BUYING PHENTERMINE WITHOUT PRESCRIPTION?

Multiple strength combinations of Phentermine HCL available:

30mg, 37.5mg, & 45mg Capsule          SR 30mg, ADIPEX P 37.5mg, & 45mg Capsule

Adipex – before you buy Adipex online without prescription, you need to understand that Adipex is not sold legally on the web. Reason is Adipex P is a brand name that belongs to Teva pharmaceuticals. Main ingredient in Adipex is Phentermine HCL. Teva pharmaceuticals holds several patents in North America. These patents protect Teva’s rights on medicine release mechanism and trade name – ADIPEX-P. Before you buy Adipex, you need to visit your primary care physician and ask for prescription. Any type of sale online without prescription is illegal.

Adipex P is sold in any pharmacy in the United States and Canada. You can simply fill your prescription at any of your local drug store at any time. There plenty of Adipex supply available, 24 hours a day, 7 days a week. Some pharmacies offering Adipex P online with prescription only and deliver it to your doorstep by a courier services, ID must be verified. Normally, Adipex P is sold with 37.5mg of Phentermine HCL.

Phentermine is a medication that has been used to assist patients who are obese and suffering one or more of the adverse effects associated with obesity such as hypertension, sleep apnea, type two diabetes, hypercholesterolemia or hyperlipidemia to lose weight. The medication was first offered in 1959 and has been available globally either as a single medication of in combination with other drugs in single dosage form to promote weight loss for many years. The medication was named based upon a contraction of the chemical description of the medication which is formally referred to as phenyl tertiary butyl amine. The other formal name for the medication is alpha, alpha-dimethylphenethylamine. It promotes weight loss by reducing the perception of hunger, allowing the patient to consume less food yet still feel satisfied.

Adipex Looks Examples
Adipex bottle, label and tablet

Phentermine Classification

Phentermine is closely related to psychostimulant drugs such as amphetamine which was also named bases on a contraction of the formal chemical name of the compound, alpha methyl phenyl amine. Phentermine has effects similar to amphetamine on the central nervous system and must be employed with caution as the side effects of phentermine can mimic those of amphetamine.

Phentermine Chemical Structure

The chemical structure of phentermine and related chemicals are shown below. The chemical structure is quite similar to both amphetamine and to a variety of naturally occurring neurotransmitters used within the brain for communication between nerve cells such as phenethylamine.

Phenylethalymine Chemical Structure
Phenylethalymine Chemical Structure
Amphetamine Chemical Structure
Amphetamine Chemical Structure
Phentermine Chemical Structure
Phentermine Chemical Structure

Phentermine / Adipex Mechanism of Action

Phentermine is a sympathomimetic drug, which means it acts in the manner of naturally occurring chemicals in the body that stimulate the sympathetic nervous system. The common naturally occurring substances that stimulate the sympathetic nervous system are the catecholamines adrenaline and noradrenaline and the mono-amine, dopamine. All of these materials serve as both neurotransmitters, facilitating communication between nerve cells, and as hormones that allow distant cells to exchange signals without the intervention of neurons.

The sympathetic nervous system is designed to prime the body for stress and rapid action, the so called “fight or flight” response. These chemicals signal smooth muscle within the walls of large and medium sized arteries to contract, reducing the volume available to the fluid and cell mass that comprise the blood, raising blood pressure. They act as dromotropes, chronotropes and innotropes on the heart. When influenced by such naturally occurring chemicals or by administered sympathomimetic drugs, the heart will contract more often in a given period of time, the organ will pump a larger volume of blood with each contraction and the internal nerves of the heart, the purkinje fibers and the bundles of His, will conduct impulses more rapidly. In addition, sympathomimetic substances reduce blood flow to the gastrointestinal system and signal fat cells to work in concert with the liver to increase the rate of gluconeogenesis. This relatively inefficient biochemical process is used to increase the concentration of glucose in the blood to serve as an immediately usable fuel for muscles and the brain in a crisis.

