Phentermine also is offered combined with topiramate for weight loss (Qsymia). Also, it may cause certain side effects to become much worse. Facts & Comparisons eAnswers. ohio.gov under the Practice APRN link.Although the Formulary allows CTP holders to prescribe these three drugs under the circumstances documented by their respective standard care arrangement, there are other factors that must be considered by the CTP holder prior to initiating Qsymin, Belviq or Contrave prescriptions for patients. Phentermine was later provided to patients in combination with dexfenfluramine and fenfluramine as a more powerful appetite suppressant that could also act as a fat burner. The dose of this medicine will be different for different patients. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. This content does not have an English version. Copyright 2023 IBM Watson Health. %PDF-1.3 Cardiovascular effects include arrhythmia, hypertension or hypotension, and circulatory collapse. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Phentermine has not been studied in patients with eGFR less than 15 mL/min/1.73m2, including end-stage renal disease requiring dialysis; avoid use in these populations. Being extremely irritable and confused, or experienced unusual behavior or thoughts. Special Populations Geriatric Patients Select dosage with caution, starting at lower end of dosage range. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Along with Ohio's telehealth law in Sub. Each tablet contains the following inactive ingredients: starch, lactose anhydrous, microcrystalline cellulose, colloidal silicon dioxide, stearic acid, magnesium stearate and blue sugar spheres. When mental impairment is present while taking Phentermine, a patient is also advised not to drive to avoid the risk of being involved in an accident. Precaution should be taken if a patient has any existing health concerns as the drug may cause further harm to their body. Thus, in order to make the most of this drug, patients need make some effort too. If the drug is taken too late in the day, it may also cause insomnia. The usual adult dose is one tablet (37.5 mg) daily, as prescribed by the physician, administered before breakfast or 1 to 2 hours after breakfast. Even patients who are overweight and pregnant at the same time are not allowed to use this product. If not, additional education or an additional certification may be needed. Systemic exposure of Phentermine may increase up to 91%, 45%, and 22% in patients with severe, moderate, and mild renal impairment, respectively [see Dosage and Administration (2.2) and Use in Specific Populations (8.6)]. The strength and dosage of Phentermine depend on the brand that is prescribed and the patients specific condition. It is an appetite suppressant with the added ability to help the body produce more energy from fat cells. In some cases, the doctor may prescribe Phentermine in smaller doses and advise the patient to take it up to three times in a single day. Studies do not permit conclusions as to the relative importance of the drug and non-drug factors on weight loss. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Dispense in a tight container as defined in the USP, with a child-resistant closure (as required). The limited usefulness of agents of this class, including Phentermine, [see Clinical Pharmacology (12.1, 12.2)] should be measured against possible risk factors inherent in their use such as those described below. ). Doctors often combined the use of Phentermine with diuretics, thyroid hormone medicines and digitalis. It helps patients lose weight by suppressing their appetite and boosting their energy levels, thus leading to a more active lifestyle and greater calorie burn. Use caution when administering Phentermine to patients with renal impairment. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Following the administration of Phentermine, Phentermine reaches peak concentrations (Cmax) after 3 to 4.4 hours. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. However in the presence of topiramate, Phentermine Cmax and AUC increase 13% and 42%, respectively. Initial U.S. Approval: 1959 -----INDICATIONS AND USAGE----- Suprenza is a sympathomimetic amine anorectic indicated as a short-term adjunct (a few weeks) in a regimen of . Many physicians who currently receive the reports have found that the reports help them better understand, and possibly alter, their prescribing practices. 5 A total of 24 patients developed heart valve disease while taking this drug, which led the FDA to withdraw the product from the market in 1997. The prescribing designation for anorexiants can be located on page 15 of The Formulary Developed by the Committee on Prescriptive Governance (The Formulary). The Topamax is added to Phentermine in order to intensify its effects and to help patients lose weight faster. Especially considering Ohios ability to track the prescribing and dispensing of the drug in Ohios drug database, OARRS. information is beneficial, we may combine your email and website usage information with hWmo8+jE'"m{F The following adverse reactions are described, or described in greater detail, in other sections: The following adverse reactions to Phentermine have been identified: Primary pulmonary hypertension and/or regurgitant cardiac valvular disease, palpitation, tachycardia, elevation of blood