression may result, necessitating caution with other CNS depressants and gradual withdrawal to avoid seizures.
Although clinically apparent liver injury is rare, caution is warranted, especially in patients with seizure disorders receiving other anticonvulsants with known hepatotoxic potential.”
Why did phentermine get a bad reputation?
As documented in Annals of Internal Medicine in 1993, “the stigma of obesity, the public opprobrium toward obese persons, and regulatory rigidity have led to unjustified distrust in the potential of drug treatment for obesity.”
However, during that time in the mid-1990s, a weight loss drug combination known as Fen-Phen, consisting of fenfluramine (“Fen”) and phentermine (“Phen”), gained popularity.
Nonetheless, concerns arose regarding its safety due to associations with cardiovascular issues. Consequently, the FDA took action in 1997 and removed Fen-Phen from the market.
Reports linked the Fen-Phen combination to significant heart and pulmonary complications, some of which led to fatalities. As a result, regulatory authorities prioritized the safety of consumers, prompting the withdrawal of this medication.
The nuance is that this FDA ban was not specific to phentermine but its combination with fenfluramine. Phentermine is still an approved drug by the FDA in the US and several other countries, as mentioned before.
The biggest problem is that some illegal companies have started selling phentermine cheaply to drug users who do not qualify for this medication.
As documented in this medical report, “phentermine can be habit-forming and is known to be abused and diverted. Phentermine should NOT be prescribed to individuals with a history of substance use disorder.”
Conclusions: What are the implications of all this, and how can we emphasize the positive aspects of phentermine while effectively minimizing its risks?
Phentermine can be a valuable alternative tool for specific obese people struggling to lose weight, particularly those who find it challenging to adhere to healthy lifestyle changes initially.
As a potent appetite suppressant, it might help these people feel less hungry and more satisfied with smaller portions. This can facilitate the initiation of weight loss efforts, especially for those who struggle with overeating or cravings.
Additionally, phentermine can boost motivation and energy levels, making it easier for people to engage in physical activity and adopt healthier habits for sustainable weight management.
For people with difficulty sticking to a nutritious diet and regular exercise routine due to personal limitations or lifestyle factors, phentermine can offer a supportive mechanism to kickstart their weight loss journey.
However, it is crucial for people using phentermine to do so under the guidance of a healthcare professional and in conjunction with long-term lifestyle changes for sustainable weight management and overall health.
I want to highlight that every drug, including caffeine, which we consume daily, comes with side effects and can be risky if consumed in excessive amounts and wrong times. So, the dose and timing of medication matters.
Pharmacologists and pharmaceutical companies extensively test medications before bringing them to market. This process involves various stages of preclinical and clinical trials to evaluate the safety, efficacy, and potential side effects of the medications in diverse populations.
Regulatory authorities, like the FDA in the US, require rigorous testing and data review before approving medications for public use. While testing cannot guarantee the absence of all adverse reactions, it aims to identify and mitigate potential risks to the extent possible before making the medication available to patients.
However, finding all side effects during the test period may not be possible. As risks are inherent in drug use, diligent monitoring and cessation when risks outweigh benefits are essential measures.
As documented in this medical report, phentermine has several side effects that range from mild to moderate. These side effects include insomnia, increased blood pressure, dizziness, dry mouth, nervousness, constipation, headache, dizziness, itching, and diarrhea.
More importantly, the report states that if you have severe reactions like swelling, confusion, dangerously high blood pressure, chest pain, and shortness of breath, you must see emergency personnel immediately.
Studies clearly highlight that phentermine is not intended for long-term use. It is only for short-term usage, typically a few weeks, to initiate weight loss efforts in people with obesity or overweight conditions when other solutions don’t work.
When researching its safety, metabolic health specialists emphasized that phentermine was a tool during the initial weight loss phase, stressing the importance of continuous evaluation to ensure optimal risk management.
One significant issue with certain prescribed medications, especially those impacting psychology, is their susceptibility to recreational misuse.
Phentermine, due to its mood-altering effects and ability to induce positive sensations, is sometimes abused and sold illicitly as a recreational drug without medical oversight.
Consequently, the risk of overdose and the potential for fatal outcomes are heightened in such scenarios, as documented in the recent review.
Another concern relates to drug addiction. Prolonged use of phentermine can lead to dependency, making it challenging for people to cease usage abruptly. Consequently, some people become reliant on the drug, continuing its consumption even when it is no longer necessary.
Hence, phentermine must be exclusively prescribed by physicians and closely monitored during short-term use to mitigate the risk of dependence and ensure appropriate management for optimal results.
While some people may require medication for specific health concerns, healthy weight management entails attentiveness to the body’s cues and implementing adjustments through sustainable lifestyle choices.
This includes a nutritious diet, prioritizing restorative sleep, regular exercise, managing stress effectively, nurturing social connections, enjoying leisure activities, and seeking timely support for physical and psychological issues from healthcare professionals when needed.
Takeaways
Before considering phentermine or any weight loss medication, you must consult qualified healthcare professionals to determine if it suits your circumstances. Don’t buy it yourself from illegal sources, and refrain from self-medicating.
You must understand that phentermine is intended for short-term use, usually a few weeks, to initiate weight loss efforts in people with obesity or overweight conditions under medical supervision.
Recognize that phentermine should be part of a comprehensive weight-loss program that includes lifestyle modifications like a reduced-calorie diet, regular exercise, and behavioral changes for long-term success.
You must commit to regular monitoring and evaluation by healthcare professionals while using phentermine to ensure safety, effectiveness, and appropriate management of any potential side effects or dependencies.
Be aware of the potential risks associated with phentermine, including the risk of dependency, side effects, and the possibility of recreational misuse, and use it responsibly under medical guidance. While the piece is about phentermine, the principles I discussed can be applied to any medication.
Once more, I want to emphasize the importance of adopting sustainable lifestyle changes, like a nutritious diet, adequate sleep, stress management, social connections, and timely support from healthcare professionals to complement the short-term effects of phentermine and promote long-term weight management and overall health.
Thank you for reading my perspectives. I wish you a healthy and happy life.
To inform my new readers, I wrote numerous articles that might inform and inspire you. My topics include brain and cognitive function, significant health conditions, longevity, nutrition/food, valuable nutrients, ketogenic lifestyle, self-healing, weight management, writing/reading, and humor.
I publish my health and wellness stories on EUPHORIA. My posts do not include professional or health advice. I only document my reviews, observations, experiences, and perspectives to provide information and create awareness. 100+ Insightful Life Lessons from My Circles for the Last 50+ Years
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