Side effect of phentermine

Phentermine

Generic Name: phentermine (FEN ter meen)
Brand Names: Adipex-P, Lomaira, Suprenza

Medically reviewed by Drugs.com. Last updated on Sep 25, 2018.

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What is phentermine?

Phentermine is similar to an amphetamine. It stimulates the central nervous system (nerves and brain), which increases your heart rate and blood pressure and decreases your appetite.

Phentermine is used together with diet and exercise to treat obesity, especially in people with risk factors such as high blood pressure, high cholesterol, or diabetes.

Phentermine may also be used for purposes not listed in this medication guide.

Important Information

Do not use phentermine if you are pregnant or breast-feeding a baby.

You should not use phentermine if you have glaucoma, overactive thyroid, severe heart problems, uncontrolled high blood pressure, advanced coronary artery disease, extreme agitation, or a history of drug abuse.

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. A dangerous drug interaction could occur.

Before taking this medicine

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

  • a history of heart disease (coronary artery disease, heart rhythm problems, congestive heart failure, stroke);

  • severe or uncontrolled high blood pressure;

  • overactive thyroid;

  • glaucoma;

  • extreme agitation or nervousness;

  • a history of drug abuse; or

  • if you take other diet pills.

Do not use phentermine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Weight loss during pregnancy can harm an unborn baby, even if you are overweight. Do not use phentermine if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

You should not breast-feed while using this medicine.

To make sure this medicine is safe for you, tell your doctor if you have:

  • heart disease or coronary artery disease;

  • a heart valve disorder;

  • high blood pressure;

  • diabetes (your diabetes medication dose may need to be adjusted); or

  • kidney disease.

Phentermine is not approved for use by anyone younger than 16 years old.

How should I take phentermine?

Take phentermine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Doses are normally taken before breakfast, or 1 to 2 hours after breakfast. Follow your doctor’s dosing instructions very carefully.

Never use phentermine in larger amounts, or for longer than prescribed. Taking more of this medication will not make it more effective and can cause serious, life-threatening side effects.

This medicine is for short-term use only. The effects of appetite suppression may wear off after a few weeks.

Phentermine may be habit-forming. Misuse can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Call your doctor at once if you think this medicine is not working as well, or if you have not lost at least 4 pounds within 4 weeks.

Do not stop using this medicine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Phentermine dosing information

Usual Adult Dose for Obesity:

8 mg orally 3 times a day 30 minutes before meals, OR
15 to 37.5 mg orally once a day before breakfast or 1 to 2 hours after breakfast.
Use: 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 in patients with an initial body mass index (BMI) of 30 kg/m2 or greater, or BMI of 27 kg/m2 or greater in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).

Usual Pediatric Dose for Obesity:

Age 17 Years and Older:
8 mg orally 3 times a day 30 minutes before meals, OR
15 to 37.5 mg orally once a day before breakfast or 1 to 2 hours after breakfast.
Use: 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 in patients with an initial body mass index (BMI) of 30 kg/m2 or greater, or BMI of 27 kg/m2 or greater in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is late in the day. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of phentermine can be fatal.

Overdose symptoms may include confusion, panic, hallucinations, extreme restlessness, nausea, vomiting, diarrhea, stomach cramps, feeling tired or depressed, irregular heartbeats, weak pulse, seizure, or slow breathing (breathing may stop).

What should I avoid while taking phentermine?

Avoid driving or hazardous activity until you know how phentermine will affect you. Your reactions could be impaired.

Drinking alcohol with this medicine can cause side effects.

Phentermine side effects

Get emergency medical help if you have signs of an allergic reaction to phentermine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • feeling short of breath, even with mild exertion;

  • chest pain, feeling like you might pass out;

  • swelling in your ankles or feet;

  • pounding heartbeats or fluttering in your chest;

  • tremors, feeling restless, trouble sleeping;

  • unusual changes in mood or behavior; or

  • increased blood pressure – severe headache, blurred vision, pounding in your neck or ears, anxiety, nosebleed.

Common phentermine side effects may include:

  • itching;

  • dizziness, headache;

  • dry mouth, unpleasant taste;

  • diarrhea, constipation, stomach pain; or

  • increased or decreased interest in sex.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect phentermine?

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. Do not take phentermine with any other diet medications without your doctor’s advice.

Many drugs can interact with phentermine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use phentermine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 10.01.

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Related treatment guides

  • Weight Loss
  • Obesity

Phentermine (Adipex-P), an amphetamine derivative, is the most prescribed weight loss medication in the United States. Available as a low cost generic, phentermine has been approved for weight loss since 1973.

Here are the great questions I hear from my patients over and over:

  1. How does phentermine work? Phentermine increases release of neurotransmitters which simulate metabolism and suppress appetite. Phentermine is a “sympathomimetic” because it simulates the release and inhibition of certain neurotransmitters in your brain. Essentially it tricks your mind into feeling full!
  2. Release of which neurotransmitters? A large body of evidence has observed that phentermine works by causing the release of two neurotransmitters, dopamine and norepinephrine, in your brain to suppress hunger.
  3. Wait, wasn’t this the scary fen-phen drug? Kind of. Here is the story: fen-phen was a mixture of fenfluramine (the “fen”) and phentermine (the “phen”). The fen-phen combination was very popular in 1996, with 6.6 million prescriptions dispensed in the US. Soon after, reports of heart valve disease and primary pulmonary hypertension were reported, caused by fenfluramine (the “fen” part of the drug). In September 1997, the FDA recommended that fenfluramine be withdrawn and that patients should immediately stop taking it. So don’t worry, phentermine was not part of these warnings and has not been shown to contribute to heart valve disease or any lung problems.
  4. What is the difference between phentermine, cocaine, and amphetamines? A lot. While it is true that they are all considered sympathomimetics, the addictive effects of cocaine and methamphetamines do not exist with phentermine. This is because cocaine and methamphetamines are much more potent releasers of norepinephrine and dopamine, which cause users to experience the addictive effects.
  5. Who should not take phentermine? Phentermine is not a good idea in patients with coronary heart disease, uncontrolled high blood pressure, hyperthyroidism, or in patients with a history of drug abuse.
  6. Why is phentermine a “scheduled” drug like Xanax, Ativan or Ambien? Phentermine is a schedule IV drug, which suggests the potential for abuse, although the actual potential is low. If you are concerned, talk to your doctor about the potential for addictive effects.
  7. How much weight will I loose with phentermine? Phentermine 37.5mg daily for 12 weeks leads to an average weight loss of 15.8 pounds (7.2 kgs).
  8. Will phentermine give me side effects? Dry mouth is the one i hear most often from my patients, and it doesn’t seem to bother them. Phentermine can also cause increased head rate, blood pressure, insomnia, constipation and nervousness. So keep an eye on your blood pressure if you do decide to start on it.

