[slaw007]

I asked a question last night regarding what research you all have done and what makes you feel safe taking this medicine. I am new to it and have had conflicting information from 2 different Doctors on risks vs. benefits. I'm interested to know your take on this information.


~Sarah

Here's the link followed by the article:

Phentermine - Wikipedia, the free encyclopedia

Phentermine

Phentermine is a drug primarily used as an appetite suppressant. Chemically, it is an amphetamine (and a phenethylamine). It is typically prescribed for individuals who are at increased medical risk because of their weight, as opposed to cosmetic weight loss. Phentermine is sold either as an immediate-release formulation (Adipex®) or as a slow-release resin (Ionamin®, Duromine® in Australia and New Zealand).

History
In 1959 phentermine first received approval from the FDA as an appetite suppressing drug. Phentermine hydrochloride then became available in the early 1970s. It was previously sold as Fastin® from King Pharmaceuticals for SmithKline Beecham, however in 1998 it was removed from the market. Medeva Pharmaceuticals sells the name brand of phentermine called Ionamin® and Gate Pharmaceuticals sells it as Adipex-P®. Phentermine is also currently sold as a generic. Since the drug was approved in 1959 there have been almost no clinical studies performed. The most recent study was in 1990 which combined phentermine with fenfluramine or dexfenfluramine and became known as Fen-Phen.

Although Fen-Phen was never approved by the FDA the agency did approve of the drug. A study was published in 1992 that Fen-Phen was more effective than diet and exercise with few side effects. However, in 1997 after 24 cases of heart valve disease in Fen-Phen users, fenfluramine and dexfenfluramine were voluntarily taken off the market at the request of the FDA. Studies later proved that nearly 30% of people taking fenfluramine or dexfenfluramine had abnormal valve findings. The FDA did not ask manufacturers to remove phentermine from the market.

Phentermine is still available by itself in most countries, including the U.S. However, because it is an amphetamine, individuals may develop an addiction to it. Hence, it is classified as a controlled substance in many countries. Internationally, phentermine is a schedule IV drug under the Convention on Psychotropic Substances.[1] In the United States, it is classified as a Schedule IV controlled substance under the Controlled Substances Act.


Mechanism of action
Phentermine, like many other prescription drugs, works with neurotransmitters in the brain. It is a centrally-acting stimulant and is a constitutional isomer (not to be confused with stereoisomer) of methamphetamine. It stimulates neuron bundles to release a particular group of neurotransmitters known as catecholamines; these include dopamine, epinephrine (also known as adrenalin), and norepinephrine (noradrenaline). The anorectic activity seen with these compounds would thus seem likely due to this effect on the central nervous system, which is consistent with current knowledge about central nervous system systems and feeding behavior. This is the same mechanism of action as other stimulant appetite suppressants such as diethylpropion and phendimetrazine. The neurotransmitters signal a fight-or-flight response in the body which, in turn, puts a halt to the hunger signal. As a result, it causes a loss in appetite because the brain does not receive the hunger message.


Clinical use
Generally, it is recommended by the Food and Drug Administration (FDA) that phentermine should be used short-term (usually interpreted as 'up to 12 weeks'), while following nonpharmacological approaches to weight loss such as healthy dieting and exercise. However, recommendations limiting its use for short-term treatment may be controversial. One reason given behind limiting its use to 12 weeks is drug tolerance, whereby phentermine loses its appetite-suppressing effects after the body adjusts to the drug. On the contrary, it has been shown that phentermine did not lose effectiveness in a 36-week trial.[2] Due to the risk of insomnia, it is generally recommended that the drug be taken either before breakfast or 1-2 hours after breakfast.


Side effects
Generally, phentermine appears to be relatively well tolerated.[3] It can produce side effects consistent with its catecholamine-releasing properties, e.g., tachycardia, increased heart rate, increased alertness, but the incidence and magnitude of these appear to be less than with the amphetamines. Because phentermine acts through sympathomimetic pathways, the drug may increase blood pressure and heart rate. It may also cause palpitations, restlessness, and insomnia. Additionally, individuals taking this drug on a long-term basis may develop euphoria and a psychological addiction to it.

[nylon]

All I can tell you Sarah from my experience is that I have used it twice in the past (first time was medically supervised and the second time was not). Both times I had great success and the span between both times was about ten years. So it's not like I gained it back quickly. This third time around well is baby and winter weight for me. It seems to be the only thing that works for me. I work out regularly (with a trainer) eat healthy for the most part and I still cannot lose the weight. It's like my metabolism has completely stopped. I lose inches yes but the damn number on that scale does not go down and when I don't see that number go down it is very defeating especially after all the time, sweat, and effort I religiously put into my health on a consistent basis.

