Question on weight-loss drug dosage.

[Chrish]

Gettings,

We have a patient who gets Phentermine 37.5 mg BID # 60 each month.

My question is, is 75 mg/ day justified? I can’t find it anywhere in package insert to go above 37.5 mg (although we have some other folks on 1.5 tab of 37.5 mg qd).

Thanks

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[smq123]

Gettings,

We have a patient who gets Phentermine 37.5 mg BID # 60 each month.

My question is, is 75 mg/ day justified? I can’t find it anywhere in package insert to go above 37.5 mg (although we have some other folks on 1.5 tab of 37.5 mg qd).

Thanks

If a patient is particularly heavy, I guess I can understand the theory behind put them on such a high dose. I’ve personally never done it but I hate Phentermine anyway.

How long has this patient been taking this dose?

 

[Chrish]

If a patient is particularly heavy, I guess I can understand the theory behind put them on such a high dose. I’ve personally never done it but I hate Phentermine anyway.

How long has this patient been taking this dose?

Been on it for a year per PDMP. Nothing showing up prior to that.

They don’t “look” heavy. It’s from the doctor who owns weight loss clinic and even sells phentermine to his patient.

 

[Make Or Break]

I would not keep them on it for a whole year or increase past what is recommended. Side effects are dose dependent. If a pt has a heart attack, I would think you’re liable if you’re going way past what is recommended.

 

[FrustratedFamDoc]

Pulling a patient off of double dose Adipex that someone else screwed her up with…. This won’t be fun for you. Stimulant cardiomyopathy is real.

 

[BigSib]

I personally have not had much success with that med long term. I usually more describe it as something that can help a new diet change with the hope that change will be easier and help habitual change. Usually I have patients taper or stop after 3-6 months.

I also require RN wt checks every 3-4 months as an opportunity to quickly discuss dosing and review adverse effects.

Wegovy / Trulicity / Ozempic is way better.

 

[scharnhorst]

Been on it for a year per PDMP. Nothing showing up prior to that.

They don’t “look” heavy. It’s from the doctor who owns weight loss clinic and even sells phentermine to his patient.

HUGE red flag

I would not prescribe it , its a band aid approach to weight loss

I tell most of my patients , weight loss involves lot of discipline , doing things you don't enjoy and eating food that don't particularly taste that great
If they come for me for stimulants I almost ALWAYS refuse

 

[Make Or Break]

HUGE red flag

I would not prescribe it , its a band aid approach to weight loss

I tell most of my patients , weight loss involves lot of discipline , doing things you don't enjoy and eating food that don't particularly taste that great
If they come for me for stimulants I almost ALWAYS refuse

I think it definitely has its place and I’ve seen success with pts maintaining a lower weight when they complete treatment but it’s not enough where I could call it a wonder drug.

 

[I_Cant_tell_you]

I've never prescribed that high and wouldn't do it.

 

[clausewitz2]

I don't prescribe phentermine but certainly am very familiar with prescribing stimulants and have a number of patients with PCPs who have started them on it. So far I see a very similar pattern as one does with stimulant prescribing for other purposes - a honeymoon period of feeling great about everything and barely eating, and a gradual fading of the subjective sense of well-being and gradual increase in food intake. Much like stimulant prescribing for other purposes, getting patient buy-in for a ruthless focus on measurable, external metrics of success that do not in any way depend on how someone feels like they are doing + deliberate strategies for maximizing benefit and identifying trouble areas seems necessary. I get how this is going to be difficult for a lot of y'all to implement on the regular all the time as it involves getting pretty far into the weeds.

 

[VA Hopeful Dr]

I don't prescribe phentermine but certainly am very familiar with prescribing stimulants and have a number of patients with PCPs who have started them on it. So far I see a very similar pattern as one does with stimulant prescribing for other purposes - a honeymoon period of feeling great about everything and barely eating, and a gradual fading of the subjective sense of well-being and gradual increase in food intake. Much like stimulant prescribing for other purposes, getting patient buy-in for a ruthless focus on measurable, external metrics of success that do not in any way depend on how someone feels like they are doing + deliberate strategies for maximizing benefit and identifying trouble areas seems necessary. I get how this is going to be difficult for a lot of y'all to implement on the regular all the time as it involves getting pretty far into the weeds.

It's not that hard. If I put you on a weight loss medication and after 2/3 months at a solid dose You have t lost weight then I stop prescribing it.

 

[clausewitz2]

It's not that hard. If I put you on a weight loss medication and after 2/3 months at a solid dose You have t lost weight then I stop prescribing it.

I meant in terms of making meaningful dietary changes etc but yes that is also reasonable.

 

[VA Hopeful Dr]

I meant in terms of making meaningful dietary changes etc but yes that is also reasonable.

If they actually want, I will absolutely do a deep dive into nutrition and exercise.

It's pretty rare that patients both want that and their eyes don't glaze over when I try.

 

[Marcus Brody]

They're probably deferring it.

It's only approved (for what that's worth) for 3 months. And studies show most weight loss is in the first few months, with diminishing returns being minimal between 6-9 months.

A year? Uh, no.

 

[goldsummer]

I never do phentermine. If med is needed, GLP-1 or referral to weight loss center to review and manage phentermine if deemed appropriate.