What has your experience been?

Dr. O

  • The Battle of Weight Loss

    Losing weight is an issue that hits close to home for a lot of people. At times, it can seem very difficult, if not impossible, to shed those extra unwanted pounds. It also seems like our diets are sabotaged everywhere we go. So many social aspects revolve around food. Going out with friends? Stop at a restaurant. Visiting family? Cake and coffee. A day out with the kids? Ice cream cones. Even if you try extremely hard, when most of us get really hungry, it is hard to stay away from all the super sized food options that are out there. We get hungry, and throw caution to the wind. Then, we step on the scale and regret what we’ve done. Here we will explain how varying phentermine dosages work. Learn more about Phentermine 37.5 mg tablet.

    What Do We Do?

    So how do we remedy this problem? By eating less! Unfortunately, this is much easier said than done. We have all heard of portion control, and balanced meals. It’s not that we don’t know how to eat healthy. It’s that we lose all self control when hunger strikes. So maybe we need a little help. We can find that help in the form of Phentermine pills. What is the first step? Talking to our doctor about the right Phentermine dosage for weight loss.

    What is the Right Dose?

    Many people think that taking a higher dosage will mean faster weight loss. It doesn’t work as simply as that. The most popular Phentermine dosage for weight loss is 37.5 mg. However, a variety of doses are available.

    What Will Determine Your Phentermine Dosage?

    Phentermine must be prescribed by a doctor, so ultimately, only he or she will determine the correct Phentermine dosage for weight loss that’s right for you. It is based on the amount of weight you have to lose, your age, lifestyle, and whether or not you have any other medical conditions. It is common for patients to start out with the maximum dose of 37.5 mg. Tablets are prescribed more often than capsules, and the most popular brand is available in the maximum dosage only. Some doctors will provide the maximum dosage in the form of a tablet, and tell you to start out by cutting them in half, taking half in the morning and half at night. This helps to reduce side effects and helps your body better adjust to the reduced appetite and increased energy. It is also effective for those who have cravings later in the day.

    Does a Higher Phentermine Dosage for Weight Loss Mean Faster Results?

    Absolutely not! Do not take more Phentermine than prescribed, thinking that it will help you shed those pesky pounds faster! This could be dangerous and detrimental to your health. Talk to your doctor about how you are feeling and progressing while on the medication. Although a higher dosage has a higher concentration of Phentermine HCL, everyone metabolizes drugs differently. With a higher dosage, the side effects, such as insomnia, can be too much for some people to handle. By contrast, a smaller dosage may not help enough with appetite suppression, so getting the correct dosage can be a balancing act. This is why its very important to communicate with your doctor. A steady metabolism is crucial to fat burning and weight loss.

    Bottom Line: Work with your medical professional to decide which dosage of this weight loss aid is right for you. Together, you can establish your needs and find out exactly which dose will provide the correct level of support in order to help you along your weight loss journey!

    Ionamin

    WARNINGS

    IONAMIN Capsules are indicated only as short-term monotherapy for the management of exogenous obesity. The safety and efficacy of combination therapy with phentermine and any other drug products for weight loss, including selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, the coadministration of these drug products for weight loss is not recommended.

    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. The possibility of an association between PPH and the use of phentermine alone cannot be ruled out. The initial symptom of PPH is usually dyspnea. Other initial symptoms include: angina pectoris, syncope, or lower extremity edema. Patients should be advised to report immediately any deterioration in exercise tolerance. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope, or lower extremity edema.

    Valvular Heart Disease

    Serious regurgitant cardiac valvular disease, primarily affecting the mitral, aortic and/or tricuspid valves, has been reported in otherwise healthy persons who had taken a combination of phentermine with fenfluramine or dexfenfluramine for weight loss. The etiology of these valvulopathies has not been established and their course in individuals after the drugs are stopped is not known.

    If tolerance to the “anorectic” effect develops, the recommended dose should not be exceeded in an attempt to increase the effect: rather, the drug should be discontinued.

    IONAMIN 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.

    When using CNS active agents, consideration must always be given to the possibility of adverse interactions with alcohol.

    Drug Dependence

    IONAMIN is related chemically and pharmacologically to amphetamine (d- and dl-amphetamine) and other stimulant drugs that have been extensively abused. The possibility of abuse of IONAMIN should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. Abuse of amphetamine (d- and dl-amphetamine) and related drugs may be associated with intense psychological dependence and severe social dysfunction. There are reports of patients who have increased the dosage of some of these drugs to many times that recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxications is psychosis, often clinically indistinguishable from schizophrenia.

    Usage in Pregnancy

    Safe use in pregnancy has not been established. Use of IONAMIN by women who are or may become pregnant requires that the potential benefit be weighed against the possible hazard to mother and infant.

    Pediatric Use

    IONAMIN® Capsules (phentermine resin) are not recommended for use in pediatric patients under 16 years of age.