Phentermine shares the same mechanism of action as that exerted by amphetamine and other psychostimulant drugs with a similar structure. Phentermine activates the TAAR1 receptor.  TAAR1 stands for trace amine associated receptor. The human TAAR family of receptors consists of six distinct proteins. TAAR1 receptors are located within cells found in the stomach, small intestine and astrocytes that act as support cells for neurons within the central nervous system. This receptor is also seen within mono-amine expressing neurons located inside the central nervous system. In these cells, TAAR1 is bound to the internal surface of the pre-synaptic membrane. TAAR receptors have very little surface membrane expression so the ligand that activates them must either be able to diffuse across the cell membrane or be transported through the cell membrane by a separate membrane transport protein. Once inside the cell, the ligand binds to the TAAR1 receptor that then interacts with potassium channels in the cell membrane, reducing the rate of firing of the mono-amine expressing neuron. In addition, the activated TAAR1 receptor activates both intracellular protein kinase A and intracellular protein kinase C. These kinase enzymes then modify mono-amine transport proteins located in the neuron cell membrane tasked with removing mono-amine neurotransmitters from the vicinity of the synapse by phosphorulating a tyrosine residue in each protein. The dopamine transport proteins then cease activity and move out of then cell membrane and into the cell. Further, a certain fraction of mono-amine transporting proteins will rejoin the cell membrane, reverse their function and engage in the release rather than the uptake of mono-amine neurotransmitter. In addition, the drug can serve as a competitive uptake inhibitor of neurotransmitter. These three effects result in higher concentration of mono-amine neurotransmitter within the synaptic cleft. The higher concentration of mono-amine neurotransmitter within the synaptic cleft leads to an increased firing rate of the post-synaptic neuron and the perception of a stimulating effect by the patient.

Phentermine acts on a variety of cells in the central nervous system that generate mono-amine neurotransmitters. The drug exerts its most potent effect on neurons producing norepinephrine. In addition, phentermine increases the concentration of dopamine and serotonin within the synapse between sells that use these mono-amines for communication. The net effect is the reduction of hunger, a cognitive process that is mediated by several nuclei within the section of the brain known as the hypothalmus. The principal structures that are thought to govern the perception of hunger are the ventromedial nucleus, the arcuate nucleus and the lateral hypothalamic nucleus.

Phentermine is also believed to facilitate weight loss via a mechanism operative outside the central nervous system. Phentermine causes the release of norepinephrine and epinephrine into the general circulation. These materials act as hormones, signaling fat cells to mobilize stored material. Fat cells break lipids into two carbon units and ready it for processing via the Kreb’s cycle operative in every cell and by the liver as a raw material for gluconeogenesis.

Application of Phentermine

Phentermine is intended for short term use. It is recommended that phentermine be prescribed for obese patients for no longer than 12 weeks and that the medication be used as part of a weight loss program that includes exercise and reduced caloric intake. Phentermine has a lasting effect on appetite that appears to extend beyond the period when the patient takes the medication. Patients prescribed phentermine for 12 weeks who were followed for24 weeks continued to lose weight in the 12 week period when they were not taking the drug. It is uncertain if the continued weight loss is caused by a lingering effect of the drug or by modification of the patient’s eating habits that carried over into the 12 week period when they were no longer taking phentermine.

Since Phentermine is similar in its effects to amphetamine, it is regulated as a controlled substance in most nations. The most comprehensive agreement regarding the regulation of controlled substances is known as the Convention on psychotropic substances. Phentermine is regulated as a schedule IV material, the same level of control applies to low activity narcotics without a strong euphoric effect such as hydrocodone.

The usual adult dose for phentermine is 15 mg to 30 mg. This should be taken by the patient approximately 2 hours after breakfast and one dose should serve to control appetite for 12 to 14 hours. Patients should be cautioned against taking phentermine in the evening as it has the potential to cause insomnia.

