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thread: Duromine

  1. #127
    Registered User

    Apr 2009
    Out on the sauce with the Tombliboos!
    206

    I just thought this might be a good article (that is written for health professionals) but seeiig the drug has been around for so long I think it's ok to let it out of the secret Doctors vault!


    Prescribing and managing the side effects of Duromine (phentermine) - News

    Prescribing and managing the side effects of Duromine (phentermine)

    13 August 2009

    Phentermine (Duromine) is one of the oldest discovered anorectic agents. In 1968 the first randomised controlled trial with the agent resulted in a mean significant weight loss in the active compound group of 12.6 kg over a period of 36 weeks for both continuous and intermittent use compared to 4.8 kg in the placebo group.1


    Professor Joseph Proietto of the Endocrine Specialist Centre in Heidelberg, Victoria, said "phentermine works fairly quickly, in maybe one or two weeks."

    Phentermine ? the safe half of phen-fen

    There has been a cloud of uncertainty surrounding phentermine since the discovery of significant associations between valvular heart disease and the potent phentermine and fenfluramine combination (phen-fen) used to treat obesity.2 In 1997 fenfluramine was withdrawn from the market, leaving the safe half of the combination, phentermine, to treat obesity alone.3
    As phentermine was developed around 50 years ago, recent safety and efficacy studies are lacking, leaving a large gap in the literature for the past 20 years.
    Professor Proietto said, "Phentermine is a very old drug. It's off patent now, so you're not going to have any pharmaceutical companies doing major studies because they cost billions."
    Studies during this time instead have been focused on orlistat, sibutramine and the research and development of around 150 new anti-obesity compounds. That said, the multitude of review papers and meta-analyses available suggest that phentermine is safe, well-tolerated and efficacious in treating obesity.3 Moreover phentermine is no longer under patent, making it a more cost effective option than other weight loss medications.4

    Side effects and medical monitoring

    The most serious and common adverse effects associated with phentermine include tachycardia and hypertension. These side effects carry with them strict medical monitoring requirements and contraindications.4
    Patients taking phentermine need to be monitored regularly for heart rate and blood pressure, even more so for patients predisposed to the cardiovascular side effects of the drug, such as patients with mild hypertension. Close monitoring should occur in all patients for the first month and at any time the dose is titrated.4 Patients that will continue the treatment for longer than 3 months must also be monitored closely as there have been no long term efficacy and safety data for the drug beyond the 36 week mark.1,3
    Phentermine use is contraindicated in patients with a history of psychiatric illness such as depression, a history of pulmonary artery hypertension, existing heart valve abnormalities or heart murmurs, moderate to severe arterial hypertension, cerebro-vascular disease or severe cardiac disease, including arrhythmias and advanced arteriosclerosis, monoamine oxidase inhibitors (MAOIs) (or within 14 days following their administration), and hyperthyroidism. The concurrent use of thyroid hormones with phentermine may increase CNS stimulation.6
    Less risky but common side effects associated with phentermine use include restlessness, dizziness, insomnia, nausea, dry mouth, headache, irritability, nervousness and constipation.3,6 These effects, if experienced, can last approximately 12?14 hours post dose,3,6 which is why it is suggested that in order to reduce restlessness and insomnia that the drug is taken in the morning or, in the case of shift workers, at a corresponding time when they have just woken. If the dose is forgotten in the morning it can be taken before lunch, but any time after this will cause sleep disturbances and hence patients should be advised to skip the dose.5

    Do patients become tolerant to the effects of phentermine?
    A patient on phentermine needs to have a medical review after three months;6 however, use can be extended if the patient is responding well to the drug at the three month mark. A good basis for this decision is the weight lost; patients responding well will have lost approximately 1.8 kg per month. If patients have not lost at least 1.5 kg in the first six weeks, or 5% of their body weight within six months, pharmacotherapy with phentermine should be reconsidered.7
    The development of tolerance to phentermine is controversial. While earlier studies report no tolerance to the medication8 newer studies have conceded that the effects of phentermine do subside over time and accordingly the weight loss effects of the drug cease after around 6 months.4
    Interestingly, findings from recent rat studies suggest that there is a degree of cross-tolerance between phentermine and sibutramine; rats pretreated with phentermine were less responsive to the anoretic effects of sibutramine compared to those that were not.9 This finding has not been replicated in humans.
    Without a long-term randomised controlled trial of phentermine the issue of tolerance cannot be determined. A trial of this nature is highly unlikely now as the drug is no longer under patent. What is known is that after 3?6 months, phentermine's anorectic effects, and subsequent weight loss, do subside; however, continuation of the drug can be efficacious in preventing weight regain.4
    Professor Proietto said, "It could be perfectly safe long term but we just don't know. There was a study in America when they did the phen/fen, where they took it for four years and kept the weight off for four years. Then as soon as they stopped the drug, they regained the weight."