    Differences Between Yellow and Blue Phentermine

    People often wonder what the difference between yellow and blue Phentermine is. Why two colors? There are multiple types of phentermine on the market, and the majority of the tablets are either blue or yellow.

    The different colors signify which ones are branded and which ones are generic phentermine pills. The generics are the identical bioequivalent to the brand-name versions. However, different pills have different inactive ingredients, which makes them different in color.

    Yellow Phentermine

    The yellow phentermine is the generic phentermine. Yellow phentermine is manufactured and distributed by Sandoz pharmaceuticals Incorporated. The yellow phentermine strength is 30 milligrams.

    It has a special imprint code of E647, which is how you know that it is the generic phentermine. The yellow phentermine has been on the market for quite some time. It is a lower cost substitute for the original.

    Blue Phentermine

    The blue phentermine is manufactured and distributed by Sandoz pharmaceuticals Incorporated as well. The strength of the blue phentermine is 30 milligrams. The special imprint code on the blue phentermine is E 5000. The blue phentermine has been on the market for quite some time.

    Yellow and blue generic phentermine diet pills are both made by Sandoz pharmaceuticals Incorporated. Sandoz pharmaceuticals Incorporated is formerly known as eon labs. The yellow and blue Phentermine differ in price and color, but have many ingredients in common. The yellow and blue Phentermine have nearly identical effects on the body.

    The Difference Between Yellow and Blue Phentermine

    While many people wonder what differs, when it comes to the yellow and blue phentermine capsules, it’s not much. Basically the difference between the yellow and blue phentermine capsules is time release. The yellow and blue phentermine capsules have the same benefits on the body, and are safe for prolonged use. Neither the blue or yellow phentermine has the equivalent slow release to Ionamin, which is another Phentermine product, but both still have a good release speed. Both the blue and yellow have the same strength.

    Both the blue and yellow phentermine generics are deemed safe when used appropriately according to a doctor’s prescription.

    What Does Phentermine Do?

    Regardless of the color, format or brand, Phentermine is a prescription obesity treatment drug. It was developed to provide people who struggle to lose weight on their own with additional assistance in dropping the pounds. This medication is powerful and therefore meant only for people with obesity and whose additional weight threatens their health.

    Excess weight can place an individual at risk of conditions such as heart disease, diabetes and even some kinds of cancer. Therefore, it can be very important to reduce body weight in order to simultaneously decrease the risk of those chronic illnesses. However, this can be easier said than done. This medication is meant to help overcome those struggles.

    How to Lose Weight Using Phentermine

    Yellow and blue phentermine, as is the case with every other version of that drug, will not cause weight to be lost automatically. They do not have a direct impact on your body weight. It’s not what they were meant for. Instead, they were developed to make it easier for you to adopt the habits that must be maintained over time in order to achieve long term weight management.

    For instance, when yellow and blue phentermine are prescribed, the obesity patient also receives instructions for a reduced calorie diet and an improved activity level. The changes will be based on several factors including medical history, starting weight, fitness level and others. That said, many people struggle to keep up with this on their own, so they need the added support of the medication to make those changes easier.

    These pills help to boost energy levels, focus and alertness and may even work to suppress the appetite. This helps dieters to overcome fatigue, loss of motivation, and hunger. Since those are often the top struggles faced by dieters, easing them can make it simpler for a diet to be successful. Moreover, it helps to provide obesity patients with the ability to build healthy lifestyle habits they will maintain over time, even after they are no longer using their medications.

    This also helps to explain why many phentermine users are referred to dietitians and physical trainers. It helps to further fine tune diets and exercise strategies in a way that is appropriate to the individual. These details often expend beyond what general practitioners can offer as it is simply not their specialty.

    Ionamin

    Ionamin is a popular weight loss drug that helps obese people to get rid of excess body fat. Read and learn all about the composition and side effects of this diet pill along with its interactions with other drugs.

    What is Ionamin?

    It is a trademark name used for a therapeutic drug known as Phentermine. Ionamin suppresses the sensations of hunger and helps users to reduce their body weight significantly. The active ingredient (Phentermine) present in the drug pill, mixed with resin, creates a long lasting effect. Certain chemicals in the medication affect the central nervous system, thus curbing the appetite significantly.

    Ionamin Strengths

    The drug is available in the market in different strengths, which include:

    15mg

    Such capsules are generally grey or yellow in color and are available in bottles of both 100s and 400s.

    30 mg

    These capsules are available in yellow color and are issued in bottles of 100s and 400s respectively.

    Ionamin Components

    15 mg capsules of this drug consist of:

    • Dibasic calcium phosphate
    • FD&C Yellow No. 6
    • Gelatin
    • Iron oxides (15 mg capsules only)
    • 15 mg Phentermine
    • D&C yellow no. 10
    • Lactose
    • Magnesium stearate
    • Titanium dioxide

    30 mg capsules comprise of:

    • FD&C yellow no. 6
    • Gelatin
    • Iron oxides (15 mg capsules only)
    • Lactose
    • 30 mg Phentermine
    • D&c yellow no. 10
    • Dibasic calcium phosphate
    • Titanium dioxide
    • Magnesium stearate

    Ionamin Manufacturers

    The diet pill is manufactured by Celltech Pharmaceuticals, Inc., which is located in New York, USA.

    How Ionamin works?

    This diet pill curbs the appetite to a great extent by affecting the brain. The active compound in the Drug Phentermine has similar chemical reactions like that of amphetamine. The drug should be taken for a short duration, not more than few weeks.

    Ionamin Dosage

    The correct dosage for you is recommended by a doctor. Normally, patients can take one capsule per day either before breakfast or 1-2 hours after it. Doctors advise not to take the pill during bedtime, since the drug increases the energy levels and often causes insomnia. Patients with more drug receptiveness are generally recommended with 15mg, while Ionamin 30mg is recommended for those individuals who are less responsive towards any form of medication. Swallow the pill properly and do not chew break or crush it.