Contraindications to the Use of Adipex / Phentermine

Phentermine should not be taken by patients who have previously been diagnosed with cardiovascular disease. This includes congestive heart failure, coronary artery disease or an arrhythmia. Patients with uncontrolled hypertension should not use phentermine as the drug has the potential to increase blood pressure, potentially leading to a hypertensive crisis requiring immediate medical intervention. Patients who have taken antidepressant drugs classified as monoamine oxidase inhibitors should avoid taking phentermine for at least 14 days after they have ceased to take the antidepressant. Patients with hyperthyroidism should not use phentermine as the drug may exacerbate the effects of the disease. Patients with hyperthyroidism who use phentermine may experience irritability, tachycardia, upper extremity tremors, insomnia and increased perspiration. Glaucoma patients should not be prescribed phentermine as the drug has the potential to cause acute mydriasis, a condition where the pupil is abnormally dialated. Should mydriasis occur, it can lead to an acute episode of closed angle glaucoma, a medical emergency. Patients suffering from an attack of closed angel glaucoma will be afflicted by increased intra-ocular pressure which, in turn, will compress the small blood vessels supplying the retina with nutrients and oxygen. Loss of circulation can lead to retinal damage or the complete loss of sight in the affected eye. Phentermine should not be prescribed to patients with a psychiatric condition that involves agitation, thought disturbance or disordered cognition as a presenting symptom as the drug is likely to exacerbate such conditions. This includes patients diagnosed with bipolar disease, schizophrenia, schizoaffective disorder or personality disorders characterized as schizoid, schizotypal, paranoid, borderline, histrionic or narcissistic.

Adipex P / Phentermine Warnings and Side Effects

Phentermine is only indicated for short term use as monotherapy for obesity with one or more associated complications. The effectiveness and safety of phentermine when used in combination with other weight loss drugs, over the counter materials, herbal supplements or agents that lead to an increased concentration of the neurotransmitter serotonin in the synaptic gaps between neurons of the central nervous system has not been extensively tested. Antidepressants classified as selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, fluoxetine and sertraline and antidepressants classified as selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine, duloxetine, levomilnacipran and venlafaxine may be unsafe if taken in combination with phentermine.

Primary pulmonary hypertension, a rare but exceptionally serious disease characterized by an abnormally high pressure in the vessels leading from the right ventricle of the heart to the lungs, has been diagnosed in patients who were prescribed phentermine in combination with a second weight loss drug. The second drug was either fenfluramine or dexfenfluramine. It is uncertain if phentermine alone can promote the development of primary pulmonary hypertension as there have been a small number of cases where this disease was diagnosed in patients prescribed phentermine as monotherapy. The first symptoms noted by the patient developing primary pulmonary hypertension are shortness of breath upon exertion, chest pain, loss of consciousness, swelling of the legs and exercise intolerance.

Serious valvular heart disease has been reported in patients taking the aforementioned drug combinations for weight loss. The two drugs, when taken in combination, led to the development of valve defects that allowed blood to flow backwards when the heart contracted, causing circulatory insufficiency. The valves most frequently affected were the aortic and mitral valves. Progressive deterioration of the heart valves can lead to heart failure and death. The role of phentermine alone in the development of heart valve defects is uncertain as a small number of patients prescribed phentermine as monotherapy also developed valve defects.

Patients can develop a tolerance to phentermine in much the same manner as patients may develop a tolerance to other sympathomimetic drugs such as amphetamine. If the patient develops a tolerance and phentermine no longer acts as an effective anorexic, it is safer to discontinue the drug rather than increase the dose.

Phentermine may impair the ability of the patient to engage in potentially hazardous tasks such as operating machinery or driving a motor vehicle. Patients should be cautioned not to engage in such activities until they have taken phentermine for a few days and are able to gauge how it will affect them.

As with all sympathomimetic drugs, phentermine may alter the patient’s cognitive state, causing excess stimulation, dizziness, insomnia, euphoria, tremors, a heightened sense of awareness and hyper-vigilance. Some patients may find these effects desirable and that has the potential to lead to drug abuse, drug seeking and dependence. Physicians should caution patients concerning the potential for abuse and dependence and monitor patient compliance with the dosage regimen prescribed.

