You may be surprised to know that phentermine does not directly burn fat. Brand names of phentermine include Ionamin, Fastin, Zantryl, Adipex-P, and Obe-Nix-30. Phentermine is a diet aid approved for use by the US Food and Drug Administration in 1959. Obesity has become a global crisis, with about two billion people estimated to be overweight or obese by 2030. And unlike newer weight-loss medications, phentermine is approved for short-term use — up to 12 weeks (3 months). In fact, studies have proven that young women who use medications like phentermine or laxatives to manage their weight are more likely to be diagnosed with an eating disorder within one to three years than those who haven’t.8 Additionally, phentermine can cause weight loss due to suppressed appetite, making it appealing for many people who struggle with body dissatisfaction or have a compulsive desire for thinness. However, taking phentermine for binge eating or as a weight loss pill comes with a host of health risks and may indicate disordered eating or increase the chance of developing disordered eating habits. The study compared two different dose regimens of phentermine/topiramate once daily versus placebo.Only Cocco 2005 did not mention any industry sponsorship, and it was the only study that was performed as a single‐centre trial.We searched for studies about the effects of taking weight‐loss medicines in people with high blood pressure.First of all, participants undergoing orlistat therapy experienced substantial side effects, mainly gastrointestinal.PubMed database was searched using the keywords “pharmacotherapy”, “weight loss”, “FDA-approved”, “orlistat”, “phentermine-topiramate”, “naltrexone-bupropion”, “liraglutide”, and “semaglutide”.Phentermine is an oral pill that should be taken on an empty stomach so that it can be absorbed properly and work most effectively.Obesity is a major contributor to CKD and kidney failure, and several behavioral modification and medication trials have shown that weight loss improves albuminuria and possibly slows eGFR decline.Do not increase your dose, take it more often, or use it for a longer time than prescribed.When at least two included trials were available for a comparison and a given outcome, we tried to express dichotomous data as a risk ratio (RR) with a 95% confidence interval (CI).Drug interactions may change how your medications work or increase your risk for serious side effects. If you experience any of these symptoms while taking phentermine, seek medical care right away. Before starting phentermine, make sure your prescriber has your full medical history. If you feel dizzy or feel your heart beating rapidly while taking phentermine, let your prescriber know. They’ll help decide if phentermine is safe for you to take. Garvey 2009 published data only The phentermine was just a crutch bridge that helped me to get from one point in my life to another. When I hit normal BMI (body-mass index), my doctor could no longer legally prescribe the drug to me–which is great because it was beginning to adversely affect me, anyway. Once I had that delicious phentermine pumping through my veins, I felt as powerful as Bane on venom. But for the time I was on adipex for weight loss, I loved it. So I went to the doctor and started a physician-monitored, medical weight loss program. Reviewer 2 The efficacy of Gelesis100 was evaluated in the Gelesis Loss of Weight (GLOW) randomized double-blind placebo-control trial (112). One dose is three oral capsules (2.25 g/dose) that is ingested with 500 ml of water min prior to lunch and dinner. For this reason, individuals of childbearing potential should be counseled to use a second form of birth control during dose escalation. While all AOMs are contraindicated in pregnancy, tirzepatide has been observed to affect absorption of estradiol-containing oral contraceptives and potentially reduce their efficacy as birth control, specifically during dose escalation phases of tirzepatide. No imbalances were noted for incidence of pancreatitis between tirzepatide groups and placebo. She plans to do another 3-month course of phentermine and then stop taking the medication permanently. Ashley takes a 37.5 mg dose of phentermine daily. Jasmine says phentermine also makes her sweat more when she is working out, helping her keep off water weight. GoodRx talked to three people about their experiences with phentermine. Many people are now turning to injectable medications like Ozempic and Wegovy. Hauner 2004 published data only “You certainly would not want anybody with a history of seizures to take it,” she says. Of course, those stimulant properties can cause some notable side effects. Phentermine stimulates the release of norepinephrine and epinephrine, which reduces appetite while also providing a surge of energy. This research also found that this combo delayed the progression of type 2 diabetes, a metabolic disorder linked to obesity (13). But if incessant food noises or slow metabolism is behind weight gain, you’d probably benefit more from a GLP-1. Older weight loss drugs are in demand. Qsymia (phentermine / topiramate ER) is another combination weight-loss pill. Among those who took the medication for the entire 15-month study period, the average weight loss was closer to 17%. But your healthcare professional could also prescribe a different pill, such as metformin or topiramate, for off-label use in weight loss. Hence, information contained in labels of older drugs may be outdated due to unavailability of more recent research and clinical experience at the time the warnings were added to the label. Drug labels are information documents produced after marketing approval but prior to marketing and are infrequently updated as new knowledge emerges from experience with the drug except when unexpected adverse effects surface. While, in general, OLDU is neither illegal nor unethical, some jurisdictions may limit the use of specific medications for specific situations. Our findings show the effectiveness rates of phentermine at 3- and 6-month follow-up in the general Mexican population, supporting the expectations of attending physicians who decide to use phentermine. Thus, a better understanding of the efficacy, safety, and even the costs of available drugs will allow clinicians to establish rational expectations and goals, when pharmacotherapy is indicated . It has been suggested that healthcare practitioners should focus on open discussions and strengthening of realistic weight‐loss goals and outcome assessment according to those goals . Ye 2017 published data only Nor do such discussions differentiate between hedonic drug liking versus drug liking because of medical benefits.They can help decide if it’s a safe and appropriate medication for you.Our data partially coincide with a study from Korea reporting a mean 8.1 kg weight loss after treatment with 30 mg phentermine for 12 weeks .Following the initiation of the selected therapeutic option, Step 3 involves reassessment of