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Pharmacological Management of the Patient with Obesity
Published in James M. Rippe, Lifestyle Medicine, 2019
Magdalena Pasarica, Nikhil V. Dhurandhar
Phendimetrazine is a sympathomimetic amine similar to amphetamine. Phendimetrazine was FDA approved in 1982 for short-term (few weeks) treatment of weight loss in addition to caloric restriction in patients with a BMI at or above 30 kg/m2 or BMI at or above 27 kg/m2 in the presence of other risk factors for patients who have not responded to a lifestyle management of obesity. It shouldn’t be used with other anorectic drugs. Even though no cases of valvulopathy have been reported with phendimetrazine use alone, it is recommended to carefully assess the benefits of weight loss vs. the potential risks for serious side effects such as valvular heart disease and pulmonary HTN. Other serious side effects include psychosis and withdrawal syndrome if discontinued abruptly. Common side effects include tachycardia, palpitations, HTN, and insomnia (https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018074s034lbl.pdf). Due to its potential for addiction, it is a Schedule III drug and is rarely prescribed by providers, similar to benzphetamine.15
Pharmacological Treatment of Obesity
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Amie A. Ogunsakin, Ayotunde O. Dokun
Decades prior, the only pharmacologic agents available to treat obesity were approved only for short-term use (≤ 12 weeks) by the US Food and Drug Administration (FDA) and include diethylpropion, phendimetrazine, benzphetamine, and phentermine [23]. However, short-term of use of these weight loss medications did not demonstrate long-term health benefits [14,15]. More recently, the FDA approved a number of medications for longer-term treatment of obesity [17–22]. Given this understanding, recent guidelines now advocate a more comprehensive approach to achieving long-term weight loss [24,25]. Recommendations of the US Preventive Service Task Force, American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology(ACE) and Endocrine Society now incorporate the use of pharmacotherapy as key components of a long-term weight loss strategy [24,25]. The guidelines also include consideration for concurrent initiation of lifestyle modification and pharmacotherapy in individuals with weight-related complications that can be improved by weight loss. Additionally, they recommend that pharmacotherapy should be considered and offered to patients with obesity, when potential benefits outweigh the risks, for the chronic treatment of the disease. Hence, pharmacologic agents are now indicated for chronic weight management in obese adults (a BMI of 30 kg/m2 or greater) or in overweight patients (BMI of 27 kg/m2 or greater) with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes, or dyslipidemia) [26] as an adjunct to lifestyle modification.
Pharmacotherapy
Published in G. Michael Steelman, Eric C. Westman, Obesity, 2016
Clinical usefulness —Fifty-six percent of bariatric physicians have found phendimetrazine to be a useful drug; those who use it do so in 18% of their patients. Phendimetrazine is another sympathomimetic amine derived from β-phenylethylamine, and its molecular structure also resembles that of amphetamine. The FDA has long presumed that all the sympathomimetic amines, including phendimetrazine, have effects and adverse effects similar to, if not identical with, those of amphetamine. Thus, the product labeling for phendimetrazine includes all the same conjectures discussed for phentermine. The mechanism of action is thought to be similar to that of phentermine.
The safety of pharmacologic treatment for pediatric obesity
Published in Expert Opinion on Drug Safety, 2018
Ariana M. Chao, Thomas A. Wadden, Robert I. Berkowitz
Several medications have been approved by the FDA for the short-term (≤12 weeks) management of obesity, as an adjunct to a reduced-calorie diet and increased physical activity, in adults with a BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with obesity-related comorbidities. These drugs are noradrenergic sympathomimetic agents that decrease appetite and include phentermine, benzphetamine, diethylpropion, and phendimetrazine. Their effectiveness in youth has not been established, though there have been some small trials of phentermine conducted for pediatric obesity [30]. Side effects of these medications include increased pulse rate, blood pressure, dry mouth, insomnia, and constipation. There is a risk of abuse and dependence. Benzphetamine and phendimetrazine have been classified as Schedule III and diethylpropion and phentermine are Schedule IV controlled substances in the US [31]. Rare but serious side effects have also been reported among patients taking a combination of phentermine and fenfluramine or dexflenfluramine, including primary pulmonary hypertension and valvular heart disease. Fenfluramine and dexfenfluramine are no longer on the market because of their association with valvulopathy. As pediatric obesity is a chronic condition and requires long-term management, use of phentermine as monotherapy in pediatric patients is not recommended, as there are no short- or long-term efficacy and safety data available in youth.
An evaluation of liraglutide including its efficacy and safety for the treatment of obesity
Published in Expert Opinion on Pharmacotherapy, 2020
Chen-Hsiu Lin, Li Shao, Yu-Mei Zhang, Yu-Ju Tu, Yuzhen Zhang, Brian Tomlinson, Paul Chan, Zhongmin Liu
Phentermine was approved by the FDA in 1959 for short-term use (<12 weeks) and some other sympathomimetic amines, diethylpropion, phendimetrazine and benzphetamine, are available in the United States, but are rarely used. These drugs increase resting energy expenditure somewhat but mainly suppress appetite with pharmacological effects similar to those of amphetamines. They are often used for longer-term weight management treatment as off-label therapy. Their safety in relation to cardiovascular disease has not been established and there is the potential for abuse [15].
The limits and challenges of antiobesity pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2020
Kishore M Gadde, Katelyn D Atkins
Four amphetamine congener drugs – phentermine, diethylpropion, phendimetrazine, and benzphetamine – continue to be marketed in the US for short-term treatment of obesity. Mazindol, another drug in this class was discontinued in the US, but remains available in other markets, such as Japan and Mexico.