Abuse of sympathomimetic drugs including phentermine may be associated with intense psychological dependence and severe social dysfunction. Reports in the literature exist describing patients who have increased the dosage of phentermine to many times the maximum recommended daily quantity. Abrupt cessation following a period of prolonged abuse of phentermine can cause the patient to exhibit extreme fatigue and apparent depression. Chronic intoxication with sympathomimetic drugs produces notable signs such as severe dermatoses, marked insomnia, irritability, hyperactivity and negative personality changes.

Patients should also be cautioned not to consume alcohol while taking phentermine as doing so may cause chest pain, exacerbate hypertension, increase the risk of drug abuse and dependence and reduce the patient’s motivation to be physically active. In rare instances, use of phentermine has precipitated a psychotic episode. Phentermine may reduce the effect of adrenergic antagonist drugs used to control blood pressure such as phentolamine, propranolol and labetalol.

Phentermine may cause mouth dryness, an unpleasant taste in the mouth, constipation or other gastrointestinal disturbances. This drug may potentiate the effects of oral anti-diabetic medications such as biguanides (metformin), thiazolidinediones (pioglitazone), sulfonylureas (glipizide, glibenclamide, glimepiride, gliclazide, glyclopyramide and gliquidone) and the meglitinides (repaglinide and nateglinide). Patients taking any of these medications along with phentermine may require a reduction in the dose of anti-diabetic medication to avoid hypoglycemia. Use of this drug has the potential to cause impotence and changes in libido.

As with all sympathomimetic drugs, phentermine has the potential to produce tachyphylaxis, an acute sudden decrease in response to the drug. Patients who experience this phenomena should be slowly tapered off phentermine.

Patients who are suffering an acute overdose of phentermine have the potential to exhibit extreme restlessness, abnormally heightened reflexes, rapid respiration, extremity tremors, confusion, hallucinations, unwarranted aggression and panic attacks. Effects on the cardiovascular system include hypertension, dysrhythmias, tachycardia and circulatory collapse. Effects of over dosage on the gastrointestinal system include abdominal cramps, nausea, vomiting and diarrhea. An extreme overdose of a sympathomimetic drug can lead to convulsions, coma and death. Over dosage of phentermine is managed by treating each symptom with one or more agents specific to the problem. Gastric lavage may be used to reduce further absorption of thsi drug that remains in the stomach and duodenum. Convulsions are managed using a long acting barbiturate such as phenobarbital or mephobarbital with short acting agents such as amobarbital or secobarbital added as needed for break through convulsive activity. Acidification of the urine using potassium hydrogen phosphate will increase the rate of excretion of phentermine. There is insufficient information available regarding the treatment of phentermine overdose patients with hemodialysis or peritoneal dialysis to make a recommendation for or against such treatment.

Case reports regarding unusual presentations of phentermine overdose have appeared in the literature. A 32 year old man presented to an emergency department after a session of vigorous exercise with a chief complaint of back, inguinal and shoulder pain. The patient had been taking twice the recommended maximum dose of phentermine for about one week along with a variety of other medications for hypothyroidism, blood pressure control, hypogonadism, gastrointestinal motility disturbances and pain control. His laboratory test values showed elevated levels of troponin I, creatine kinase, and serum creatinine, indicating cardiac muscle damage, skeletal muscle damage and renal failure. On day 2 of his hospital stay, the patient progressed to complete renal failure. He was diagnosed with generalized rhabdomyolysis, a breakdown of skeletal muscle. The patient received extensive intravenous hydration with half normal saline (0.45%) along with sodium bicarbonate to alkalinize his urine, preventing the precipitation of myoglobin released from damaged skeletal muscle cells in his kidneys which would lead to irreversible kidney failure. His urinary output improved by day 5 of his hospital stay and the patient was discharged.