pressure, ischemic events. They are usually real doctors who prescribe real phentermine without the now-mandatory face-to-face consultation. It also isn't for people who are pregnant, may become pregnant or are breastfeeding. Follow your doctor's orders or the directions on the label. Concomitant use of alcohol with phentermine may result in an adverse drug reaction. hb``````>X,K10wdjdZ(`l Ro4' b2h>$:-9.AKL1}c$vEP;-@c=en`Y %YQh` &^ privacy practices. Patients must be informed about the risks of use of Phentermine (including the risks discussed in Warnings and Precautions), about the symptoms of potential adverse reactions and when to contact a physician and/or take other action. Take this medicine only as directed by your doctor. In patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73m2), limit the dosage of Phentermine to 15 mg daily [see Dosage and Administration (2.2)]. 4 0 obj Some people also receive a phentermine prescription from their gynecologist (OB-GYN). U.S. Food and Drug Administration. But weight management can take time. eG)mW`Bq:qq_W#!]WD w">=qtP"&Lb1=D.$MaK'5c'c84@i6j8H:{V6K}sTL N[v})xukk\+3+A{g$q5|zX99{c]Y7l3.dD6[\ U,r ,!,'\N "(%7M$7M_@3&riT~H!IJx$"SC4DiivT69SjH$2 oQ+#?G2 %Jj\ongTRQr$$Ym&" %e"[6X)X\R phIl;ZL#ac %PDF-1.6 % In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. potentially hazardous activities such as operating machinery or driving FULL PRESCRIBING INFORMATION in the presence of other risk factors (e.g., controlled hypertension, 333-33-100411 Tasks 35 This medication has been linked to physical dependence, which means a patient may become addicted to it. A weight loss doctor will be more familiar with the research on phentermine for weight loss and, in many cases, more likely to prescribe it. https://www.uptodate.com/contents/search. 0 It is freely soluble in water; sparingly soluble in warm alcohol, insoluble in chloroform, acetone, ether and benzene. The drug is classified under a certain chemical class known as amphetamine as it has a similar pharmacology value to other drugs classified in the class. This combination of ingredients was branded as Fen-Phen. Mid-Level Practitioners Authorization by State Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual Tell patients to keep Phentermine in a safe place to prevent theft, accidental overdose, misuse or abuse. N;d0)zQ|,]8EtXy(En"GX omjU3Y3>kfkYHYi]-zhm{= o`i$G1BK%?9Z+(dm`mKt,?;6K@Q 7}}*Tw>7BkKsJ;E|Viexb T-3j%5QB%wI5'$5oB :h*C"Q7yjTzLO%6QS/u>HX 4DGz*A!1*p"7$-joX2YF8ht@\l[&LS$FU=udM&y.l_ Taking too much Phentermine can be harmful to the patients body. LZ(6&JQKU5@5_M.~#p = yLgzP"Z90* v~1iu0pV (s:J&Q,. } }& 8}q>u@y)dO|fRmknw huA0@6-%&k-1qI6fSt4#>=sHMk>8fztq9_ nw:>NxHfib Lx.c QEWg\@y@ ~[*+-Dze~Ej+%.E`|IdW#o~#` MM Our members represent more than 60 professional nursing specialties. Later on, between 1940 and 1960, Phentermine was combined with other medications to improve its effectiveness. It is both dangerous and potentially illegal to use an online phentermine doctor. Instead, wait until you can go to a local doctor or consider other, over-the-counter weight loss options. Tak YJ, et al. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Adults and children 17 years of age and older15 to 30 milligrams (mg) once a day, taken at approximately 2 hours after breakfast. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. This content does not have an Arabic version. x\8zS wU^TM;J`Kc=@y\} Blf\3K|xL?D$aesY"_(ceD!s!@P,?K&Bd8cKS~zq=7'kiw\dqL:A ?O0O@+}y"z[?Os/Kht;[SN4h9c31{8Eh7dPc\BFE(e&9;!PUqK\aD 7) &\1!j-_Y7jD,Sp)AWc/igg?v{5\%a'd9"D0=gRGEZgpbMQJD *k*;1'w24w, d r d?&8xeEj`\2C6xrhq2@-{P5CbBL(/0m8&8Ltnvf};y852q*+I%l=+rwGUv*:!80|>tb?U?L,zG8%K`n]+:,LCE")Xz\^):{~{=vu=Qg`A\6qT=WCZ TcR%mi,OV_RtK1e&:By~i~!nu include protected health information. Last updated on Mar 22, 2022. Phentermine hydrochloride, an anorectic agent for oral administration, is available as a tablet containing 37.5 mg of Phentermine hydrochloride (equivalent to 30 mg of Phentermine base). The CPG determination is specific to Qsymin, Belviq and Contrave only. Your email address will not be published. The doctor also looks at the patients medical history for any pre-existing medical conditions that the medication should not be taken with. 121 0 obj <>/Filter/FlateDecode/ID[<5D80FCFEE48BF540827EEA7155FB4128>]/Index[104 35]/Info 103 0 R/Length 85/Prev 180155/Root 105 0 R/Size 139/Type/XRef/W[1 2 1]>>stream It can help weight loss by making you less hungry. Phentermine is 17.5% plasma protein-bound, while topiramate is 15 - 41% plasma protein-bound when the blood concentration range is 0.5 to 250 g/mL. With respect to the care and treatment of patients with obesity, APRNs are required to incorporate the State Medical Board rules applicable to physicians and prescribing practices. Phentermine is contraindicated during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm. phentermine, one tablet daily, #30 on September 1, 2013. FULL PRESCRIBING of the risk of hypertensive crisis. information is beneficial, we may combine your email and website usage information with Portions of this document last updated: Feb. 01, 2023. 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. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. All rights reserved. When performing prospective DUR, the pharmacist notices a 30-day gap in treatment. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Biliopancreatic diversion with duodenal switch (BPD/DS), Endoscopic Sleeve Gastroplasty (Gastric Sleeve), Biliopancreatic diversion with duodenal switch. Some of the studies that have linked Phentermine to positive results in humans include: The main active ingredient is known as Phentermine Hydrochloride. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Phentermine hydrochloride (phentermine HCL) is the active ingredient in phentermine weight loss pills. health information, we will treat all of that information as protected health Phentermine. Intravenous phentolamine (Regitine, CIBA) has been suggested on pharmacologic grounds for possible acute, severe hypertension, if this complicates overdosage. Symptoms of extremely high blood pressure, such as uneven heartbeats, chest pain, blurred vision, anxiety and a severe headache. It is not known if Phentermine is excreted in human milk; however, other amphetamines are present in human milk. These lifestyle changes often include participating in regular exercise and physical activities, as well as eating a well-balanced diet that does not contain large amounts of calories or harmful substances. Won Son J, et al. JC. Diabetes & Metabolism Journal. %%EOF Phentermine is most commonly prescribed to patients who experience negative health effects to excessive amounts of body weight. ). Package insert / product label 100 TABLETS Take 1 tablet or capsule once a day before breakfast or 1-2 hours after breakfast. Take the disintegrating tablet with or without food. Alternatively, 18.75 mg twice daily. Weight Loss Prescribing Rules Ohio Administrative Code 4731-11-04 and 4731-11-04.1 The medical board is currently reviewing its long-standing rules regarding prescribing controlled substances for the treatment of obesity. ). Due to its status as a controlled substance, the sale, distribution, and possession of this drug is tightly regulated by the DEA and international regulatory authorities ( Dr. Lazarus, we will discuss combination phentermine therapy later in this roundtable discussion. The weight loss experts who OSMA has consulted with have indicated that misuse of phentermine is unlikely. Numerous side effects have been linked to the use of Phentermine. BMI is calculated by taking the patients weight, in kilograms (kg), divided by the patients height, in meters (m), squared. Phentermine Hydrochloride Tablets, USP 37.5 mg are white oval shaped bisected tablet with blue specs, debossed with 810 on bisected side. Phentermine: 18.75 to 37.5 milligrams (mg) once a day, taken before breakfast or 1 to 2 hours after breakfast. Phentermine is related chemically and pharmacologically to the amphetamines. Phentermine 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. Phentermine, an amphetamine congener, is the most widely used anti-obesity drug in the U.S. However, weight loss clinics are not the perfect solution. Concomitant use of alcohol with Phentermine may result in an adverse drug reaction. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. This study guide will help you focus your time on what's most important. Click here for an email preview. endstream endobj 105 0 obj <> endobj 106 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/Type/Page>> endobj 107 0 obj <>stream Review/update the Your doctor may prescribe both of these drugs separately, or choose to prescribe Qsymia, which is another medication that combines Phentermine and Topamax. 1558 0 obj <>/Filter/FlateDecode/ID[<7182559B062CF74D9CEE71C953F61692>]/Index[1530 62]/Info 1529 0 R/Length 121/Prev 89015/Root 1531 0 R/Size 1592/Type/XRef/W[1 2 1]>>stream However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. For oral dosage form (disintegrating tablets): Adults and children 17 years of age and olderOne tablet once a day, taken in the morning. National Association of Boards of Pharmacy. According to the medical board, at this time, only physicians who prescribe opioids are receiving benchmark style reports and the board thinks that all prescribers who report into OARRS should receive the same information. Phentermine may decrease the hypotensive effect of adrenergic neuron blocking drugs. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use . (1981, February 4). Rule 4731-11-01 | Definitions. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Place the tablet on the top of your tongue right after removing it from the bottle. A reduction in insulin or oral hypoglycemic medications in patients with diabetes mellitus may be required. Phentermine is a Schedule 4 drug. Nationwide Efforts to Combat the Problem Questions To Discuss At the completion of this block of instruction you will be able to answer the following questions: 1. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. He or she may prescribe the medication him/herself if you are an appropriate candidate, or he/she may choose to refer you to a specialist for further evaluation and follow-up. Obesity has been linked to many different diseases, including type 2 diabetes and cardiovascular disease. Metabolism Phentermine has two metabolic pathways; hydroxylation and oxidation. The medical board is currently reviewing its long-standing rules regarding prescribing controlled substances for the treatment of obesity. (2012). Some of the most common withdrawal symptoms include weight gain, fatigue, insomnia and a bad mood. 