My husband is amazed i'm not a stick figure with what I eat. I'm thinking perhaps I don't eat enough???? So to get back to your original question about the research. Like you and many on this board we have ALL done the research and know the consquences. You just have to weigh (no pun intended ) the pros vs. cons for your individual situation. For me and my body type this works the best besides going under the knife. **I hope** Three times a charm

[rebeleagle1965]

First off-you have to understand the reasons why some doctors are simply unwilling to delve into this field. Many are of the opinion that if something is unnecessary, then it should not be prescribed. Every doctor tries to make safe choices involving risk vs benefit, and in most cases that's in everyone's interest.
Too many people are of the mindset that if we would all just get off our butts and stop gourging ourselves that there would be no fat people And in that respect, we should be able to change bad behaviors, and problem solved. There's no NEED for weight loss meds, so any risk involved is too much.
But that's just not how it happens for alot of people, and once the weight is on, it's a nightmare to take it off. Like for me, maintenance is not a problem, but LOSING weight is next to impossible.
Which is why I decided, many years ago-but for the same reason as today (pregnancy pounds I couldn't budge)-to see a doctor at a weight loss clinic in New Orleans, where I lived at the time. He went over with me different possibilities for meds, the possible benefits and side effects, and of course nutritional counseling. I had great results, so it was worth it to me. THe way I saw it is that being overweight carried with it just as many, if not more, health risks than any of the meds he could have put me one. It was picking the lesser of two evils. This is not for everyone, because some people DO have side effects that are strong enough to make them discontinue use.
If you DO do the research, you will find out about all of those things, but you will also find that no one has attributed any fatal or even long term negative effects from taking phentermine. And in the history of prescription drugs, and the little "surprises" that come along decades down the road, that actually speaks volumes for it's safety in my book.

It's not a miracle drug. Lots of people regain the weight after they stop taking it. You have to start any weight loss program with the ability and determination to KEEP it off once it's gone. If once the meds are stopped, or a diet is stopped, we go back to the habits that made us overweight, then of course that's going to happen.
If you still have any conflicting feelings or coubt about it, then I would suggest speaking to both doctors again, and asking some questions. FOr the one that approves, why does he? What kind of results has he seen with use?
And for the one that doesn't approve, ask him why he doesn't. Is it just becuase of what I described here, or something he read in a medical journal 30 years ago? Or is it from supervision of patients actually on the medication, or recent medical news, etc. In the end, it's up to you-because with any health problem.....from obesity, to acne, to cancer, and so on....each different doctor will have a different idea, experience, and course of treatment.

[findingme4me]

Thanks ladies for all the advise that you gave here and i agree with it all. you cant live in fear. and if you are healthy and responsible and openminded, you should not be willing to just walk away. if your being told by your doctor that is a all around doctor that its ok....and yet one that looks at va jayjays all day long disagrees... i think that i would trust someone who has many paticents like you and honestly if your doctor feels comfortable...then great for you cause lots wont even think about it, healthy or not....i hope this make sence. talk to you soon.
Cassandra

[slaw007]

Originally Posted by nylon

All I can tell you Sarah from my experience is that I have used it twice in the past (first time was medically supervised and the second time was not). Both times I had great success and the span between both times was about ten years. So it's not like I gained it back quickly. This third time around well is baby and winter weight for me. It seems to be the only thing that works for me. I work out regularly (with a trainer) eat healthy for the most part and I still cannot lose the weight. It's like my metabolism has completely stopped. I lose inches yes but the damn number on that scale does not go down and when I don't see that number go down it is very defeating especially after all the time, sweat, and effort I religiously put into my health on a consistent basis.

My husband is amazed i'm not a stick figure with what I eat. I'm thinking perhaps I don't eat enough???? So to get back to your original question about the research. Like you and many on this board we have ALL done the research and know the consquences. You just have to weigh (no pun intended ) the pros vs. cons for your individual situation. For me and my body type this works the best besides going under the knife. **I hope** Three times a charm

I hope the third times a charm for you also! Thanks for the response.