In a second case report, a 24 year old man presented to the emergency department exhibiting intense sweating, hyperventilation, tachycardia, fever, combative behavior and mydriasis. This constellation of symptoms constitutes a sympathetic nervous system storm, an exceptionally dangerous situation which can rapidly progress to high output cardiac failure, circulatory collapse and death. He was treated with adrenergic antagonists, neuromuscular paralytic medication, sedatives and mechanical ventilation. The patient subsequently developed adult respiratory distress syndrome which required he remain on mechanical ventilation for 12 days. The patient was discharged from the hospital but he did not follow up so it was not possible to determine if he suffered any permanent cardiac damage.

Special Populations

The effectiveness and safety of phentermine has not been examined in children under the age of 16. Childhood obesity is regarded as a chronic condition that requires long term management. Since phentermine is intended to be used for 12 weeks or less, the drug is not suited to the treatment of childhood obesity and it should not be not be prescribed to those under the age of 16.

Elderly patients can be treated with phentermine but dose selection should start at 15 milligrams daily and be titrated up cautiously if required. Older patients often have reduced hepatic, renal and cardiac function along with other comorbidities. Phentermine is largely (62 to 85%) removed from the body by the action of the kidneys and the risk of the circulating level of phentermine rising to unsafe levels is increased in the elderly and other patients with compromised renal function. Renal function monitoring should be considered in patients with borderline glomerular filtration rates.

Weight Loss Drug Combinations Using Phentermine

Although phentermine is intended as monotherapy for obesity control, it has been combined with other agents in single dosage form. The combination of phentermine with either fenfluramine or dexfenfluramine was heavily marketed in the 1990s. In 1996, papers began to appear in the medical literature warning about the enhanced incidence of primary pulmonary hypertension and regurgitant heart valve disease in the population treated with combination anorexic drug therapy. When this population was examined using echocardiography, it was found that 30% of the patients who had been treated with combination anorexic drug therapy for up to 24 months had significant heart valve abnormalities. For patients treated for up to 3 months, the incidence of heart valve abnormalities was less than 3%, a statistic still very much higher than expected in the general population. This approach to obesity management had to be abandoned.

Vivus Qsymia with Phentermine

A new combination therapy using phentermine and an extended release form of the anti-epilepsy drug topiramate was developed by Vivus, The combination is marketed under the trade name Qsymia. The drug combination was pioneered by an individual who worked on previous combination pharmaceuticals that incorporated phentermine. He began to prescribe topiramate in combination with phentermine in an off label application in 2001 at a privately owned weight loss clinic. Vivus subsequently created a single dosage form and petitioned the FDA for approval to market the two drugs together for the treatment of obesity. The combination was approved in 2012.

Adipex Diet Pills

Adipex P – normally comes in white tablet with blue specks. Manufactured in the United States for the North American market. Ingredients in adipex diet pills will only include Phentermine HCL as active and the rest are additives.

You can buy Adipex online with home delivery or go to your local pharmacy to fill the RX prescription. Each capsule or tablet comes with over the counter Phentermine 37.5 – active ingredient. Buying Phentermine online and shipping by mail is not legal. You can only buy Phentermine at local pharmacy store or online with home delivery.

Phentermine K28 Capsules

Buy Phentermine 37.5 mg – this is the most popular dosage. KVK Tech, maker of Generic medication, comes in white and blue capsule form. Other popular Phentermine dosages are 15 mg and 30 mg. Ask your doctor what’s the best Phentermine dosage for you.

​Normally you will get 15 mg dosage prescribed if you just starting taking this medicine. When you get used to 15 mg, you will get 30 mg and later 37.5 mg. Get KVK Tech generic with 37.5 mg – the cheapest over the counter Phentermine pill among other makers.

Lomaira white and blue specks tablet

Lomaira is KVK Tech’s new prescription only diet pill. Developed in September of 2016 for the US market. After enormous success in the United States, KVK tech is planning to sell Lomaira in United Kingdom and later in Australia and the rest of the world. Looks like Lomaira is going to be the most popular version of the these diet pills.

What makes Lomaira different from the rest is that each tablet comes with 8 mg of Phentermine HCL. Lomaira is intended to be taken 3 times a day before the meals. Having such concentration of Phentermine HCL per tablet allowing more controlled way of administering active ingredient into the body. Instead of taking 37.5 mg of over the counter Phentermine dosage all at once, you can control your intake by having to take lower dosages more than once a day.

