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Phentermine is an oral sympathomimetic amine used as an adjunct for short-term e. The pharmacologic effects of phentermine are similar to amphetamines. Phentermine hydrochloride was FDA approved in In the mids, there was renewed interest in phentermine in combination with another anorectic, fenfluramine, for the treatment of obesity and substance abuse, however, little scientific data support this sand. On July 8,the FDA issued a 'Dear Health Care Professional' letter warning physicians about the does adderall cause large pupils of valvular heart disease and pulmonary hypertension in women receiving the combination of fenfluramine and phentermine; fenfluramine was subsequently withdrawn from the US market in fall of Use of phentermine with other anorectic agents for obesity has not been evaluated and is not recommended.

In Maythe FDA approved a phentermine hydrochloride orally disintegrating tablet Suprenza for the treatment of exogenous obesity. Limited data are available in reference texts regarding the mechanism of action of this drug. Phentermine is an analog of methamphetamine. Similar to the amphetamines, phentermine increases the release of norepinephrine and dopamine from nerve terminals and inhibits their reuptake.

Thus, phentermine is classified as an indirect sympathomimetic. Appetite suppression is believed to occur through direct stimulation of the satiety center in the hypothalamic and limbic sand. Tolerance to the anorexiant effects of phentermine usually develops within a few weeks of starting therapy. The mechanism of tolerance appears to be pharmacodynamic in nature; higher doses of phentermine are required to produce the same response.

When tolerance develops to the anorexiant effects, it is generally recommended that phentermine be discontinued rather than the dose increased. Phentermine is administered orally. The rate and extent of phentermine exposure under fasting conditions is equivalent regardless of oral formulation administered. Limited data exist on the sand of phentermine. Phentermine is primarily excreted by the kidneys.

The elimination half-life ranges 19—24 hours and is influenced sand urinary pH. Because phentermine pKa of phentermine is 9. Following oral administration, most absorption of phentermine occurs from the small intestine. The duration of action following administration of the 8 mg capsules or tablets is about 4 hours and 12—14 hours after administration of the 30 mg capsules or can you take tylenol with azithromycin while pregnant Phentermine oral disintegrating tablet Cap phentermine 30 sand mg reaches peak concentrations Cmax 3—4.

Use sand caution in patients with renal impairment. As a stimulant similar to some amphetamines, phentermine acts as an appetite suppressant by stimulating branches does lexapro cause euphoric symptoms the sympathetic nervous system located within the central nervous system and is best used when used in conjunction with a healthy lifestyle.

Phertermine is indicated in the management of exogenous obesity as a short term several weeks adjunct in a regimen of weigh reduction based on caloric restriction. It is often recommended can xanax cause rage obese patients who possess greater cap factors for high blood pressure, phentermine 30 mg cap sand cholesterol, or diabetes.

Phentermine is contraindicated sand use phentermine any patient with a prior history of sympathomimetic amine hypersensitivity. According to the manufactures of phentermine capsules and tablets, its products are contraindicated in patients with cardiac disease, advanced arteriosclerosis, moderate to severe hypertension, agitated states, or glaucoma.

Therefore, coadministration of these drug products for weight loss is not recommended. Further, primary pulmonary hypertension PPH has been reported to occur in cap receiving a combination of phentermine with fenfluramine or dexfenfluramine. The possibility of an association between the use of phentermine alone and PPH or valvular heart disease cannot be ruled out.

The initial symptom of PPH is usually dyspnea. Other initial symptoms include: Patients should be advised to report immediately any deterioration in exercise tolerance. Treatment should be discontinued in patients who cap new, unexplained symptoms of dyspnea, angina pectoris, syncope, or lower extremity edema.

Because phentermine is a sympathomimetic agent, it is contraindicated in patients with hyperthyroidism. It should also be used with caution in patients with thyroid disease. Phentermine is contraindicated for use during or within 14 days following the use of MAOI therapy or other drugs with MAO-inhibiting activity. Monoamine oxidase inhibitors MAOIsor drugs that possess MAO-inhibiting activity such as furazolidone or procarbazine, can prolong and intensify the cardiac stimulation and vasopressor effects of phentermine.

Phentermine is contraindicated in patients with agitated states. Phentermine could aggravate certain mental conditions, such as those patients who exhibit highly nervous or agitated behavior, including psychosis, mania, or severe anxiety. The use of phentermine may cause dizziness, mask signs of fatigue or the need for rest, or impair the ability of a patient to participate in activities that require mental alertness. In general, ethanol ingestion may aggravate sand effects or cause an adverse drug reaction.

Use phentermine cautiously in patients with diabetes mellitus. Insulin or other antidiabetic medication requirements may be altered in these patients "sand" using phentermine during weight loss and due to altered dietary regimens. Patients should you take adderall xr on an empty stomach monitor their blood glucose regularly and follow the recommendations of their health care provider.

Tapering off lexapro side effects suppressant therapy is not recommend for use in those sand with a history of anorexia nervosa or other eating disorders. Use of phentermine is contraindicated in patients with a known history active ingredient in ambien cr drug or substance abuse.

Phentermine is chemically and pharmacologically related to the amphetamines which have been extensively abused. The possibility of abuse of phentermine should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. The least amount reasonable should be prescribed or dispensed at one time in order to limit the potential for overuse or drug diversion.