the patient for the impact of weight loss on complications after equilibrium weight loss is achieved.I took vitamin injections once a week and went on a medium dose of phentermine (or you may have heard them called adipex diet pills before, too).Discussion of OLDU in this review is limited to US obesity medicine physicians and the US FDA label, and is intended to review some of the data on how US physicians are actually using drugs off-label.A GLP-1 agonist that helps with weight loss might be covered when prescribed for a different approved use. It is appropriate to monitor blood sugars during treatment for obesity since dose lowering or elimination of diabetic medicines is often a benefit and is to be expected with weight loss. Surveys of US physicians treating obesity have revealed these physicians frequently combined the various antiobesity drugs with other drugs approved for obesity and with a variety of other drugs that have an effect on weight loss. US physicians view this warning as an anachronism since the FDA has approved the two combination drugs phentermine/topiramate and bupropion/naltrexone. As with other medications that have anticholinergic side effects, phentermine is contraindicated in patients with narrow-angle glaucoma. And around 20% of adults lost at least 10% of their body weight. And it seems safe for long-term weight management. It typically takes about 8 to 12 weeks to notice weight loss with Qsymia. To assess the long‐term effects of pharmacologically‐induced reduction in body weight in adults with essential hypertension on all‐cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non‐serious adverse events). Results from a few RCTs showed no beneficial effect on cardiovascular events for liraglutide or phentermine/topiramate compared to placebo (LeBlanc 2018). None of these reviews investigated the efficacy and safety of weight‐reducing drugs in the subgroup of overweight or obese people with hypertension. The mechanisms by which these three medications cause weight loss are not yet fully understood. But they have other risks and side effects to consider. Wegovy and Zepbound are once-weekly injectable phentermine alternatives. Zepbound (tirzepatide) is another injectable phentermine alternative. Possible side effects of phentermine include dry mouth, increased blood pressure, insomnia, headache and dizziness. This prescribed drug for losing weight is often prescribed along with a reduced-calorie diet and increased physical activity for the treatment of obesity. It didn’t take long to wean off phentermine completely, and I have been off the adipex diet pill for years with no adverse effects to my health. However, it’s only approved for short-term use and may not be a safe option if you have a history of heart problems. The study was fielded between July 10 and August 18, 2023, across demographic groups, genders, and health conditions. “Patients on these medications tell me they don’t even have to think about eating less.” Common side effects include nausea, headache, constipation, dizziness, vomiting, and dry mouth, with occurrence ranging from approximately 4% to 25%.43 These side effects make Contrave the second most likely anti-obesity agent to be discontinued due to side effects, after liraglutide.43 Patients who are taking benzodiazepines, barbiturates, other bupropion medications, opioids, opiate agonists, or anti-epileptic medications are advised not to use Contrave. When starting treatment with Contrave, a four-stage dose-escalation regimen is followed by a dose increase every 7 days. Step 2 is to select therapeutic targets for improvement in complications and to determine the appropriate treatment modality and intensity. Step 1 is to evaluate patients for the presence and severity of obesity-related complications. Complications-centric medical model for treatment of the overweight or obese patient. Therefore, clinicians may wish to consider factors other than BMI alone when deciding whether or not to add an obesity medication to a patient's weight management regimen.82, 90, 95 For example, a patient with a BMI of 30 kg/m2 who has prediabetes and knee osteoarthritis may warrant greater consideration of adjunctive obesity medication use; for a patient with a similar BMI but no elevation in cardiometabolic risk or other obesity related conditions, the balance of benefits to risks may be less favorable. The scientific literature on drug treatment for obesity is limited, particularly for studies conducted before the requirement for registration of all clinical trials, by short intervention periods, high attrition, inadequate description of methods, and data analyses that used biased approaches to deal with missing data79 or concentrated on results of those completing the trial. Those on drug were more likely to both maintain their initial weight loss (81 vs. 49%) and to lose ≥5% (51 vs. 22%) or ≥10% (26 vs. 6%) additional weight than those taking placebo during follow-up, suggesting a potential role for liraglutide in augmenting weight loss or ameliorating regain after initial weight loss achieved through lifestyle intervention. So your prescriber may have you continue taking phentermine if it’s working for you and side effects aren’t an issue. Taking too much phentermine can lead to an overdose, which is a medical emergency. If you miss a dose of phentermine, take it as soon as you remember. Common questions about Phentermine (Adipex-P) Patients were allocated to receive 15 mg of phentermine or 30 mg of phentermine. Pre-hypertensive and well-controlled hypertensive individuals were allowed to be included in the study if the evaluating physician considered the benefit to be greater than the risk. Thus, it is reasonable to make efforts to improve the level of evidence and address unsolved questions of the suitability of old and less expensive drugs. It’s an upper that gives you tons of energy, a lack of appetite, and some pretty severe side effects. Phentermine, the generic version of adipex, is similar in composition to an amphetamine. I wasn’t gaining weight back, but I wasn’t losing any extra, either. But there are a few side effects that you should know about as you wean off. Well, it’s because when I first started to lose weight, I didn’t do it all by sheer willpower, diet, and exercise. The antiseizure agents carbamazepine (Carbatrol, Shire) and phenytoin (Dilantin, Pfizer) may reduce plasma levels of topiramate by approximately 40% to 48%.7 Overall, phentermine/topiramate CR has a limited drug-interaction profile.6,7“While taking phentermine, you’re going to be less hungry,” McGowan says.There are no studies evaluating semaglutide specifically in the post-bariatric surgery population.After SG and RYGB, revisional bariatric surgery has become the third most common type of bariatric surgery performed in the Unites States (54), with weight regain as the most common indication for revision (55).Liraglutide at 1.8 mg daily is approved by the FDA for the treatment of type 2 diabetes in