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Introduction to Phentermine

Phentermine is a prescription medication classified as a sympathomimetic amine anorectic or appetite suppressant that was first approved by the FDA in 1959. It is most often prescribed as a short-term (maximum of 12 weeks) adjunct treatment for exogenous obesity along with diet, exercise, and behavior modification. 

Phentermine works as an appetite suppressant by stimulating the release of norepinephrine, dopamine, and serotonin in the brain. This triggers a fight-or-flight response which decreases appetite. Phentermine stimulates the hypothalamus gland in the brain and affects certain neurotransmitters to decrease appetite. The exact mechanism is not fully understood but the overall effect is a reduction in appetite, caloric intake, and an increase in energy expenditure.

Phentermine Dosage

Phentermine is available in tablet and capsule form in doses ranging from 8mg to 37.5mg. The most commonly prescribed dose is 15mg to 30mg taken once per day before breakfast or 1 to 2 hours after breakfast. Phentermine is also available as an orally disintegrating tablet and extended-release capsule.

The time-released formulation is designed to slowly release the medication throughout the day to provide appetite suppression for up to 16 hours. This can help minimize side effects and avoid spikes in phentermine blood levels compared to immediate-release tablets or capsules.

Dosage considerations include:

• Starting with a lower dose and slowly increasing over several weeks based on tolerability and weight loss response. Doses over 37.5mg per day are not more effective.
• People with reduced kidney function may need smaller doses to avoid accumulation. 
• Phentermine is only approved for short-term use of 12 weeks or less due to the potential for abuse and dependence with longer-term use.
• Taking phentermine too late in the day can lead to insomnia in some people. It’s best to take it early and no later than late morning.
• Phentermine should be used along with a reduced-calorie diet and exercise program for maximum weight loss benefit. Using it alone without lifestyle changes is unlikely to lead to significant sustained weight loss.

Effectiveness for Weight Loss

Phentermine can help patients lose a significant amount of weight when combined with diet and exercise. On average, patients lose around 5-10% of their body weight over 3-6 months on phentermine. This amounts to around 10-20 pounds for an individual weighing 200 pounds initially. 

However, weight loss results can vary widely. Some patients lose very little weight, while others lose up to 25 pounds or more. Phentermine generally produces more weight loss than diet and exercise alone. It is considered one of the most effective weight loss medications available.

Compared to other prescription weight loss drugs, phentermine generates slightly more weight loss on average. In clinical trials, patients taking Qsymia (phentermine/topiramate) lost 8-10% of their body weight over a year. With Saxenda (liraglutide), patients lost 5-8% over 56 weeks. Phentermine alone often exceeds these amounts when combined with lifestyle changes.  

Certain factors can improve weight loss results on phentermine:

• Adhering to a reduced-calorie diet – Cutting about 500 calories per day optimizes weight loss. Eating high-protein foods helps retain muscle.
• Drinking plenty of water – Proper hydration supports metabolism and appetite suppression.
• Sleeping 7-9 hours per night – Adequate sleep regulates hormones that influence weight.
• Avoiding alcohol – Alcohol provides empty calories and disrupts sleep, hindering weight loss.

Side Effects of Phentermine

Phentermine, like many medications, has potential side effects that users should be aware of. While phentermine can be effective when used as prescribed, it does carry risks.

Common Side Effects:

Some of the more common side effects associated with phentermine may include:

• Increased blood pressure
• Faster heart rate 
• Insomnia
• Dry mouth
• Constipation
• Headaches
• Dizziness
• Restlessness

Serious Side Effects to Watch For:

Rare but serious side effects have been reported with phentermine. These require immediate medical care and may include:

• Heart palpitations or fast heart rate
• High blood pressure 
• Shortness of breath
• Swelling in the legs and ankles  
• Hallucinations
• Fever
• Confusion
• Loss of coordination
• Chest pain

Drug Interactions

Phentermine can interact with several other medications and cause serious side effects. Here are some important drug interactions to be aware of.

MAO inhibitors – Phentermine should not be taken together with monoamine oxidase inhibitors (MAOIs), which are used to treat conditions like depression and Parkinson’s disease. Taking phentermine with an MAOI can result in dangerous increases in blood pressure. There should be at least 14 days between discontinuing an MAOI and starting phentermine.

Other weight loss drugs – Taking phentermine together with other weight loss medications may increase the risk of serious cardiovascular side effects like high blood pressure, fast heart rate, and heart valve problems. Combining phentermine with other diet pills is not recommended. 

Dextroamphetamine – Phentermine taken together with dextroamphetamine (used to treat ADHD) can increase the risk of cardiovascular side effects.

Warnings Related to Phentermine

Phentermine has several important warnings and contraindications that patients should be aware of before taking it: 

• Phentermine should not be taken by those with heart disease, high blood pressure, an overactive thyroid, or glaucoma. It can exacerbate these conditions.
• Pregnant women should never take phentermine, as it can cause harm to the fetus. Breastfeeding women should also avoid phentermine, as it passes into breast milk. 
• Those with a history of drug or alcohol abuse should not take phentermine, as it has the potential for abuse and dependence. 
• Patients should not drive or operate heavy machinery when first starting treatment until they know how phentermine affects them, as it may impair mental and/or physical abilities.
• To reduce side effects, phentermine should be taken early in the day with or without food. Extended-release forms may be taken with or without food. 
• Do not crush, chew, or break extended-release capsules or tablets. Swallow them whole.

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