Phentermine products are now sand as FDA pregnancy risk category X, as are many anorexiants used for weight cap, and are contraindicated during pregnancy. Phentermine should not be taken by pregnant women or by women who may become pregnant "sand," in the opinion of the physician, the potential benefits outweigh the possible hazards.

Abrupt discontinuation of phentermine after prolonged high doses may result in severe mental depression or extreme fatigue; sleep EEG changes have also been noted. Gradual withdrawal of therapy is recommended. If immediate discontinuation is medically necessary, careful monitoring and symptom management is warranted. Phentermine is contraindicated during breast-feeding.

Safety sand effectiveness of phentermine in children have not been established. Phentermine is not recommended for children or adolescents sand years of age and under. There is no established use of phentermine in infants or neonates. Cap sand debilitated or geriatric patient may be more susceptible to the Sand and sympathomimetic side effects of phentermine; use with caution in elderly patients. Patients with renal impairment may also be more susceptible to side effects.

Exposure increases can be expected in patients with renal impairment or renal failure. Use caution when administering phentermine to patients with renal impairment. The use of inhalational anesthetics sand surgery may sensitize the myocardium to the effects of sympathomimetic drugs. Because of this, and its effects on blood pressure, in general, phentermine should be discontinued several days prior to surgery. The safety of phentermine when used with other anorexiant agents such as amphetamine, benzphetamine, dexfenfluramine, dextroamphetamine, diethylpropion, ephedrine, fenfluramine, and sibutramine 9 is controversial and concurrent use should be avoided.

The role of phentermine in the production of cardiac valvulopathy when combined with dexfenfluramine, fenfluramine, interaction of xanax and marijuana other medications for weight loss is uncertain. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmias. Similarly, because phentermine cap sand 30 mg phentermine a sympathomimetic and anorexic agent i.

Monitoring for cardiac effects during concurrent use of ergot alkaloids with phentermine may be advisable. Concurrent use of bromocriptine and some sympathomimetics such as phentermine should be approached with caution. One case report documented worsening headache, hypertension, side effect of klonopin overdose ventricular complexes, and ventricular tachycardia in a post-partum patient receiving bromocriptine for lactation suppression who was subsequently prescribed acetaminophen; dichloralphenazone; isometheptene for a headache.

In theory, an interaction is "phentermine" between cabergoline, an ergot derivative, and some sympathomimetic agents such as phentermine. Use sand the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic i. Concurrent use sand dronabinol, THC or nabilone 13 with sympathomimetics may result in additive hypertension, tachycardia, and possibly cardiotoxicity. Monoamine oxidase inhibitors MAOIs sand mg phentermine 30 cap, or drugs that possess MAO-inhibiting activity sand as furazolidone, linezolid, or procarbazine, can prolong and intensify the cardiac stimulation and vasopressor effects of phentermine.

Phenelzine and tranylcypromine appear to produce the greatest risk since these two MAOIs also have intrinsic amphetamine-like activity. In the presence "cap phentermine 30 sand mg" MAOIs, phentermine and other drugs that cause release of norepinephrine induce severe cardiovascular 2.5 mg wellbutrin xl dosage cerebrovascular cap. It sand unclear if selegiline, an inhibitor of MAO type B, can also predispose to this reaction.

The pressor response to some sympathomimetics is exaggerated in patients currently receiving tricyclic antidepressants. Concomitant use of tricyclic antidepressants with sympathomimetics, including phentermine, should be avoided whenever possible. Phentermine has vasopressor effects and may limit the benefit of antihypertensive agents particularly sympatholytic agents such as guanadrel, guanethidine, methyldopa or reserpine.

Concomitant use of phentermine with methyldopa or reserpine may antagonize the antihypertensive effects of these agents. Although leading drug interaction texts differ in the potential for an interaction between phentermine and this group of antihypertensive agents, these xanax side effects dilated pupils are likely to be clinically significant and have been described in hypertensive patients on these sand.

Use caution in combining phentermine with antidiabetic agents. Phentermine exhibits sympathomimetic activity. Sympathomimetics may increase blood sugar via stimulation of beta2-receptors which leads to increased glycogenolysis. Diabetic patients may have decreased requirements of insulins, sulfonylureas, or other antidiabetic agents in association with the use of phentermine and the concomitant dietary regimen and weight loss.

As long as blood glucose is carefully monitored to avoid hypoglycemia or "phentermine," it appears that phentermine can be used concurrently. Halogenated anesthetics may sensitize the myocardium to the effects of the sympathomimetics. Concurrent use of phentermine and phenothiazines may antagonize the anorectic "phentermine" of phentermine. In addition, psychostimulants can aggravate psychotic states. Although not studied, the concomitant use of ethanol and phentermine may result in an adverse reaction and should be avoided.

Atomoxetine sand mg cap phentermine 30 been reported to increase blood pressure and heart rate, probably via inhibition of norepinephrine reuptake. Consider monitoring heart rate and blood pressure at baseline and regularly throughout treatment if these agents must be used together. Bupropion is is 40 mg adderall xr too much with a dose-related risk of seizures.

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