    Ionamin Missed Dose

    Ionamin should be taken as prescribed by the doctor for your specific body. If you missed a dose, take it when you remember it. Do not skip your regular dose for the missed ones. In any case, do not take the missed dose and regular dose together.

    Ionamin Overdose

    If an overdose of the drug is suspected, medical help should be sought immediately. Unless treated on time, it can give rise to a series of health problems and even result in death. The warning signs of an overdose of this medication may include:

    • Tremor
    • Increased breathing rate
    • Assaultiveness
    • Panic
    • Depression
    • Hypertension
    • Nausea
    • Abdominal cramps and sickness
    • High energy level
    • Hyperreflexia
    • Confusion
    • Hallucinations
    • Extreme tiredness
    • Arrhythmia
    • Circulatory collapse
    • Diarrhea

    Ionamin Side Effects

    The use of Ionamin may include certain side effects. If you experience signs of any allergic reactions, get medical help immediately. You should stop taking the drug and consult your doctor at once if you experience certain side effects which include:

    • Shortness of breath
    • Uneven chest pain
    • High blood pressure
    • Swelling
    • Restlessness
    • Rapid weight gain
    • Confused

    Ionamin Precautions

    While consuming the drug, a few precautions must be taken to get the optimum results. These involve:

    • Informing your health care provider whether you are allergic towards Phentermine or any medicine.
    • Updating your doctor if you have high blood pressure, hyperthyroidism, heart disease, arteriosclerosis or diabetes.
    • Not driving car or working on any machine (since the drug will make you drowsy).
    • Requirement of a bigger dose of Phentermine, if you are suffering from diabetes
    • Informing your doctor if you are taking any prescription or nonprescription medicine.
    • Informing your doctor if you have become pregnant while consuming Phentermine

    A few disorders may interact with this pill. You are advised to keep your doctor informed if have any medical condition, including:

    • If you are consuming any dietary supplement, prescription medicine or herbal preparation.
    • If you are suffering from artery hardening, spinal cord disorder, high cholesterol, high blood pressure, diabetes etc.
    • If you are conceiving or thinking of having a baby.
    • If you have allergy towards a food or any other substance.

    Ionamin Drug Interactions

    A number of drugs can interact with Ionamin. Inform your doctor immediately if you are taking any other medicine, namely:

    • Fenfluramine, MAOIs like phenelzine, or Dexfenfluramine which enhances the intensity of the side effects such as high blood pressure, increased temperature, increasing headache, slow heart rate and fatal lung problems.
    • Guanethidine or Guanadrel, since their efficacy may get reduced due to the diet pill. Consult your doctor before you change the dose of the medicine or stop taking it.
    • Serotonin specific reuptake inhibitors, since the risk of adverse effects may increase due to the use of lonamin.

    Ionamin Storage

    This diet pill should be kept in a tightly closed environment, away from the reach of the children. It should also be stored in a spot free from moisture or heat. Make sure you put away all Ionamins which are not required anymore.

    An experimental weight loss/blood pressure pill may pack a one-two punch against hunger and high blood pressure, one of the main health consequences of obesity, according to new research presented at the American Society of Hypertension’s 25th annual meeting in New York.

    Taken once a day, Qnexa combines the appetite suppressant phentermine with the anti-seizure drug topiramate in a unique formulation. Data on this drug are slated to be reviewed this summer by a Food and Drug Administration advisory panel. The FDA is not obligated to follow the advice of its expert panels, but it usually does.

    Phentermine quickly suppresses appetite while the controlled-release topiramate decreases appetite and increases satiety throughout the day.

    “When the hunger comes back, the topiramate kicks in,” says study author Dr. Suzanne Oparil, a professor of medicine, physiology and biophysics and director of the vascular biology and hypertension program at the University of Alabama at Birmingham.

    Topiramate also has blood pressure-lowering effects, she says. Oparil is a consultant for Qnexa manufacturer Vivus.

    The new analysis of three separate studies included more than 4,500 people. Researchers compared several doses of the new pill with placebo among severely obese adults as well as overweight, non-obese people who had other health problems related to their weight, such as high blood pressure or metabolic syndrome, a cluster of risk factors that increase risk for diabetes and heart disease.

    Overall, people who took the combination pill lost more weight than their counterparts who were given a placebo. The higher the dose, the more substantial the weight loss, and the more likely it was to be maintained over time, the study shows.

    At six months, people who took the full dose of Qnexa once daily lost nearly 10 percent of their body weight; by one year, it was up to 10.4 percent. Those who took the medium dose of the pill lost 8 percent of their body weight at six months and 8.2 percent by one year. The people who took the lowest dose of the drug dropped about 5.1 percent of body weight at six months, and, on average, gained some back by one year.

    The new drug also resulted in drops in systolic blood pressure – the upper number in a blood pressure reading – at one year.

    A sub-analysis of people with high blood pressure showed that the new pill also helped reduce blood pressure in this group and allowed them to reduce the number of other blood pressure medications they were taking.

    The new pill did have some side effects, including altered taste, constipation, dizziness, dry mouth and headache. But “there were no surprises,” Oparil says.

    “It was safe and efficacious across a broad patient population – some who were very obese and some who were less obese but had metabolic syndrome or high blood pressure,” she says.

    Not Another Fen-Phen

    Phentermine was once widely prescribed as the “phen” part of the fen-phen weight loss combo that shot to fame in the mid-1990s and then fell from grace after its use was linked to pulmonary hypertension – high blood pressure in the lungs – and heart valve disease. The problems were found to be related to the “fen” or fenfluramine part of the combination, not the phentermine.