adolescents and adults.When I hit normal BMI (body-mass index), my doctor could no longer legally prescribe the drug to me–which is great because it was beginning to adversely affect me, anyway. And people with hyperthyroidism (an overactive thyroid) should avoid phentermine. Common phentermine side effects include insomnia, headache, and tremors (shakiness). Another difference is that Ozempic and phentermine can cause different side effects. It has several effects in the body that can help lower blood glucose (sugar) levels. Talk with your primary care provider if you're not sure how you should take phentermine (Adipex-P). Phentermine (Adipex-P) is meant for short-term treatment only. Talk to your primary care provider if you've more questions about what to expect with phentermine (Adipex-P). Lilly's Zepbound (tirzepatide) superior to Wegovy (semaglutide) in head-to-head trial showing an average weight loss of 20.2% vs. 13.7%. Pfizer scraps daily weight loss pill after liver injury in one patient. The most effective weight-loss pill for many people is Wegovy (semaglutide) tablets. Robust cardiovascular safety data exists on the use of GLP-1 RAs with systematic reviews and meta-analyses demonstrating this class improves weight and glycemia, even when compared to dipeptidyl peptidase-4 inhibitors(46). Other benefits of exercise demonstrated in CKD include improving exercise capacity, functional capacity, and quality of life; no effects on albuminuria have been observed (34-36). Cardiometabolic benefits of exercise in CKD include decreases in systolic blood pressure (−5.6 mmHg), diastolic blood pressure (−2.9 mmHg), and BMI (−1.3 kg/m2), although BMI was reduced only in exercise interventions of 6-12 months duration. An RCT randomized 322 adults with obesity (99 with stage 3 CKD, 23 with albuminuria ≥ 30 mg/g) to follow 1 of 3 restricted-calorie diets (low-fat, Mediterranean, or low-carbohydrate) (32). After the study was ended early due to a futility analysis, a post-hoc analysis examining kidney outcomes was conducted(29). Metformin has also been used to prevent or ameliorate weight gain with atypical antipsychotic agents and mood stabilizers. Some results reported in the studies (e.g. for follow-up intervals other than 1 year) are not included in the table. Results for weight change are reported from intention to treat analyses, generally with the last observation carried forward. See full prescribing information for all adverse effects, cautions, and contraindications. The study included short and long-term results and follow-up. The most recent report on the long-term safety of phentermine was released in 2019. Again, it was found safe and effective with a 9 to 12% weight loss. Contact us at if you see an error. The Edge upholds the highest standards of health journalism. They aren’t cheap and the science on their accuracy is mixed, but DeCotiis says they can give a more accurate picture of the type of weight you’re losing. The plethora of on- and off-label AOMs creates the unique challenge for physicians to decide which medication may be most appropriate for the individual patient. With the advent of highly effective AOMs and newer agents targeted specifically at fat mass loss, pharmacotherapy is likely to become more acceptable by society and the medical community to treat obesity as a disease. During therapy, patients should be tested for neutralizing anti-metreleptin antibodies if they develop severe infections or loss of efficacy. Metreleptin (trade name Myalept) is a leptin analog approved to treat the complications of leptin deficiency in individuals with congenital or acquired generalized lipodystrophy (158). Caution should be taken if used in patients predisposed to renal stones, acute angle glaucoma, or metabolic acidosis (154). Your diabetes care team might need to adjust the dose of your blood sugar medications after you start phentermine (Adipex-P). There isn't enough information to know whether it's safe to take phentermine (Adipex-P) along with other medications for weight loss, including ones found over-the-counter. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. They note that pairing these medications with precision nutrition and lifestyle strategies ensures that weight loss translates into lasting health. Since then, a number of weight-loss drugs have been rolled out to try to meet the high demand for these medications. More research is needed assessing long-term cardiovascular and kidney outcomes of most weight loss medications. This is because clinical studies have shown other variables can influence the amount of weight loss that occurs while taking phentermine. Thus, when prescribing anti-obesogenic agents, health care providers should take care to properly monitor patients and cease medicinal treatment if the expected reductions in weight and cardiometabolic risk factors are not obtained within a reasonable period of time. Consequently, weight management trails were carried out, and they documented dose-dependent weight losses of 4.5 to 10.6 kg, or 4.4 to 10.4 %, of participants’ initial body weight with 59 to 91 % of patients achieving a ≥5 % weight loss (Fig. 1 and Table 2) . Naltrexone-bupropion use in diabetic patients demonstrated beneficial effects on HbA1c levels and HbA1c goal attainment which ultimately resulted in significantly fewer participants requiring an increase in diabetic medications over 56 weeks of treatment (Table 1) . Bariatric surgery should be considered for patients with CKD and severe obesity who fail lifestyle modifications with potential benefits on slowing CKD progression. There are also risks of micronutrient deficiencies (e.g. thiamine, cobalamin, folic acid, iron, vitamin D, calcium, vitamin A, zinc, and copper deficiencies), protein malnutrition, iron deficiency anemia, fractures, and mental health disorders (e.g. alcohol-use disorders, suicide, self-harm) (66). However, it should be noted that patients who undergo bariatric surgery are carefully selected and typically healthier than ineligible patients. Unfortunately, the vast majority of patients with kidney failure trying to achieve BMI requirements for transplant listing fail with medical management of obesity(81-84). So the weight loss results won’t be the same. Have your healthcare team review your medication list for any possible interactions with Contrave. It takes about 4 weeks to notice weight loss from Contrave. Labelled as a sympathomimetic amine, also known as an “anorectic” or “anorexigenic” drug. Phentermine and the other appetite suppressants remain very effective. Insomnia is controlled by taking the medication earlier in the day and avoiding caffeine after lunch. In fact, the only side effects I see are dry mouth and a little bit of insomnia. Phentermine is a stimulant that has a chemical structure similar to amphetamine. These include Ozempic’s effects on the appetite center of the brain. People with and without diabetes may be eligible for Wegovy to help them lose weight. But some people develop tolerance to it after a while. Since FDA-mandated Risk Evaluation and Mitigation Strategies (REMS) for metreleptin rigidly restrict the use of this leptin analog to patients with generalized lipodystrophy on a case-by-case basis, it is unlikely the drug has been used off-label for weight loss maintenance. After early reports of successful use for weight loss in nondiabetic patients,49 physicians began using it off-label to treat obesity.14 Since the maximum dose of phentermine in the combination is 15 mg/day, some US physicians prescribe additional phentermine, a combination which is an off-label use of both phentermine/topiramate and phentermine. Since it’s a controlled substance, it’s best to take the lowest effective dose of phentermine. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of phentermine in the elderly. It is used in patients with obesity who have not been able to lose weight with diet and exercise alone. If you are struggling with disordered eating behaviors, such as phentermine misuse, laxative use, self-induced vomiting, caloric restriction, and compulsive exercise, treatment is available in many different settings. Although society wants us to believe that there is only one ideal body type, we can actually be healthy and happy at any size (and body weight), and the real danger is weight discrimination and anti-fatness. While she lost 36 lbs in 4 months, she’s torn about whether to continue taking phentermine. Key’Miya heard about phentermine and asked her doctor about it. Key’Miya Pinkney is unsure about her future with phentermine. She did feel her heart racing one time after she took phentermine. Ashley experiences very few side effects from the medication. Phentermine is thought to promote weight loss by increasing norepinephrine release and decreasing its uptake in hypothalamic nuclei, leading to a decrease in food intake (59). In the 4-year XENDOS study conducted in Sweden, the cumulative incidence of T2D was 9.0% in the placebo plus diet and lifestyle group and 6.2% in the subjects receiving orlistat (24), corresponding to a risk reduction in development of T2D of 37.3%. Subjects in the orlistat group lost significantly more weight in the first year (10.2 vs. 6.1%) and regained half as much weight during the second year of treatment, as compared to the placebo group (53). Rossner et al. found that subjects receiving orlistat lost significantly more weight in the first year of treatment, and fewer regained weight during the second year of treatment, than those taking placebo (52). Phentermine’s and diethylpropion’s main side effects are related to their sympathomimetic properties, including elevation in blood pressure and pulse, insomnia, constipation, and dry mouth (47). It’s also approved for people with a BMI of at least 27 with one or more weight-related health conditions, such as high blood pressure or diabetes. So, how much phentermine do people usually take for weight loss? Thinness does not automatically equal health, especially in the face of using medications like phentermine, which can have catastrophic consequences. A study of abrupt phentermine cessation in patients in a weight management program. She is an experienced healthcare executive and the President of Global Insight Advisory Network.Naltrexone was approved for the treatment of opioid and alcohol addiction and antagonizes an opioid-dependent feedback loop that limits the effects of bupropion on the POMC neurons; hence, this drug combination works synergistically .There are no studies evaluating the individual efficacies of naltrexone, bupropion, or naltrexone/bupropion specifically in the post-bariatric surgery population.Together, the phentermine-topiramate combination helps people lose more weight than when taking either drug by itself.Phentermine isn’t recommended if you have heart problems or a history of substance misuse.But it’s important to have a conversation with your prescriber about the potential risks of controlled substances like Qsymia.The EMA's CHMP has indicated that a long-term cardiovascular outcomes trial would be necessary to support PHEN/TPM-ER centralized approval in Europe .In all three trials, the study medication was combined with a reduced‐calorie diet and increased physical activity.After 14 weeks of study, the drug treatment group lost 16.5 lbs. But the medication has known side effects, such as dry mouth and trouble sleeping. Sympathomimetics, such as phentermine (Adipex-P, Lomaira) and diethylpropion, are taken as oral pills. Weight loss at first month and development of tolerance as possible predictors of 30 mg phentermine efficacy at 6 months. Predicting risk of adverse drug reactions in older adults. Reach out to them if you have questions about your dose or about how to take the medication. This medication works best when it's part of a treatment plan that involves healthy diet and regular exercise. It's a prescription weight loss pill for people ages 17 years and older. Like other weight-loss medicines ordered by providers, phentermine is meant to be only part of a weight-loss plan. But they may help you make the lifestyle changes that you need to practice to lose weight and improve your health. The other drugs in this group aren't often prescribed. Other possible side effects include an increase in heart rate and blood pressure, insomnia, constipation, and nervousness. Phentermine has the potential to be misused because it acts like a stimulant drug called an amphetamine. So your provider will need to check your blood pressure regularly at the start of treatment. In XENDOS 2001‐2006, there were two deaths in the orlistat‐treated group in the first subgroup analysis (diastolic BP ≥ 90 mm Hg) and one death in the orlistat group in the second subgroup analysis (systolic BP ≥ 140 mm Hg); no deaths occurred in the placebo group. Three of four studies reported on mortality. BNo data on adverse events were reported for the whole study duration. There was an increased risk of bias because of very high withdrawal rates (84% and 94%, respectively), without imputation for missing data (Nissen 2016). The gastrointestinal side effects of orlistat, including fatty/oily stool, fecal urgency, oily spotting, increased defecation, fecal incontinence, flatus with discharge, and oily evacuation (48), are the main reasons for discontinuation of therapy. Obesity is a major risk factor in the development of cardiovascular disease (CVD), type 2 diabetes (T2D), musculoskeletal disorders, and several cancers (2). Obesity is recognized as a major pandemic of the 21st century, contributing to increased morbidity, mortality, and the burden of healthcare costs (1). Learn more about link terms and conditions. Phentermine is also one of the best medications to help stop weight loss plateaus. Phentermine is a safe and effective weight loss pill; it is not an amphetamine and remains an effective obesity treatment. OLDU for obesity treatment is very common in the USA and will likely continue in the