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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?
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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.
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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.
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.
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.
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.
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've never prescribed that high and wouldn't do it.
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.
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.
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.
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.
I never do phentermine. If med is needed, GLP-1 or referral to weight loss center to review and manage phentermine if deemed appropriate.
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