    Dr. Louis Aronne, founder and director of the Comprehensive Weight Control Program at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, believes that combination drugs such as Qnexa hold promise in the battle of the bulge.

    “Instead of using single agents, we need to use combination drugs to break through the plateaus,” says Aronne, who was not involved in the trials but has been an adviser to Vivus and other companies developing weight loss drugs.

    “This is a breakthrough in that we have something that we know is effective and we can use it at lower doses,” which improves the safety profile, he says.

    Although both pills are independently FDA-pproved, the new combination pill can’t be used simply by combining the two drugs as the dosages in Qnexa are unique and lower than what is commercially available, he says.

    If approved, candidates for Qnexa may include people with a body-mass index (BMI) of 27 to 30 and other conditions related to being overweight, and people with a BMI of 30 or higher. A BMI takes height and weight into account to measure body fat. If your BMI is greater than 25, you are considered overweight. If it is over 30, you are considered obese.

    Some people are candidates for weight loss surgery, and others who are just slightly overweight may be able get by with proper diet and exercise, Aronne says.

    “The one-third of people who fall in the middle and have all the risks and complications of obesity, that is where I see this drug having an application,” he says.

    Dr. George Bakris, president of the American Society of Hypertension and a professor of medicine and the director of the Hypertension Center at the University of Chicago, is cautiously optimistic about the potential benefits of this new drug.

    “I would like to see a 24-hour blood pressure reading to see if blood pressure levels really are down,” he says. “If true, that would be huge.”

    Blood Pressure and Heart Rate Effects, Weight Loss and Maintenance During Long‐Term Phentermine Pharmacotherapy for Obesity

    Discussion

    The prevalence of high blood pressure and mean levels of SBP and DBP are known to increase as BMI increases ((14)). Multiple studies have shown that weight loss induced by caloric restriction and behavior change without antiobesity pharmacotherapy is associated with decreased blood pressure ((15)).

    In this study, we found that SBP and DBP declined significantly during weight loss in patients treated with phentermine, just as did blood pressures in the P0 patients. Patients with hypertension experienced the greatest declines while those with prehypertension had lesser declines and those with normal blood pressure had the least change. That weight loss induced by two‐drug combinations including phentermine produced greater declines in patients with hypertension than in those with normal blood pressure has been reported previously ((16),(17)), but these reports did not stratify patients by JNC 7 blood pressure categories so blood pressure declines in prehypertensive patients were not analyzed. In this study we found that a significant proportion of both PT and P0 patients experienced a categorical shift from prehypertension to normotension at 12, 26, and 52 weeks. This categorical shift typically occurred in the first 12 weeks of therapy. Although the numbers of P0 patients was too low for statistical comparisons beyond 52 weeks, the categorical shift persisted in smaller numbers of PT patients at 104 and 156 weeks.

    The data from this study suggests that the occurrence of hypertension associated with phentermine pharmacotherapy is rare rather than common. One patient, initially prehypertensive, of the 269 PT patients developed hypertension after 1 year on phentermine. Excluding the patients initially hypertensive, data for 119 patients remained in the study at 52 weeks for an incidence rate of 0.84%/year. If only the prehypertensive patients are considered at 1 year (N = 95), then the 1‐year incidence would be 1.05%. In considering these incidence rates comparison should be made to other data on the incidence of new hypertension. Because elevations of blood pressure in the hypertensive range (≥140/90) and in the prehypertensive range (120/80–139/89) are very common in obese subjects, one could expect an annual incidence rate of newly diagnosed hypertension in untreated normotensive and prehypertensive obese subjects followed for a year to be higher than 1%. The ATTICA study ((18)) found an annual incidence of new hypertension in the general Greek population to be 2.86 cases per 100 in men and 2.68 cases per 100 in women. The Strong Heart Study ((19)) found that the 4‐year incidence of hypertension in a group of patients with prehypertension to be 38% and a 5‐year study in Taiwan ((20)) found a conversion rate from prehypertension to hypertension to be 31.2%. These incidence rates, in populations not selected for obesity, are substantially higher than the rate of conversion of prehypertension to hypertension calculated for this study. These data suggest that weight loss assisted by phentermine pharmacotherapy retarded progression of prehypertension to hypertension. Data from the fixed‐dose combination of phentermine‐topiramate (Qnexa) clinical trials also suggested progression to hypertension was retarded ((17)).

    Long‐term nonpharmacological intervention trials have been unsuccessful in maintaining weight loss and lower blood pressure for longer than 3–4 years ((21)). The number of patients retained beyond 4 years in this study is small, but the data suggests the possibility that long‐term phentermine therapy could be effective in maintaining a lower weight and in lowering blood pressure for >4 years in some patients.

    Given the data from this study and the previous studies cited suggesting that blood pressure declines rather than increases with phentermine therapy, why does the assumption that phentermine adversely affect blood pressure persist? The conception that phentermine can elevate blood pressure and HR apparently derives from the often‐repeated fact that phentermine is an amphetamine congener. That amphetamine can increase blood pressure and HR and induce or worsen hypertension is well documented ((22)). These adverse cardiovascular effects are dose‐related and dependent upon the route of administration of the drug; inhalation or drug administration via intranasal or intravenous routes rapidly produces higher blood levels and therefore greater toxic effect than dose oral administration. Certain amphetamine congeners such as methamphetamine ((23)) and 3,4‐methylenedioxymethamphetamine ((24)), which are typically abused by intranasal, inhalation, or intravenous routes, have even greater toxic potential and are also known to produce adverse cardiovascular effects. Subjects who use the amphetamines of abuse often self‐administer large doses producing very high blood levels in trying to achieve the desired stimulant effect. On the other hand, the route of administration and dose of amphetamines used for pharmacotherapy of attention deficit and attention deficit hyperactivity disorder have a much lower toxicity potential. Therapeutic use of these drugs is associated with slight increases in blood pressure and in HR of questionable clinical impact ((25)). In phentermine pharmacotherapy low (compared to the doses used of the amphetamines of abuse) oral doses are used, and phentermine blood levels achieved are comparatively lower than blood levels achieved by subjects of the abused drugs. In addition phentermine has a substantially lower toxic potential. Thus the potential for adverse effects with phentermine pharmacotherapy is significantly lower than for the abused amphetamines.