[slaw007]

Originally Posted by rebeleagle1965

First off-you have to understand the reasons why some doctors are simply unwilling to delve into this field. Many are of the opinion that if something is unnecessary, then it should not be prescribed. Every doctor tries to make safe choices involving risk vs benefit, and in most cases that's in everyone's interest.
Too many people are of the mindset that if we would all just get off our butts and stop gourging ourselves that there would be no fat people And in that respect, we should be able to change bad behaviors, and problem solved. There's no NEED for weight loss meds, so any risk involved is too much.
But that's just not how it happens for alot of people, and once the weight is on, it's a nightmare to take it off. Like for me, maintenance is not a problem, but LOSING weight is next to impossible.
Which is why I decided, many years ago-but for the same reason as today (pregnancy pounds I couldn't budge)-to see a doctor at a weight loss clinic in New Orleans, where I lived at the time. He went over with me different possibilities for meds, the possible benefits and side effects, and of course nutritional counseling. I had great results, so it was worth it to me. THe way I saw it is that being overweight carried with it just as many, if not more, health risks than any of the meds he could have put me one. It was picking the lesser of two evils. This is not for everyone, because some people DO have side effects that are strong enough to make them discontinue use.
If you DO do the research, you will find out about all of those things, but you will also find that no one has attributed any fatal or even long term negative effects from taking phentermine. And in the history of prescription drugs, and the little "surprises" that come along decades down the road, that actually speaks volumes for it's safety in my book.

It's not a miracle drug. Lots of people regain the weight after they stop taking it. You have to start any weight loss program with the ability and determination to KEEP it off once it's gone. If once the meds are stopped, or a diet is stopped, we go back to the habits that made us overweight, then of course that's going to happen.
If you still have any conflicting feelings or coubt about it, then I would suggest speaking to both doctors again, and asking some questions. FOr the one that approves, why does he? What kind of results has he seen with use?
And for the one that doesn't approve, ask him why he doesn't. Is it just becuase of what I described here, or something he read in a medical journal 30 years ago? Or is it from supervision of patients actually on the medication, or recent medical news, etc. In the end, it's up to you-because with any health problem.....from obesity, to acne, to cancer, and so on....each different doctor will have a different idea, experience, and course of treatment.

I'm just like you, I don't fluctuate with my weight. I have always been a steady healthy weight but could NOT recover after my 2nd pregnancy. That's why my PCP said I would be a great candidate for Phen.. once I lose it I should be able to stay there just like I did at this weight. He warned me that this was a controversial drug but in his medical experience I would benefit from it. I agree with you, I will take it anyway. I was just wondering how other users felt about the warnings.

Thanks for your honesty.

[slaw007]

Originally Posted by findingme4me

if your being told by your doctor that is a all around doctor that its ok....and yet one that looks at va jayjays all day long disagrees... i think that i would trust someone who has many paticents like you and .
Cassandra

ha ha ha.. I suppose that's why I announced WHAT kind of Dr disagreed with the med. I was shocked that he addressed it at all, much less with so much passion. lol I suppose I should take the PP's advice and schedule another appt just to ask him more questions about Phentermine. I wonder if he'd make me wear that stoOpid gown?

[thewomanwithin67]

I have posted this before, sorry if you've read this previously.

If you are overweight or taking Phen or any other meds for that matter, please take the time to go to the CDC, FDA ; Wikopedia or Mayo Clinic and educate yourself on the complications of obesity and weight loss.

Have you stopped to consider the complications of weight gain and obesity versus the complications of using weight loss medications?

I did back in Jan 2006 when my PcP first asked me if I had thought about taking them. I was really dead set against any type of medication, but was ok with having Lap Band Surgery until I researched medications for almost 4 full months.

It took me until July to go back with a book full of information to ask for a prescription. I had been researching weight loss since June 2005 and felt pretty good in my decision.

Consider this from the Mayo Clinic:

If you're obese, you're more likely to develop a number of potentially serious health problems.
These may include:
High Blood Pressure - As you put on weight, you gain mostly fatty tissue. Just like other parts of the body, this tissue relies on oxygen and nutrients in your blood to survive. As demand for oxygen and nutrients increases, the amount of blood circulating through your body also increases. More blood traveling through your arteries means added pressure on your artery walls.

Weight gain also typically increases the level of insulin, a blood-sugar-controlling hormone, in your blood. The increase in insulin is associated with retention of sodium and water, which increases blood volume. In addition, excess weight often is associated with an increase in your heart rate and a reduction in the capacity of your blood vessels to transport blood. All of these factors can increase blood pressure.

Diabetes. Obesity is a leading cause of type 2 diabetes. Excess fat makes your body resistant to insulin, the hormone that helps your body maintain a proper level of a sugar (glucose) in your blood. If your body is resistant to insulin, your blood sugar is high — which isn't good — and leads to negative health effects.