future, given the paucity of approved drugs for treating obesity and the current regulatory environment. The paradigm should also acknowledge that guidelines should not replace treatment decisions made according to an individual physician’s judgment and the clinical needs of an individual patient.OLDU for obesity treatment is very common in the USA and will likely continue in the future, given the paucity of approved drugs for treating obesity and the current regulatory environment. It can be challenging to maintain a healthy body weight with lifestyle changes alone. Off-label drugs for weight management. Amgen wants in on the booming weight loss drug market — and it’s taking a different approach. Dose-ranging study to evaluate the efficacy, safety, and tolerability of AMG 133 in adult subjects with overweight or obesity, with or without type 2 diabetes mellitus. A study of IBI362 in Chinese adolescents with obesity or overweight. One of them is phentermine (Adipex-P), an oral medication that’s been around for decades as a short-term option for weight loss. Based on clinical study data, you could lose up to 1lbs over a 12 week weight loss program with phentermine. This calculator reveals potential monthly weight loss over time using a formula based on publicly available data from clinical studies on phentermine. Further, prior findings demonstrated that anti-obesity drugs cannot be used as a panacea for the treatment of obesity; instead, they should be used to facilitate weight control. Be sure to check the cordovaweightloss.com homepage for discounts or new patient specials. At Cordova Weight Loss, the office visit price is $50, and the cost of a one-month supply of Phentermine is $25. Phentermine has been around for decades and there have been no reported cases of heart valve disease with Phentermine alone.Phentermine is well-known, affordable, and proven effective. Phentermine has been around since 1959, so its safety profile is well known. Although, about 10% of our patients lose an estimated 10 pounds a month! This is why doctors only prescribe it for short-term use.1 Chronic phentermine use can lead to dependence and addiction, especially if you’re misusing it or continue to increase your dose as time goes on. In addition to a possible overdose, phentermine can also be addictive, especially if used for an extended period of time. However, it can be dangerous to take Lomaira for weight loss for both physical and mental health reasons. Attrition for each study was calculated from the total number of participants who were randomized to treatments. Automated searches were supplemented by examination of expert recommendation reports and bibliographic references from included research studies, and searches of for each identified medication. Weight change relative to placebo (95 percentile confidence interval) using intent-to-treat analyses for each medication at 1 year. Thirty-six percent of US adults are obese and many cannot lose sufficient weight to improve health with lifestyle interventions alone. Clinical trials investigating weight loss as a therapeutic option for these conditions may be beneficial. The FDA approval of phentermine/topiramate ER in July 2012 included a risk evaluation and mitigation strategy (REMS) to inform patients and providers about teratogenic risk and the need to avoid fetal exposure . This trial not only is designed to rule out any cardiovascular risks of treatment with phentermine/topiramate ER, but will also attempt to demonstrate benefit of treatment through a superiority design. Subjects were assigned to once-daily treatment with placebo, phentermine 7.5 mg/topiramate ER 46 mg or phentermine 15 mg/topiramate ER 92 mg for 56 weeks . Weight loss with phentermine/topiramate ER in (A) EQUIP, (B) CONQUER and (C) SEQUEL studies from baseline to study end 26,27,29. 67% of patients given the top dose lost ≥5% of initial weight and 47% lost ≥10% of initial weight, compared with 17% and 7%, respectively for placebo. Benzphetamine is less commonly prescribed for obesity treatment than the other noradrenergic drugs,41 and there are few data from controlled trials evaluating its safety or efficacy.37 All were approved before the necessity of long-term treatment for obesity was established. Four centrally-acting noradrenergic agents (phentermine, diethylpropion, phendimetrazine, benzphetamine) are FDA-approved for the “short-term” (usually considered ≤12 weeks) management of obesity. Pooled, sample size-weighted, estimates and confidence intervals for weight loss at 1 year were calculated from the primary studies of 452 orlistat-treated and 449 placebo-treated adults reported in the two primary studies13, 15 that met criteria for inclusion. This is a reasonable amount of weight loss in that time frame. Beyond 1 month, weight loss typically slows down to a more sustainable 1 to 2 pounds per week. So in one week, weight loss is usually in the 1% to 3% range. Phentermine can also cause dependence and tolerance with long-term use, so it is only approved for short-term periods of a few weeks to 3 months. Combined treatments had a placebo-subtracted weight loss of approximately 7%, while both monotherapies resulted in weight loss of approximately 4% after 28 weeks.25Incidence rates for cardiovascular event outcomes (MACE endpoints; all exposed patients)The role of pramlintide for weight loss.For a select group of overweight or obese people for whom lifestyle interventions are unsuccessful, anti‐obesity drugs may be an option to help reduce body weight.So your prescriber may have you continue taking phentermine if it’s working for you and side effects aren’t an issue.A lesson from the withdrawal of previous anti-obesity drugs is that uncommon but serious adverse effects may become apparent only when a drug is used in larger populations or for longer periods of time than in pre-approval trials.80 Given that more than one-third of the US adult population is obese, there is great potential exposure to any obesity medication.Because these medications were approved prior to the requirements for long-term trials with adequate power to ascertain clinical endpoints, an adverse effect of noradrenergic obesity drugs on cardiovascular disease events cannot be excluded, and is of concern given their known effect on heart rate and blood pressure. “And if your doctor can’t do this, ask for an obesity medicine specialist.”No studies for older noradrenergic agents (phentermine, diethylpropion, phendimetrazine, and benzphetamine) met inclusion criteria for length of treatment, sample size and/or attrition.These medications, twice-daily lorcaserin (Belviq®, Arena Pharmaceuticals, Switzerland) and once-daily phentermine/topiramate ER (Qsymia®, VIVUS, Inc., Mountain View, CA, USA), have greatly enhanced medication treatment options for clinicians and patients.One such medication is Zepbound (tirzepatide).Phentermine can increase heart rate and blood pressure.There was often a lot of overlap among people who lost weight