    Aside from a few anecdotal reports, there is no data in the peer‐reviewed medical literature to support the perception that phentermine increases blood pressure or HR. Phentermine clinical trial reports, when details of blood pressure and HR have been given, have shown that trial subjects experienced decreases in SBP and DBP and minimal or no changes in HR ((8),(9),(26)). The same is true of most trials with combinations with phentermine as one of two antiobesity drugs. ((16),(17),(27),(28)). The one exception to the latter statement is a recent clinical trial in which patients given a combination of pramlintide plus phentermine showed no significant change in clinic visit SBP and DBP but an increase in HR of 5 beats/min (P < 0.01) ((29)). Ambulatory blood pressure monitoring in the latter study revealed about a 3 mm increase in DBP in the pramlintide plus phentermine subjects (P < 0.01) and an increase in HR of about 5 beats/min (P < 0.001). Because SBP and HR decreased slightly in the pramlintide only group, the implication is that the phentermine produced the observed increases, however no subjects treated with phentermine alone were included in the study and patients with hypertension were excluded. We did not measure ambulatory blood pressures in this study.

    Our data suggests that phentermine pharmacotherapy does not significantly influence HR at any time during treatment.

    In adjustment of phentermine dose using a dose‐to‐effect method, previously described by Rothman ((30)), the desired effects are on eating behaviors rather than weight loss ((31)). Dose‐to‐effect titration is a common practice in medicine that is employed with a wide variety of drugs. The most cogent comparison here would be with the methods used in adjusting amphetamine dose for attention deficit disorder and attention deficit hyperactivity disorder. Two approaches have been described in treating ADD and ADHD: (i) prescribe an initial low dose, evaluate behaviors, then gradually increase dose until behavior improves, or (ii) ramp up dose until undesirable side effects appear, then reduce dose to the level before they appeared ((32)). The first approach was typically employed in adjusting phentermine doses in this study. Phentermine dose‐to‐effect was evaluated at each patient encounter and if undesirable side effects appeared the dose was most often reduced. Mean and median phentermine dosage trended upward for patients in long‐term treatment as shown in Table 3. Patients with adult attention deficit disorder, which is common among the obese ((33)), often derive behavioral benefit from phentermine ((34)) and may tolerate higher doses. A few of the patients on higher doses in this study were thought to have previously undiagnosed adult ADD, but the majority were simply more comfortable with their eating behavior at a higher dose. Phentermine doses higher than the US Food and Drug Administration recommended maximum of 37.5 mg daily have been previously described ((2),(7),(30),(35)), but there have been no clinical trials that have examined this issue.

    Phentermine is presumed to have addiction potential and is classified as a category IV controlled substance. An important criterion is making a diagnosis of addiction is that drug‐addicted subjects typically manifest dysfunction in one or several spheres such as social, work, or legal arenas. Practitioners and staff of the clinic observed the patients in this study carefully for signs of such dysfunction, and no such behaviors were observed.

    This study has several strengths. The study clinic is well established with many long‐term patients. The physician in charge has had long experience with phentermine. As is always with retrospective observational studies, a limitation could have been bias in subject selection, which is possible even though criteria were set in place to avoid bias. The methods for blood pressure and especially for HR determination are another limitation. The small sample size in some of the cohorts is yet another limitation.

    We conclude the data from this retrospective study suggests that the addition of phentermine pharmacotherapy for patients in a comprehensive weight management program does not adversely affect HR or blood pressure. Indeed, this study suggests that in this setting phentermine pharmacotherapy, can be especially beneficial for the obese hypertensive and prehypertensive patients since persistent weight loss assisted with such therapy may lower blood pressure long‐term and retard the progression of prehypertension to hypertension delaying the natural course of hypertension in the obese and potentially reducing the risk of mortality due to congestive heart failure, stroke and ischemic heart disease. Some of these patients maintained a weight loss of 10% or greater for as long as 8 years suggesting long‐term phentermine pharmacotherapy may be a useful treatment for long‐term weight maintenance.

    The P0 patients who adhered to diet alone without phentermine treatment garnered similar benefits to PT patients over the first year of treatment, but the benefits for the P0 patients began to vanish as they regained weight whereas PT patients’ benefits persisted. PT patients also had slightly better initial weight loss. Finally, there is a suggestion that phentermine doses >37.5 mg/day are safe and can be useful in selected patients.

    The potential benefit to the obese population is huge if the findings of this study can be confirmed and phentermine pharmacotherapy ultimately is used more widely. We suggest there is a need for more investigations into both the clinical effects of phentermine and its molecular basis of action. Development of psychometric scales to assess phentermine effect on eating behavior for guidance of dose‐to‐effect titration could prove clinically useful. We suggest a long‐term, dose‐ranging phentermine clinical trial and outcome study could potentially confirm the cardiovascular benefits implied by this study.

    I Was Addicted to the Weight-Loss Drug Phentermine for 15 Years: ‘I’d Spiraled to a Dark Place’

    Every time I walked into a medical weight-loss clinic, the experience was the same: dog-eared tabloids, subtle reminders of what an ideal body should look like, were scattered next to dated table lamps with pleated shades. Dingy mini blinds (were they beige or white and just really dusty?) remained closed, allowing me to hide in plain sight, praying that no one would see me for what I really was—an alcoholic addicted to prescription diet pills.

