28 Apr Phentermine 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 doctor’s 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 it’s 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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