Abnormal blood fats. A diet high in saturated fats — red meat and fried foods, for example — can lead to obesity as well as elevated levels of low-density lipoprotein ("bad") cholesterol. Obesity is also associated with low levels of high-density lipoprotein ("good") cholesterol and high levels of triglycerides.
Triglycerides are the form in which most fat exists in food as well as in your body. Over time, abnormal blood fats can contribute to atherosclerosis — the buildup of fatty deposits in arteries throughout your body.
Atherosclerosis puts you at risk of coronary artery disease and stroke.
Coronary artery disease. This is a form of cardiovascular disease. It results from the buildup of fatty deposits in arteries that supply your heart.
Over time these deposits can narrow your heart's arteries, so less blood flows to your heart. Diminished blood flow to your heart can cause chest pain (angina). Complete blockage can lead to a heart attack.

Stroke. Obesity is associated with atherosclerosis — the buildup of fatty deposits in arteries throughout your body, including arteries in your brain. If a blood clot forms in a narrowed artery in your brain, it can block blood flow to an area of your brain. The result is a stroke. Being obese raises your risk of a stroke.
Osteoarthritis. This joint disorder most often affects the knees, hips and lower back. Excess weight puts extra pressure on these joints and wears away the cartilage that protects them, resulting in joint pain and stiffness.

Sleep apnea. This serious condition causes a person to stop breathing for short periods during sleep and to snore heavily. The upper airway is blocked during sleep, which results in frequent awakening at night and subsequent drowsiness during the day. Most people with sleep apnea are overweight, which contributes to a large neck and narrowed airways.
Cancer. Many types of cancer are associated with being overweight. In women, these include cancers of the breast, uterus, cervix, ovaries and gallbladder. Overweight men have a particularly higher risk of cancers of the colon, rectum and the prostate.

Fatty liver disease. When you're obese, fats can build up in your liver. This fatty accumulation can lead to inflammation and scarring of the liver. Such scarring can cause cirrhosis of the liver, even if you're not a heavy alcohol drinker.

Gallbladder disease. Because overweight people may produce more cholesterol, which can be deposited in the gallbladder, the risk of gallstones is higher in obese people. Fast weight loss — more than 3 pounds a week — also can increase the risk of gallstones.

Obesity can also contribute to gout, a joint disorder.

Now consider the side effects of Phentermine:

dry mouth
nausea
vomiting dizziness
lightheadedness

***Side Effects of This Medicine***

Appetite suppressants may cause some serious side effects, including heart and lung problems.

Along with its needed effects, a medicine may cause some unwanted effects.

More common

Increased blood pressure.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare -

Difficult or painful urination;
fast or irregular heartbeat;
feeling that others can hear your thoughts; feeling that others are watching you or controlling your behavior;
hallucinations (feeling, seeing, or hearing things that are not there);
headache (severe);
mental depression;
numbness, especially on one side of the face or body;
skin rash or hives;
sore throat and fever (with diethylpropion); talking, feeling, and acting with excitement and activity you cannot control;
unusual bleeding or bruising (with diethylpropion).

Check with your doctor immediately if any of the following side effects occur:

Rare -

Chest pain; decreased ability to exercise; fainting; swelling of feet or lower legs; trouble in breathing.
This medicine may cause some people to feel a false sense of well-being
Check with your doctor immediately if you notice a decrease in your ability to exercise, if you faint, or if you have chest pain,
swelling of your feet or lower legs, or trouble in breathing .

These may be symptoms of very serious heart or lung problems.
The good news is that losing even modest amounts of weight can:

lower your blood pressure,
reduce your risk of cardiovascular disease and stroke,
improve glucose control in diabetes,
improve signs and symptoms of osteoarthritis
and sleep apnea,
and lower your risk of cancer.

The amount of weight you need to lose to improve your health may be much less than what you feel you need to lose. The first goal in dealing with obesity is to achieve and maintain a healthier weight. That usually requires reducing your weight by approximately 5 percent to 10 percent.

That means that if you weigh 200 pounds and are obese by BMI standards, you would need to lose at least 10 to 20 pounds. That doesn't mean you should stop there. But it's a place to start.

Slow and steady weight loss of 1 or 2 pounds a week is considered the safest way to lose weight and the best way to keep it off.

In many cases, losing weight can be accomplished by committing to eating a healthier diet, exercising and changing behaviors.

Other treatments for obesity include prescription medications and surgery.
Now consider this:

National Estimated Cost of Obesity from the CDC:

According to a study of national costs attributed to both overweight (BMI 25–29.9) and obesity (BMI greater than 30).

Medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion; $92.6 billion in 2002 dollars

(Finkelstein, Fiebelkorn, and Wang, 2003).

Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs.

Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days.

Mortality costs are the value of future income lost by premature death.
$78.5 billion in 1998 and $92.6 billion dollars in 2002.

Yes; that is $92.6 BILLION US dollars just in 2002 alone, that’s an astounding amount of money.