    Individual responses to phentermine

    Individual side effect profiles and weight loss response to phentermine are variable and seem to be unrelated to the plasma concentration of the drug.10 The recommended starting dose is 30 mg. This should be titrated to a maintenance dose of 15?40 mg depending on the individual response to the drug.6 For some, phentermine may affect their work or lifestyle; for example dizziness may cause work safety issues for those who work with heavy machinery.5

    References

    1. Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. BMJ. 1968; 1: 352-4.
    2. Connolly HM, Crary JL, McGoon MD, Hensrud DD, Edwards BS, Edwards WD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med. 1997; 337(9): 581-8.
    3. Schnee DM, Zaiken K, McCloskey WW. An update on the pharmacological treatment of obesity. Curr Med Res Opin. 2006; 22(8): 1463-74.
    4. Kaplan LM. Pharmacological therapies for obesity. Gasteroenterol Clin North Am. 2005; 34(1): 91-104.
    5. Duromine (Phentermine) Consumer Product Information. Thornleigh NSW: 3M Pharmaceuticals Pty Ltd, 2000 Dec.
    6. Duromine (Phentermine) Product Information. Thornleigh NSW: iNova Pharmaceuticals (Australia) Pty Limited, 2007 May 18.
    7. Caterson ID, Finer N. Emerging pharmacotherapy for treating obesity and associated cardiometabolic risk. Asia Pac J Clin Nutr. 2006; 15(Suppl): 55-62.
    8. Langlois KJ, Forbes JA, Bell GW, Grant GF. A double-blind clinical evaluation of the safety and efficacy of phentermine hydrochloride (Fastin) in the treatment of exogenous obesity. Curr Ther Res Clin Exp. 1974; 16(4): 289-96.
    9. Wellman PJ, Jones SL, Miller DK. Effects of preexposure to dexfenfluramine, phentermine, dexfenfluramine-phentermine, or fluoxetine on sibutramine-induced hypophagia in the adult rat. Pharmacol Biochem Behav. 2003; 75(1): 103-14.
    10. Douglas A, Douglas JG, Robertson CE, Munro JF. Plasma phentermine levels, weight loss and side-effects. Int J Obes. 1983; 7(6): 591-5.



  2. #128
    Registered User

    Dec 2006
    In the Angelic Realm
    1,675

    I'm almost at the end of my first month on Duromine.

    I want another prescription, but don't know if my dr will give it to me. I just have the last 5kgs to go and then i'm done with my 20kg weightloss. I'm going to be exercising this next month too, so i should lose it with the Duromine too.

    I've lost about 5kgs without any exercise. I still eat, but not as much as i used to. I think its great. I should have known about this when i first began losing weight at the 80kg mark. I would have saved heaps in the money i spent trying to lose the weight.

  3. #129
    Registered User

    Dec 2007
    Adelaide, SA
    896

    i am currently on duromine 15mg.
    My only side effect is a dry mouth, which in a way is a good thing as I am drinking water now and lots of it

  4. #130
    Registered User

    Apr 2010
    Townsville
    2,832

    I was on 30mg duromine tablets, my Dr prescribed it to me when I was 60kgs and 166cms... she really shouldn't have at all but she did. And I lost 14kgs in about 2.5 months... That combined with my ED and exercise addiction meant I was able to lose a huge amount of weight that I shouldn't have,
    But I found it very effective and I want to go back on it now, only to lose my 10kgs of baby weight, except I am BF and you can't take it while BF...

    Guess I will have to do it the hard way this time!

  5. #131
    Registered User

    Jan 2008
    Queensland
    1,176

    For those of you who were on Duromine or are still on Duromine and had trouble sleeping did your body eventually get used to the Duromine and you could sleep again? I've been on 30mg of Duromine for the past 3 days and the first night I got about 1 hr & a half sleep, night two I got about 3hrs sleep and last night I didn't sleep at all. The sleeplessness is the only side effect that I have. I'm loving the fact that I'm feeling full and not eating as much as I have a lot of weight to lose but I don't want to go for weeks/months on end not sleeping as I know my body does need sleep even if I have loads of energy from the duromine.

  6. #132
    Registered User

    Apr 2010
    Townsville
    2,832

    I dont sleep anyways! Lol.
    When do you take it? I always took it as soon as i woke up, then by night it had worn off a bit.



    Sent from my iPhone so sorry for the spelling and punctuation!!

  7. #133
    Registered User

    Jan 2008
    Queensland
    1,176

    I'm naturally a bad sleeper as well. I am taking it at 6.30-7.00am and can still feel the energy pumping through my body in the middle of the night when I'm laying there wide awake. Both Friday night and Saturday night I never slept at all again so yesterday I didn't take a tablet and slept so well last night. My cousin was on duromine and it worked well for her but she never had any sleep issues. She suggested taking it at like 4am to give it more time to wear off by night, so maybe I could try that. I'm just hoping my body gets used to it & learns to sleep while taking it.

  8. #134
    Registered User
    Add damprye on Facebook

    Aug 2009
    Western Australia, SOR
    1,152

    Sorry for not reading though everyone elses before adding my own but there is a lot to get through lol.

    I was first prescribed 15mg but after about two weeks, there was no weightloss or any other side effects. With nothing at happening, my doctor put me straight up onto the 40mg. Within 10 days, I had lost 5kgs. The only change to my diet at this stage is that my Family from over east came to visit so we were eating out for almost every meal My workout routine was the same. I dropped 15kgs on Duromine 40mg before it stopped affecting me (about six weeks) so I had a break from it. My weight yoyod a little, never more than a 5kg gain. After a while my body learnt to cope with the weightloss without Duromine and I went on to lose a little over 20kgs from my starting weight which is what my goal was at that stage, to be 95kgs down from 117. Two years on and I did gain a little weight back but that was purely through bad eating habits and not working out.

    The bad side-effects I had on it was slight paranoia, I got scared that someone would be hiding in the dark lol and I felt a bit shaky on the inside but it didnt show on the out, quite a weird sensation to me, like having too many redbull lol. I didn't get mood swings, high BP or any troubles sleeping at all. I did have a lil more energy than normal and wasn't needing my nanna naps anymore which was good as it meant that while DS was sleeping, I could get some housework done

    That's it from me and I hope that helps some people

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