For example if you take 37.5 mg dosage twice a day, which is strictly prohibited, because you might overdose and experience dangerous side effects, you can take 3 tablets of Lomaira a day and feel great! Out of all branded cheap Phentermine HCL products, looks like Lomaira is the next “big hit”! Popularity of Lomaira grows day by day.

Make sure you ask your doctor for a Lomaira prescription. When you buy Lomaira online from your local pharmacy store (ID will be verified upon delivery) or at the pharmacy counter, make sure it looks like doggy cookie and has blue specks in it. That’s how you can tell if you are getting real Lomaira and not some generic Phentermine online.

Do not buy Lomaira online without prescription. It is just as illegal to sell Lomaira online without prescription as any other Phentermine products. Lomaira cost depends on location and promotions offered by KVK Tech. When it was just leased there was no cost for the first time buyers.

People were able to get their hands on freebies because it was new product. At this point the cost of Lomaira went up as demand grew and there is no way to get a bottle of Lomaira under $100. Many home delivery pharmacies online will get that product delivered to your door step safe and secure.

Weight Loss Drug - Contrave
New weight loss drug - Contrave

Contrave – Approved By the  FDA in 2017. Manufactured in La Jolla by Therapeutics inc. Unlike Phentermine HCL products, Contrave includes a combination of drugs, Bupropion and Naltrexone.

A combination of these two medications effecting central nervous system in the similar way as Phentermine HCL. It activates the neurons responsible for receiving messages that stomach is full and therefore users feel no hunger at all. Right after FDA approval, Contrave quickly earned it’s status as world’s #1 appetite suppressant.

The Contrave side effects are similar to the ones individual may experience from taking Phentermine appetite suppressants. Before taking Contrave, make sure your doctor is aware of all the medications and supplements you are currently taking. The most common dosage you get prescribed is 8 mg of Naltrexone and 90 mg of the Bupropin.

Clinical Studies of Phentermine Effectiveness

Numerous studies of the effectiveness of phentermine as a weight management drug have been completed. These studies will be discussed to illustrate the results that can be achieved in both the short and long term by patients who take phentermine. References are provided for each study at the end of this section.

Study 1: This 20 week long study enrolled 50 women who were suffering from long term obesity. Of the 50 initial enrollees, 34 completed the course of therapy. The average weight loss was 6.4 kilograms. Nine of the patients lost 10 kilograms or more. The drug proved effective in suppressing appetite for all of the patients who completed the study. If the drug did not produce its intended effect at a low dose, researchers found that increasing the dose did not produce a better response in individuals who proved refractory to phentermine.

Study 2: This 36 week long double blind random patient assignment study enrolled 108 women aged from 21 to 60 who were over their ideal body weight by at least 20%. Of the 108 initial enrollees, 64 completed the course of therapy. The subjects were provided with either phentermine capsules or placebo medication along with a counseling session concerning diet and exercise. At the conclusion of the study, patients taking the placebo capsules lost an average of 4.8 kilograms while patients given phentermine capsules either intermittently or continuously throughout the study lost an average of 12.2 and 13.0 kilograms respectively.

Study 3: This 24 week long double blind randomly controlled study enrolled 81 people who were 30 to 80% over their ideal body weight. Patients receiving 30 mg of phentermine daily lost an average of 10.0 kilograms over the course of the study.

Study 4: This 12 week long open label clinical study enrolled 50 people who were more than 20% over their ideal body weight. Each patient was supplied with one capsule containing 30 mg of phentermine and was asked to restrict their caloric intake to 1500 calories per day. Patients taking phentermine exhibited significant weight loss, particularly during the first 4 weeks of the study.