versus those who maintained or gained weight. Since the market approvals of rimonabant and sibutramine have been withdrawn since 2009 and 2010, respectively, these two drugs were no longer considered as relevant for long‐term weight management and were therefore excluded from the 2020 version of this review. Long‐term trials assessing the effects of sibutramine and rimonabant on mortality and morbidity have confirmed concerns about the potentially severe side effects that led to marketing withdrawal of these two drugs throughout the world. Although LeBlanc 2018 could include more than 30 trials that addressed medications for weight loss, no reliable conclusions could be drawn about clinical outcomes. A major limitation of this review is that due to insufficient information in the included studies, we can draw no conclusions on the effects of the different pharmaceutical weight‐loss interventions on patient‐relevant long‐term outcomes. We regarded the two included trials investigating phentermine/topiramate (CONQUER 2013) or naltrexone/bupropion (Nissen 2016) as having no major deficiencies in study quality. If an individual does not lose 5 percent of body weight after 12 weeks on the highest dose, phentermine-topiramate should be discontinued due to lack of response. Phentermine (trade name Adipex) was among the first FDA-approved short-term medications for weight loss and remains available today. Today, nine FDA-approved AOMs remain on the market, with six approved for long-term weight loss, of which one is indicated for specific monogenic obesity mutations, and one “device” that functions as a medication (Table 2). Current guidelines recommend that individuals who have attempted lifestyle improvements and continue to have a body mass index (BMI) of ≥ 30 kg/m2 or ≥ 27 kg/m2 with an obesity-related comorbidity are eligible for weight loss medication treatment. Today, six anti-obesity medications (AOMs) are approved by the Federal Drug Administration (FDA) for the long-term treatment of obesity. Adipex Weight Loss Program Heart valve problems and high blood pressure in the lungs are rare but have also been reported. It can also potentially increase your blood pressure and heart rate. Serious side effects include pancreatitis and gallbladder problems. But they are not covered for weight loss. If your plan won’t cover GLP-1 agonists for weight loss, you may have other options. In 2024, nearly 1 in 5 companies with 200 or more employees and 1 in 4 companies with 5,000 or more employees covered GLP-1 agonists for weight loss. Coverage for weight loss alone is less common. Insurance coverage for GLP-1 medications depends on the condition being treated. Both drugs are frequently used off-label in the US in manners similar to phentermine. These patients typically are less scattered, can focus better and are more productive when taking phentermine and, realizing this, “like” taking the drug. In phentermine post-marketing studies, we found that long-term phentermine use, even at doses higher than 37.5 mg/day, did not induce phentermine cravings, and that abrupt cessation of long-term phentermine did not induce a stimulant withdrawal syndrome.23,34 As discussed in a previous communication, isolated reports of PPH occurring in patients who have taken phentermine have relied on theoretical but unproven adverse effects and ignored the underlying incidence of idiopathic pulmonary hypertension.32 Phentermine is longer acting than caffeine and does not have the adverse gastrointestinal effects of high doses of caffeine, so some students studying for exams and some long-haul truck drivers use it to stay awake and alert. Topiramate, like other carbonic anhydrase inhibitors, may produce CNS and peripheral nervous system (PNS) effects, such as paraesthesias, acute myopia, blurred vision, redness of the sclera, photophobia, and eye discomfort resulting from secondary angle-closure glaucoma, as well as psychiatric and neurologic disturbances, including fatigue, somnolence, depression, and difficulties with concentration and memory 65,66. Topiramate may decrease food intake via effects of carbonic-anhydrase inhibition on taste 67,68, or through its effects on GABA transmission, since GABA-A receptor activation and the interaction between GABA and leptin pathways are known to mediate effects on appetite and metabolism. It is suggested that topiramate acts on kainate/alpha-amino-3-hydroxy-5-methylisoxozole-4-propionic acid glutamate receptors. Phentermine has no affinity for the 5-HT2b receptor and does not increase circulating serotonin 60,61. AContraindications listed for topiramate immediate-release apply to the product's European package leaflet. The aim of this study was to analyze body weight loss in kilograms during the first month (1 mo-BWLkg) of treatment with 30 mg phentermine and development of tolerance to phentermine, on its 6-month efficacy. The most common adverse drug events (ADEs) (in 10% of patients or more) that occurred significantly more often with any dose of phentermine/topiramate CR than with placebo were constipation, paresthesia, and dry mouth. This design was used to increase power of the safety analysis by having more patients receive placebo and a treatment group consisting of patients using the highest doses of phentermine/topiramate CR. The most commonly used medications approved for weight loss include phentermine resin (Ionamin, UCB Pharma); phentermine HCl (Adipex-P, Gate), diethylpropion (Tenuate, formerly Sanofi-Aventis), and orlistat (Xenical, Roche/Genentech; nonprescription Alli, Glaxo-SmithKline). The one-year EQUIP trial, a phase three 56-week RCT enrolled 1267 patients with obesity (mean BMI of 42.0 kg/m2) and showed 3.5% weight loss in the starting dose group (3.75 mg/23 mg) and 9.3% placebo-subtracted weight loss in the top treatment dose (15 mg/92 mg) group (27). People taking a placebo lost only about 1% during the same time. Its 78-week, phase 3 study is actively underway. The study kicked off in September 2023, and it ended in the first portion of 2024. A tablet version of the medication is also in the works, but it’s in earlier stages of development. Phase 3 studies are set to run through April 2026, and the corresponding data should be released during the first half of the year. Terminated early as sponsor decided to develop controlled-release formulation; results presented for modified-intention-to-treat analysis of 229 patients completing 10-month follow-up While visceral adiposity is best captured by imaging, elevated waist circumference (≥102 cm for men, ≥88 cm for women) is a simple alternative that captures some of this risk(11, 13). In contrast, lower-body subcutaneous fat may serve as a metabolic buffer, preventing other tissues from accumulating lipotoxicity (10). Another important issue is heterogeneity in fat distribution as visceral fat has more adverse metabolic effects than subcutaneous fat (9). First, BMI is a poor metric for body fat distribution and is unable to differentiate