    I did not grow up around alcohol or drugs. My upbringing was a conservative one, in a stable, loving environment in South Louisiana. It wasn’t until I went through a painful breakup during my freshman year of college that I began searching for something to numb the constant buzz of fear and anxiety coursing through my body. I found that something in food, sex, drugs, and finally, at the bottom of a bottle.

    Struggling silently through PTSD looked a lot like a quarter-life crisis to everyone on the outside, and my already low self-esteem was in the crapper. My weight ballooned; I dropped out of college one semester shy of graduation. Alcohol made me forget all of my troubles, but I didn’t want to continue packing on weight. So when a friend recommended diet pills, I immediately took interest.

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    How easy would it be, I thought, to just take a pill and not be hungry? For an emotional eater like me, it seemed like the perfect solution. I looked up the nearest medical weight-loss clinic and took the first appointment. The year was 2001, and I picked the clinic with the nicest ad in the phone book. Little did I know, I would eventually visit them all.

    When I stepped on the scale at the clinic, it read 170. I was informed that my BMI was firmly in the overweight category for my height. I am 5’6, so a normal weight for someone my height can be anywhere between 118-148 pounds. The doctor talked to me briefly about healthy habits, and prescribed phentermine, a commonly prescribed amphetamine-like medication used to suppress appetite.

    Phentermine is one of four FDA-approved weight-loss drugs intended for short-term use only. (Five other medicines are approved for long-term use.) Potential side effects include an increase in heart rate and blood pressure, insomnia, constipation, and nervousness. On more than one occasion, I woke up with my heart beating out of my chest—scary as fuck, but not scary enough to make me stop.

    The paperwork accompanying the drug explained that it isn’t intended to be taken for more than three months at a time; it’s meant to shore up or support a medically overweight person’s diet and exercise plan. Once my weight dipped below a number considered overweight, then they would no longer be able to prescribe the medication. I was excited to lose 22 pounds and drop into the normal range for my height.

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    I had no idea what was about to happen to me.

    There is something about phentermine that made me feel invincible. Not everyone has that reaction, just like not everyone has the same reaction to alcohol or opioids. But for me, from the very first time I took it, I was hooked. The way my extremities tingled, my face and gums felt numb, and the weight fell off because I wasn’t eating or sleeping—I don’t talk about it much, because the very thought of one of those blue and white pills makes my mouth water. Thirty days later, I went back for more.

    The medication can also be obtained from a primary-care physician or an ob-gyn, according to my girlfriends who were fans of the drug. I personally never had the guts to ask a doctor who knew me to prescribe phentermine; the potential for questions was too high, and why risk it when I knew I could waltz in and out of a weight-loss clinic and skip the interrogation?

    In 2015, the New York Times reported on the remarkable staying power of the weight-loss drug, which came on the market in 1959. One reason: Phentermine is prescribed widely at for-profit diet clinics nationwide.

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    I continued using phentermine on and off for the next 15 years.

    “It’s sort of like a cheap speed,” C. Richard Allen, then director of the Georgia Drugs and Narcotics Agency, which oversees the use of controlled substances like phentermine, told the Times.

    Those pills are what I used to snap myself out of a hangover every morning in order to parent my three small children. The sick part of my brain told me that phentermine made me more desirable to my husband, more fun and interesting at parties, and a better employee. On the outside, I was winning at life. Amphetamines helped camouflage my alcoholism for many, many years. They’re what I used to fuel my creativity, and by extension, my livelihood as a freelance writer. Even though I’ve been sober for over two years, I miss that high; especially during the summer months, when the sensation of my thighs sticking together fuels my already rampant self-loathing.

    There will always be a small part of me that wants to try just one more time. That is the devastating power of addiction.

    Over a stretch of years in a variety of cities across the South, I sat staring at mauve or tan waiting-room carpets, wishing I was a naturally thin person who didn’t have to resort to such nonsense to get just one more bottle, one more month of feeling on top of the world. Of course, now that I’m sober, I know that even if I were naturally thin, I would still be an addict.

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    No one in the waiting room made eye contact. Our shame was palpable. The overweight patients, it seemed to me, were embarrassed to have let themselves go this far—far enough to be in a clinic dedicated to helping overweight people become less so. The thin women seemed ashamed, too, because they either suffered from body dysmorphia, or because they were addicts. Either way, no one wanted to be there.

    Over the course of my prescription pill-popping career, I’ve fallen into both the fat and thin camps. There was a time when I was in my 20s, just before my husband and I got married, that my weight almost dropped below the line of allowing the doctor to write me the prescription. Fear of living without phentermine ensured from that point on that I made certain to eat a big meal and wear my heaviest shoes before going back for a refill.

    The problem was, as it always is with addiction of any kind, that after years and years of taking a drug expressly made for short-term use only, it stopped working. I began pairing a pill with a Red Bull, or adding in other types of uppers, in an attempt to reach the same effect. I had to take it in order to function, to feel normal.

    Sometimes I’d take a few months off. “I’ll give my body a break,” I told myself, because that makes an addict feel like she isn’t truly an addict. Real addicts don’t give themselves breaks, right? They can’t because they’re too busy administering a blow job to a random stranger in a windowless van for drug money. True addicts don’t have families or properly sized undergarments, if they have undergarments at all.

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    I still had all my teeth. I still had properly sized undergarments. I wasn’t giving strangers sexual favors. I was fine.

    “Your blood pressure is perfect!” The nurse ripped back the Velcro to pull the blood-pressure cuff from my arm. “The doctor will be in shortly.”

    The doctor was usually someone who looked like he or she had seen much better days; I don’t know what the rules are, but all of them carried a deep sort of sadness. On the day I sat across from him or her, I was grateful. I smiled, I tried to look like the type of person who was attempting to be healthy but kept falling short. Genetics, I’d say, or motherhood, was preventing me from reaching my true potential. The scales didn’t lie: I was overweight, most of the time. I kept myself within a certain range on purpose because I’d rather be a little fat on speed than thin without access to it.