Study 5: Several researchers performed a meta-analysis to determine if the combination of phentermine with topiramate was more effective in facilitating weight loss than either drug administered alone. This type of study utilizes mathematical techniques to combine the results of several previous studies, allowing researchers to achieve a higher level of predictive power without running additional studies. All studies included in this research project were placebo controlled trials with weight loss serving as the sole measure of success. Patients treated with a combination of phentermine and topiramate had an average weight loss in excess of the placebo group of 7.2% of starting body weight. This stands in contrast to the average weight loss in excess of the placebo group for patients treated with topiramate monotherapy of 4.6% and a weight loss for patients treated with phentermine monotherapy of 5.8% of starting body weight.

Study 6: This 56 week long phase 3 placebo controlled randomly assigned patient study enrolled 2487 patients from 18 to 70 years of age with a body mass index ranging from 27 to 45 kilograms per meter squared. Each patient exhibited two or more comorbidities associated with obesity. Patients were treated in an office environment and provided with either a placebo medication, low dose phentermine with topiramate in single capsule form (7.5 and 46 mg respectively) or with high dose phentermine and topiramate in single capsule form (15 and 92 mg respectively). Patient progress was judged based upon percentage change in body weight and the proportion of each group that achieved at least a 5% loss of body weight. At the conclusion of the study, placebo patients had achieved an average weight loss of 1.4 kilograms while patients on low dose combination therapy averaged 8.1 kilograms and patients on high dose therapy averaged 10.2 kilograms. The authors concluded that combination drug therapy for obesity using phentermine and topiramate was effective and could be implemented in a medical office environment.

Study 7: This study is a massive meta-analysis of randomized patient assignment placebo controlled clinical trials performed using regulatory authority approved long term weight loss drugs for at least one year. The criteria used to judge success were the proportion of patients able to achieve a 5% weight loss, the proportion of patients able to achieve a 10% weight loss, the absolute weight loss achieved by patients and the proportion of patients who had to drop out of the study due to experiencing side effects from the drugs they were given. A total of 28 studies that enrolled 29,018 patients met the criteria for inclusion in the meta-analysis. For patients given a placebo, 23% were able to achieve a 5% weight loss while 75% of patients taking phentermine and topiramate combination therapy were able to achieve the same goal. The average weight loss for patients taking phentermine and topiramate was 8.8 kilograms. The authors concluded that phentermine and topiramate combination therapy was one of only two drug systems studied that was associated with the highest odds of achieving at least a 5% weight loss. Patients treated for an extended period with phentermine and topiramate combination therapy, however, should taper these medications rather than suddenly cease taking them. Topiramate is a neuron stabilizing agent used to reduce seizure kindling in patients diagnosed with epilepsy. Neurons in the central nervous system become habituated to the drug and abrupt drug cessation has the potential to precipitate a seizure.

REFERENCES

  1. Douglas, J.G. & Munro, J.F. (1982); Drug Treatment and Obesity. Pharmacology and Therapeutics, 18:351-373
  2. Comparison of Continuous and Intermittent Anorectic Therapy in Obesity, J. F. Munro,* M.B., M.R.C.P.ED.; A. C. Macuish,* M.B., CH.B. Elizabeth M. Wilson,* S.R.D.; L. J. P. Duncan,* M.B., B.SC., F.R.C.P.ED. British. Medicine. 7., 1968, 1, 352-354
  3. Weintraub M, Hasday JD, Mushlin AI, Lockwood DH. Archives of Internal Medicine 1984 Jun; 144(6):1143-8.
  4. Vallé-Jones JC, Brodie NH, O’Hara H, O’Hara J, McGhie RL. Pharmatherapeutica. 1983; 3(5):300-4.
  5. Thompson JA, Heaton PC1, Kelton CM2, Efficacy Of Phentermine Monotherapy, Topiramate Monotherapy, And Phentermine/Topiramate Combination Therapy On Weight Loss: A Network Meta-Analysis Of Randomized Controlled Trial Data, Poster presented at the Value in Health Symposium 17 (2014)
  6. Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, Day WW. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Apr 16; 377(9774):1341-52. doi: 10.1016/S0140-6736(11)60205-5. Epublication 2011 Apr 8.
  7. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Journal of the American Medical Association. 2016 Jun 14; 315(22):2424-34. doi: 10.1001/jama.2016.7602.