between fat and muscle mass. A total of 803 adverse events (AEs) were reported for 166 patients receiving 30 mg phentermine during the 6-month follow-up period. The subclassification of patients according to 1 mo-BWLkg exhibited a clear relationship with the subsequent efficacy of phentermine in terms of mean BWR% (Figure 2A). Anthropometric and cardiometabolic changes induced by 30 mg phentermine in subjects who completed at least 3 months of treatment. Phentermine therapy significantly improved anthropometric and cardiometabolic variables (waist circumference, fasting glycemia, tryglicerides, and total cholesterol) after 3 and 6 months of treatment, while diastolic blood pressure and HDL-cholesterol improved until the 6th month of therapy (Table 2). Perhaps this is one reason the existing paradigm has made no impact on the global pandemic of obesity; instead, it fosters continuation of worldwide obesity by allowing early stage patients to accumulate ever-higher amounts of adipose tissue. Unfortunately, most of the patients deserving surgical treatment will not receive it since there are only sufficient global surgical and monetary resources to treat some of them. An 8-year loss of 5% therefore represents 5 kg or 11 pounds, a loss statistically significant in terms of risk reduction but far from satisfactory to the patient. The best the diabetes prevention trial could come up with was a 5% weight loss at 8 years.57 Other trials have had equally dismal results. The variation in dose required for effective treatment is thought to be due to intra-individual variability in drug metabolism and plasma clearance. The label lists 37.5 mg per day as the “usual dose” (30 mg of phentermine resin is the same dose). There was protracted opposition to re-approval from those who maintained the sympathomimetic obesity drugs that had dangerous addiction potential. Physicians used 5 mg methamphetamine tablets up to 3 times daily before meals in the 1940s and 1950s for treating obesity, but then turned toward using sympathomimetic amines as these became available beginning with phenmetrazine in 1956; phentermine, diethylpropion and phendimetrazine in 1959; and benzphetamine in 1960. However, a massive obstacle in developing treatment guidelines remains the lack of prolonged studies monitoring the long-term safety and efficacy of obesity medications. In this review, we searched the PubMed database for studies exploring the safety and efficacy of the five medications currently approved by the FDA for the treatment of obesity. We confirmed that 30 mg phentermine is effective and safe during a 6-month treatment course and that weight loss in kg during the first month, alongside development of tolerance to phentermine at specific time could allow clinicians to predict drug efficacy. Capsules containing phentermine as a resin complex should be stored in tight containers at 15-30degreesC. In addition, while phentermine produced CNS stimulation, fenfluramine produced CNS depression. As with other amphetamine derivatives, no primary effect on appetite has been demonstrated with phentermine and it is probable that its anorexigenic action is secondary to CNS stimulation. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Some people may turn to online sources for GLP-1s like Wegovy and Zepbound. The best way to save on Zepbound or Wegovy is to use your health insurance. In some cases, they may be able to raise it or switch you to a different medication. In this case, your prescriber may have you start with a lower Zepbound dose and slowly work your way up. But each medication’s dosage schedule looks a bit different. In SURMOUNT-2, adults with BMI ≥ 27 and A1c 7-10% on stable anti-diabetic therapy, either diet and exercise alone or oral antihyperglycemic medication for at least 3 months were randomized to tirzepatide 10 mg, 15 mg, or placebo for 72 weeks (109). The mean weight change was -15.0%, -19.5%, -20.9%, and -3.1% with tirzepatide 5 mg, 10 mg, 15 mg, and placebo, respectively. SURMOUNT-1 enrolled 2539 participants with BMI ≥ 30 or ≥ 27 with at least one weight-related comorbidity who were randomized to 5, 10, or 15 mg of tirzepatide or placebo for 72 weeks (108). The patients were classified into 6 groups according to the month when they developed tolerance to phentermine or if tolerance did not occur. At every visit, patients were required to empty their bladder upon arrival, dress with a hospital gown, and a nude body weight was obtained with a calibrated scale. Body weight and body mass index (BMI) were determined during monthly visits between months 0 to 6. It’s generally well tolerated, with common side effects including dry mouth, tingling and constipation. When it comes to effective weight-loss pills, Dr. Apovian says these four options come out on top. “It’s highly regulated and can raise blood pressure and heart rate. A study of tirzepatide (LY ) in participants with overweight or obesity and chronic kidney disease with or without type 2 diabetes (TREASURE-CKD). A research study to see how semaglutide helps people with excess weight, lose weight (STEP UP). A study of tirzepatide (LY ) in participants with obesity or overweight with weight related comorbidities (SURMOUNT-5). Using these medicines together may cause serious unwanted effects. It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and does not cause any unwanted effects. Ask your healthcare professional how you should dispose of any medicine you do not use. A 48-week randomized placebo-controlled trial randomized individuals with obesity to placebo, 300 mg, or 400 mg of bupropion sustained release (SR). While the mean weight loss seen with bupropion is small, it is a preferred alternative to most antidepressants, which commonly cause weight gain. Bupropion (trade name Wellbutrin or Zyban) is used for depression and smoking cessation and can cause weight loss as a side effect. The impact of Gelesis100 on the absorption of other medications was investigated only with metformin. Overall, there were no significant differences between Gelesis100 or placebo in cardiovascular risk factors of LDL-C, HDL-C, triglycerides, systolic BP, diastolic BP, or HOMA-IR. It is important to note that not all patients with overweight or obesity have cardiometabolic disease or mechanical complications; up to 30% have been observed to be insulin sensitive without cardiometabolic disease and may not progress to T2DM or CVD, giving rise to the term ‘healthy obese' to characterize these patients 41,42. The patients who will benefit most from obesity treatment have obesity-related complications that can be ameliorated by weight loss. For example, lorcaserin resulted in 3.6% placebo-subtracted weight loss after 1 year in the BLOOM Study (5.8% weight loss with lorcaserin vs 2.2% for placebo), with some weight regain in lorcaserin-treated patients over the second year of the study . By offering an effective medical option to complement lifestyle and surgical approaches, phentermine/topiramate ER offers a medical model for comprehensive obesity care that can be used to promote the health of individuals by ameliorating obesity complications. Thus, phentermine/topiramate ER represents a well-tolerated, effective option for the treatment of obesity and its related co-morbidities, when used in conjunction with lifestyle changes. The treatment duration was 56 weeks. About 90% of the included participants were taking antihypertensive medication. The study had a parallel, double‐blind design and the industry sponsor was mentioned. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone. If you answered yes to these questions, a prescription weight-loss drug may be a choice for you. Are you an adult who has serious health problems because of your weight? If you do, there’s a higher risk you’ll experience side effects. But if you have severe kidney damage, your phentermine dosage shouldn’t go higher than 15 mg daily. So if you have kidney damage, you may need a lower phentermine dosage. Phentermine is removed from the body, in part, by the kidneys. Of all the weight loss drugs, phentermine is the least expensive. This also included all FDA-approved drugs, including all doses of phentermine. A British study found phentermine also to be a safe and effective weight loss pill when compared to a placebo over a period of months. Having a support system can provide encouragement, accountability, and guidance throughout your weight loss journey. At Horizons our weight loss programs are created with support in mind. Chronic stress can lead to emotional eating and hinder weight loss efforts. Lack of sleep can disrupt hormone regulation and increase appetite, making weight loss more challenging. Additionally, phentermine can increase energy levels, which may encourage individuals to exercise and burn more calories. Consult your healthcare professional before taking any drug or commencing or discontinuing any course of treatment. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. If you are taking or have taken other appetite-suppressant drugs in the past year (such as diethylpropion, ephedra/ma huang), tell your doctor or pharmacist before starting this medication. This drug should not be used with certain medications because very serious interactions may occur. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). This gives your body time to adjust to Zepbound and find the right dose for you. Yes, if you need more help managing your body weight, it’s possible to switch from Wegovy to Zepbound. When starting Zepbound or Wegovy, your dosage is slowly raised over time to help manage side effects and find the right dose. Because of this, your health history and risk factors can make one option a better fit over the other. Individual clinical trials also suggest that Zepbound may result in greater weight loss than Wegovy injections and pills. Today, it remains the longest licensed antiobesity drug for long-term use and is available over the counter (Alli®). Although the prevalence of being overweight was similar between men (39%) and women (40%) in 2016 according to the World Health Organization, recent studies have reported more rapid increases in obesity-related indicators in men than in women 2,3. As a chronic and relapsing disease, obesity negatively impacts the health of men to a greater extent than that of women, with a higher risk of cardiovascular disease. Improvement in obesity-related health conditions is common for those who lose the higher percentages of body fat. By 3 months, most patients see a weight loss of 10% to 15% of their starting weight. Multiple factors—from your unique biology and genetics to behavioral patterns and medical conditions—all influence your weight loss journey. PCOS is linked to insulin resistance and hormonal imbalances that make weight loss particularly difficult. Other reasons include thyroid surgery, radiation therapy, certain medications (like lithium), and sometimes pregnancy. Breastfeeding is not recommended while using this drug. This medication must not be used during pregnancy. If you are using the tablets made to dissolve in the mouth, your medication may contain aspartame. Phentermine-Adipex 37.5 mg Diet Pill including phentermine HCL and 30 mg phentermine have been prescribed for initial weight loss and weight control successfully for more than 50 years in the United States. While these medications work differently to help with weight loss, there's not enough research to understand whether they're safe to take together. Let your PCP know if you notice your blood pressure rising after starting treatment because they might need to adjust your medications. Phentermine also is offered combined with topiramate for weight loss (Qsymia). Levothyroxine should not be used for the treatment of obesity or for the purpose of losing weight. Store phentermine and topiramate in a safe place so that no one else can take it accidentally or on purpose. Phentermine and topiramate may cause other side effects. If you suddenly stop taking phentermine and topiramate, you may experience seizures. Phentermine is a stimulant appetite suppressant in the amphetamine family. Sue DeCotiis, M.D., is triple-board-certified in internal medicine, functional medicine, and obesity medicine, and based in New York City. He’s also a leader in endobariatrics, a new field of gastroenterology that targets the obesity epidemic without bariatric surgery. Christopher McGowan, M.D., is triple-board-certified in internal medicine, gastroenterology, and obesity medicine. Systematic reviews on the long‐term effects of weight‐reducing drugs in people with hypertension are rare. This updated systematic review attempted to determine the long‐term effects of weight loss through approved pharmacological intervention on patient‐relevant endpoints, namely death and cardiovascular complications, in the antihypertensive therapy of people with essential hypertension. In addition, significantly more participants in the hypertensive subgroup achieved weight loss of ≥ 5%, ≥ 10%, and ≥ 15% with phentermine/topiramate compared with placebo (CONQUER 2013). The study compared two different dose regimens of phentermine/topiramate once daily versus placebo. The relevant information to be extracted was the duration of the intervention, length of follow‐up (in months), the type of anti‐obesity drug (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, or liraglutide), the dose, and the administration route. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. It can cause serious heart issues, dependence, and addiction, and increase the risk of an eating disorder. You'll have access to a personalized team of healthcare professionals, including dietitians, nutritionists, therapists, and more. Our remote treatment program at Within Health provides integrated, compassionate, and inclusive care that can work around your busy schedule. A Lomaira overdose may include psychotic symptoms, such as auditory hallucinations and persecutory delusions.6