Q. What medications do we use in our weight loss program?

We use an FDA approved medications that are intended to suppress your appetite and speed up your metabolism such as Phenternine (Adipex), Phendimetrazine (Bontril) and others that you might have used in the past successfully.

Phentermine is a stimulant that is similar to an amphetamine. It is an appetite suppressant that affects the central nervous system. Phentermine is used together with diet and exercise to treat obesity.

Like any other medication Phentermine and other appetite suppressants have side effects. You should not take any of them if you have taken an MAO inhibitors such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days. Serious, life threatening side effects can occur if you use phentermine before the MAO inhibitor has cleared from your body.

Taking phentermine together with other diet medications such as fenfluramine (Phen-Fen) or dexfenfluramine (Redux) can cause a rare fatal lung disorder called pulmonary hypertension.

You should not take phentermine if you are allergic to it, or if you have:

  • coronary artery disease (hardening of the arteries)
  • heart disease
  • severe or uncontrolled high blood pressure
  • overactive thyroid
  • glaucoma
  • if you have a history of drug or alcohol abuse
  • if you are allergic to other diet pills, amphetamines, stimulants, or cold medications.

Although it is not known whether phentermine will harm an unborn baby it is best to tell your doctor if you are pregnant or plan to become pregnant while using this medication. Phentermine can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking phentermine.

Do not give this medication to a child younger than 16 years old.

All medications may cause side effects, but many people have no, or minor side effects.

Most common side effects of Phentermine:Dry mouth, constipation, insomnia, mild headache, nervousness, increased energy, Dry mouth is the most common side effect we see, and the one, which lingers on the longest. It is usually manageable by following common-sense measures such as drinking lots of water and chewing sugar-free gum.

Sleeplessness is the next most common side effect, presenting either in the form of having a hard time falling asleep or of awakening very early in the morning and not being able to get back to sleep. This occurs primarily in the first week of phentermine use subsiding to the level of a nuisance; however, for some patients it can linger for a few weeks, diminishing gradually over this time. Constipation also occurs fairly frequently, and lingers for some, but except in rare cases it can usually be managed by being aggressive in terms of water and fiber intake.

Less common side effects include:

Shortness of breath, tightness in the chest, fluid retention, fast heartbeat and increase in blood pressure, changes in the libido, and changes in the menstrual cycle.

Rare side effects:

Pulmonary hypertension and valvular heart disease has been reported in patients who used Phentermine in combination of other drugs. (Valvular heart disease has been reported in patients taking phentermine in combination with fenfluramine or dexfenfluramine, but not in patients taking phentermine alone. Analysis of available data suggests that fenfluramine and dexfenfluramine are the causal agents, and both drugs have been withdrawn from the market as of September 15, 1997).

The maximum recommended daily dose of Phentermine is 37.5mg per day taken once a day or half a tablet twice a day.

The use of alcohol while on Phentermine is not recommended as it may result in an adverse drug interaction.
In addition, alcohol can lead to weight gain from the calories it provides and by causing you to eat more calories while consuming the alcohol.

Phentermine is classified as a Schedule 4 controlled substance by the Food and Drug Administration, which means that it does have a minimal abuse liability.
(Schedule 1 being the highest and 5 the lowest). Tolerance to the medication does develop, to where its side effects and some of its appetite suppressant effects lessen over time,
which is one common component of a potentially addictive drug.

However, for the vast majority of participants, no significant euphoric effect or “high? is experienced from the medication, nor does the development of “craving” for the drug appear to occur.

If the drug were to be discontinued abruptly, many participants would experience some of rebound hunger and a little rebound fatigue, but no severe withdrawal symptoms of the sort generally associated with abrupt nicotine or caffeine cessation.
So while the possibility of phentermine “addiction” must be kept in mind, based on our experience, it would appear to be a very rare event.

A history of high blood pressure is not an exclusionary condition to use of phentermine. However, blood pressure does need to be under adequate control (e.g., ideally systolic blood pressure

Most patients in our program lose between 8- 15 lbs per month. However, we have patients who lost less than that and we have patients who lost 20lbs or more in one month. It all depends on you and the changes you make to your life style.

Your weight is a balancing act, and the equation is quite simple: If you eat more calories than you burn then you gain weight.

If you eat fewer calories than you burn, you lose weight.

We advise caution in the use of other over-the-counter stimulant medications such as decongestants.

If a decongestant must be used, we recommend that a participant have his or her blood pressure checked several times while on Phentermine.

We also recommend that all products containing the drug ephedrine be avoided. This long list includes various energy boosters, fat burners, and various diet supplements, which promise metabolism-enhancing effects.

Phentermine takes about three to five days to build up in the system

(to what is called a “steady state” Which is why some people report not feeling its full effect until being on it for several days.)

Similarly, phentermine also takes about three to five days to “wash out of the blood, so that if a day is missed, there is still quite a bit left in the system.

Even though forgetting a day here or there appears to have little effect, we have still found that the participants who do the best at weight loss tend to be those who are very regular in taking their prescribed phentermine doses every day.

If you were to quit taking phentermine very abruptly, you would likely experience some rebound hunger and rebound fatigue, and there could be some weight gain associated with this. Unless you have significant side effects from the phentermine, or a doctor has advised you to discontinue it, we generally recommend that wean down off it over time, even after achieving the target weight, to avoid this abrupt transition.

From patient reports, it appears that for most participants hunger does not jump back to its previous level within the first few weeks or months of phentermine cessation.

The typical pattern is that the diet and physical activity are well-maintained for several months to years after phentermine is discontinued and that subsequent weight regain,
if it does occur, is usually precipitated by an injury or severe environmental stressors which disrupt the maintenance routine.

In a study that was published in the Journal of the American Dietetic Association (Skender, M.L., Goodrick, G.K., & Del Junco, D.J., 1996), 127 adults were assigned to diet only, exercise only, or diet plus exercise. After two years, the diet only group weighed on the average 2 pounds more than they did when they started, even though they initially lost an average of 15 pounds. The exercise only group initially lost only 6 pounds, but at the end of two years they still weighed an average of five pounds less than when they started. The diet plus exercise group did the best, losing 20 pounds right away and were still 6 pounds less than when they started two years later.