SCPA Posted April 17, 2016 Share Posted April 17, 2016 The prescribing info is kind of soft, "Short-term (few weeks) adjunctive use as part of weight-reduction regimen" I remember reading somewhere that 3 months is recommended max. Also seems like I've seen others prescribe 3 months on , one month off type schemes for extended use.. Thoughts? Link to comment Share on other sites More sharing options...
UpRegulated Posted April 17, 2016 Share Posted April 17, 2016 The prescribing info is kind of soft, "Short-term (few weeks) adjunctive use as part of weight-reduction regimen" I remember reading somewhere that 3 months is recommended max. Also seems like I've seen others prescribe 3 months on , one month off type schemes for extended use.. Thoughts? My thoughts are 0 days max use. I'm kinda' serious. Aside of the potential CV problems, it just doesn't work. It does cause weight loss in many in the short-term, but you can't stay on it forever, and when you stop, all of the weight is gained back and then some (in most patients). The patients that want it are wanting a "quick fix" and those are the ones 90+ percent of the time put all the weight back on and more. Obesity is much more complex than simple appetite suppression in the short term. Not only is there a huge psychological component, but there is homeostasis - physiology 101. The body ferociously fights any change your try to make and it usually wins. You aren't doing them any favors by prescribing it. There are better alternatives. Contrave is my first choice in most cases. Belviq and Qsymia are also reasonable choices in some circumstances. Adipex is last line to me in most all cases. If I have to use it for some odd reason, I wouldn't do it more than 4-8 weeks. Link to comment Share on other sites More sharing options...
sas5814 Posted April 17, 2016 Share Posted April 17, 2016 I doubt there is a canned correct answer but if there is I'd like to see it too. I have a long talk with patients who want phentermine before I even consider it. The usual lecture about it is just a tool for someone who is motivated and has a plan for long term lifestyle modification and not a magic bullet.... no such magic exists. Physical and labs, monthly weigh in. No weight loss any month and we are done. 2 months on, one month off, 2 cycles max. I agree with he post above about there being better meds and Contrave is my current favorite but has poor insurance coverage and is expensive....coupons from the company can be a big help. Link to comment Share on other sites More sharing options...
UpRegulated Posted April 17, 2016 Share Posted April 17, 2016 Contrave is my current favorite but has poor insurance coverage and is expensive....coupons from the company can be a big help. Insurance is a problem for a lot of people with Contrave (and the others). In my area, insurances are increasingly helping with it, though. Most patients I see can now get it for around $50/mo. Max out of pocket for privately insured is $70. That's still too much for some, but those that tell me that are often the ones that spend that much each month on sodas and fast food. If they give that up, they can afford it. If they won't give it up, there's no drug that will help them anyway. Link to comment Share on other sites More sharing options...
BruceBanner Posted April 17, 2016 Share Posted April 17, 2016 Agree with the above. I refuse to prescribe it. Part of it is I have an ethical issue with "weight loss" drugs, especially ones that are controlled. The other part is THEY DON'T WORK. People take phentermine (or similar) for a couple of months, they lose a few pounds, then plateau. Then you see them a year later, they are STILL getting refills and just as fat as they were when they started. Now they are just fat people hooked on a mild stimulant. I like to tell fat patients (professionally) that no one gets fat by accident. The aggregate, nickel-and-dime behaviors that make someone fat will also make someone thin if done in reverse. Yes I know, your metabolism. Yes I know, your thyroid. Excuses. There are thousands of people out there who lose weight because they are MOTIVATED and DISCIPLINED. I cant feel sorry for them. Sorry OP, I know that didn't answer your question. I just hate phentermine. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted April 18, 2016 Share Posted April 18, 2016 My doc is way more liberal with Phentermine than I am. He at least has the patients wean off by breaking the 37.5 tablet in half as they come off of it. I see way too many people come in for repeat courses of it. I have a professional limit of 6 months use in a lifetime. I cite the law of diminishing returns. The results you get the first month are the best and everything after that is gravy (bad food humor intended). Four week weight, BP, pulse checks and, if weight loss, is the only reason they come to the office, then their insurance won't cover the visit 99% of the time - so says my biller. So, they have to be all in on the program or I don't Rx. If there is zero weight loss in a 4 week period or actual weight gain - we are done. If resting pulse is over 90 and BP goes up - we are done. I get folks who ask for it 3 months before a beach vacation - huge eye roll and deep heaving sigh..... 6 months is all they get - in total - adding up all starts/stops/attempts. The old Weight Watchers Exchange Plan was the best and most successful. I hate the Points system - a Big Mac is 11 points - what a waste. That's my take......................... Link to comment Share on other sites More sharing options...
mandrew1 Posted April 30, 2016 Share Posted April 30, 2016 I have been working in bariatric medicine for over 12 years, including owning my own medical weight loss clinic for eight years. I also passed the board certification examination in bariatric medicine from the ASBP. Phentermine can be used long-term without any adverse consequences; as long as the patient is losing weight. I would recommend a month holiday at 6 month intervals, and also be sure that the patient does not have an arrhythmia, MI in the past 3 months, or CVA in the past year. Also, I wouldn't recommend prescribing with ADD meds or other stimulants. Contrary to popular belief, phentermine is not addicting, and does not increase blood pressure or heart rate if the patient actually loses weight. I use phentermine very liberally in conjunction with a Very Low Calorie Diet (VLCD) protocol. It is the # 1 drug used by bariatricians across the US. Be sure to do EKGs at 6 month intervals or with 50 pounds weight loss. Hope that helps Link to comment Share on other sites More sharing options...
UpRegulated Posted May 1, 2016 Share Posted May 1, 2016 I have been working in bariatric medicine for over 12 years, including owning my own medical weight loss clinic for eight years. I also passed the board certification examination in bariatric medicine from the ASBP. Phentermine can be used long-term without any adverse consequences; as long as the patient is losing weight. I would recommend a month holiday at 6 month intervals, and also be sure that the patient does not have an arrhythmia, MI in the past 3 months, or CVA in the past year. Also, I wouldn't recommend prescribing with ADD meds or other stimulants. Contrary to popular belief, phentermine is not addicting, and does not increase blood pressure or heart rate if the patient actually loses weight. I use phentermine very liberally in conjunction with a Very Low Calorie Diet (VLCD) protocol. It is the # 1 drug used by bariatricians across the US. Be sure to do EKGs at 6 month intervals or with 50 pounds weight loss. Hope that helps Why do you need to do an EKG at 6 months (or with 50 lbs weight loss) if it does not have cardiovascular effects? Link to comment Share on other sites More sharing options...
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