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. Or it can help you feel full longer. endstream endobj startxref Clinics specializing in weight loss often employ bariatric specialists who have additional training in obesity management. Use of Phentermine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors because of the risk of hypertensive crisis. What could be the cause? https://fco.factsandcomparisons.com/. Typical actions of amphetamines include central nervous system stimulation and elevation of blood pressure. Y$iqzZz\vlt1a;svw&aBS8Z(HGCkr&_Qxt97t,GWceTL^QqX(%8_A2'"%tD'DNz"G*"Tc. Current Obesity Reports. The drug is mainly an appetite suppressant, thus making a patient feel fuller after (and between) meals and making the patient more likely to consume foods that have lower amounts of calories. OSMA has historically had concerns with the limitations that these rules place on physicians who treat patients with obesity. Medically reviewed by Drugs.com. Overdosage of pharmacologically similar compounds has resulted in fatal poisoning usually terminates in convulsions and coma. These include, but are not limited to:Whether the care and treatment of obese patients and weight management is new to the APRNs existing practice, and whether this aspect of practice is within the APRNs national certification and patient population specialty, meeting the scope of practice requirements in Section 4723.43, ORC. The most common side effects that patients experience include tremors, headaches, dizziness, dry mouth, diarrhea, constipation, upset stomach, feeling restless and being hyperactive. Adipex-P (phentermine hydrochloride) capsules label, Greater than 27 kg/m2 + one or more weight-related condition, Vitals (heart rate, blood pressure, etc. Keep from freezing. This content does not have an English version. The most severe manifestation of chronic intoxications is psychosis, often clinically indistinguishable from schizophrenia. Even after the period that the drug has been prescribed for, the doctor will often recommend to gradually stop using the Phentermine to avoid the withdrawal symptoms. In some cases, especially when the health concern is not too serious, the doctor may prescribe the drug at lower doses spread throughout the day, instead of advising the patient to take one single dose every day. Below is a chart of body mass index (BMI) based on various heights and weights. See Drug Abuse and Dependence (9) and Overdosage (10). 2021; doi:10.1007/s13679-020-00422-w. They help the body produce a larger amount of energy from fat cells, which further reduces body fat percentage. In some cases, the use of this drug in combination with other pills may cause the effects of other drugs to increase. But regarding phentermine monotherapy, phentermine hydrochloride (HCl) is a sympathomimetic Drug Enforcement Agency (DEA) scheduled IV drug approved as an anti-obesity medication and marketed in the US since 1959 (See Table 1).The reported weight reduction efficacy of phentermine [10] derived from . Specializes in Med nurse in med-surg., float, HH, and PDN. (1) The prescriber shall assess the patient, at a minimum, once in the first three months of utilization of controlled substances for weight reduction, and shall record in the patient record information demonstrating the patient's continuing efforts to lose weight, the patient's dedication to the treatment program and response to treatment, and Adults and children 17 years of age and older. What to offer the 99% of patients with severe obesity who do not undergo bariatric surgery? Before writing a phentermine prescription, he or she will evaluate your: While any doctor can prescribe phentermine, not all doctors feel comfortable doing so. It is vital to talk with the doctor before using Phentermine with other products. The medical boards ICD-10 Committee is tasked with reviewing ICD-10 data that physicians submit to the OARRS system when prescribing controlled substances. The dosage may be adjusted to the patients need. This medicine is available in four forms: capsules, disintegrating tablets, extended-release capsules, and tablets. In fact, one study conducted at the Duke University School of Medicine found that apart from the Phentermines ability to effectively reduce body weight, it can also help improve a patients health-related quality of life. Rx only. Phentermine is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and dll-amphetamine). Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema, and patients should be evaluated for the possible presence of pulmonary hypertension. (2009, April 06). In order to help patients reduce their risk of developing these diseases when they are obese, doctors usually prescribe Phentermine. All rights reserved.5115 Parkcenter Avenue Suite 200 Dublin, OH 43017ph: 800.766.6762info@osma.org. Phentermine Hydrochloride Tablets are indicated as a short-term (a few weeks) adjunct 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). Acidification of the urine increases Phentermine excretion. United Nations Office on Drugs and Crime. Contraindications History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension) During or within 14 days following the administration of monoamine oxidase inhibitors Hyperthyroidism This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function.
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