    Every summer since I have been in recovery, an internal battle rages on.

    No one would know.

    I could go get them anytime.

    It’s legal.

    I’m 20 pounds overweight—it would be so easy.

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    And it would. Just as easy as picking up a bottle of vodka or whiskey at the grocery store and stowing it away somewhere in my house. Just as easy as taking a drink when no one is looking, except that I’d have to sneak money out of the bank account I share with my husband, figure out a place to put my children, make an appointment, get the pills, and then hide them.

    I would have to lie over and over and over again.

    By the end, when I was perpetually bloated from drinking too much the night before and gaining weight rather than losing, no matter how many pills I was taking, I started worrying about my health. The doctors—all of them—began looking at me curiously because my weight never went down; it always stayed the same. I’d go in, get 30 pills, and leave. When I ran out, I went to a different clinic, perhaps on the other side of town. I rotated my appointments so that I rarely saw the same doctor two months in a row.

    “What are you doing here?” a medical assistant asked me once, after taking my blood pressure. “You don’t belong here.” I suspect he may have meant that I didn’t look like I belonged on that side of town, which was questionable, or maybe he was making a general comment that I didn’t appear overweight. Either way, he was right on all accounts. I didn’t feel like I belonged anywhere, including my own skin.

    My last visit to a medical weight loss clinic was in December 2016. When I finally made the decision to get sober in 2017, it was out of desperation. I’d spiraled to a dark place of profound unhappiness and depression, and no matter what I poured down my throat to combat those feelings, I was never okay. That is the essence of addiction.

    As a 39-year-old recovering addict and alcoholic, I can now say that I’m more comfortable with myself than I’ve ever been before, due to the intense, life-altering work that sustained sobriety requires. I can’t place blame on anyone but myself for my struggles, and I’m still looking for balance in every part of my life. I am still not happy with my weight, but I know the answer to that can’t be found inside of a medical weight-loss clinic.

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    When you take phentermine weight loss pills you may experience side effects. Phentermine diet pills can lead to an increase in blood pressure, alter your heart rate, disrupt your sleeping pattern and cause nausea and dry mouth. If you drink alcohol while taking phentermine you increase your risk of these side effects, as well as their severity.

    To drink alcohol while on phentermine can seriously endanger your life. Drinking alcohol while taking phentermine can lead to dangerous psychic effects such as dizziness, confusion, nervousness, aggression and sleeplessness.

    Alcohol makes the already dangerous side effects of phentermine, like those mentioned above, more likely and more severe. Taking phentermine and alcohol together also increases the risk of becoming addiction. Taking phentermine weight loss pills while also drinking alcohol will make you more likely to abuse phentermine.

    Alcohol acts as an irritant on your gastric mucosa and forces acid to be released. This increases your chances of suffering from gastrointestinal side effects such as nausea, heartburn, vomiting, stomach ache and xerostomia. Drinking even a little bit of alcohol while on phentermine can lead to a higher risk of suffering from one of these gastrointestinal side effects.

    Phentermine manufacturers also warn that drinking alcohol while taking phentermine diet pills can increase the risk of cardiovascular side effects. These including elevated heart rate, higher blood pressure and chest pains. Even a small amount of alcohol increases the risk of suffering from a heart attack or stroke for obese people with heart disease taking phentermine tablets for weight loss.

    Drinking a small amount of alcohol while taking phentermine may lead to an elevated mood, increased vitality, appetite loss and increased physical activity. However the euphoria is quickly replaced by irritability, anxiety and depression. This can cause you to refuse to take your phentermine weight loss pills. If you do this you increase your risk of becoming dependent.

    Suddenly refusing to take your pills can lead to symptoms such as a change in personality, irritability, nervousness, depression, nausea, vomiting, an allergic reaction, tremors and even hallucinations. These are common side effects for people who mix phentermine with alcohol.

    If people stop taking phentermine when they aren’t drinking alcohol they will only feel a decrease in the effectiveness of other obesity pharmacotherapy they undergo. As a result it’s recommended that you only stop taking phentermine before your therapy is done after consulting with your doctor and getting their approval.

    If you are planning on buying phentermine then remember that this is a drug that is not recommended for people who are prone to alcohol dependency.

    Can you drink alcohol on Phentermine?

    Play it safe for now and always: DON”T drink alcohol. Remember the old saying: “The alcoholic started with only one drink” From “WebMd: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to any other sympathomimetic amines (e.g., decongestants such as pseudoephedrine, stimulants such as amphetamine, appetite suppressants such as diethylpropion); or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: uncontrolled high blood pressure, glaucoma, history of alcohol/drug abuse, vascular heart disease (e.g., chest pain, heart attack), mental/mood problems (e.g., severe anxiety, bipolar disorder, psychosis, schizophrenia), high blood pressure in the lungs (pulmonary hypertension), stroke, overactive thyroid (hyperthyroidism). Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, controlled high blood pressure, other heart problems (e.g., heart murmur, fast/irregular heartbeat, heart valve problems), kidney disease, seizure problem. ************ This drug may make you dizzy or (rarely) drowsy or cause blurred vision. Use caution engaging in activities requiring alertness and clear vision such as driving or using machinery. Avoid alcoholic beverages. ********************** READ THE ABOVE VERY CAREFULLY Before having surgery, tell your doctor or dentist that you are using this medication. Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for dizziness and high blood pressure while using this drug. During pregnancy, this medication should be used only when clearly needed. It is not recommended for use for long periods or in high doses near the expected delivery date because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for a long time or in high doses may have withdrawal symptoms such as irritability or extreme tiredness. Tell your doctor immediately if you notice any of these symptoms in your newborn. This drug may pass into breast milk and could have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding. You didn’t mention if you are male or female but it seems it has something to do about over weight Look up the drug on webmd.

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