Phentermine (phenyl–tertiary-butylamine), sold under the brand name Ionamin among others, is a medication used together with diet and exercise to treat obesity.^[3] It is taken by mouth for up to a few weeks.^[3] After a few weeks the beneficial effects no longer occur.^[3] It is also available as the combination phentermine/topiramate.^[5]

Common side effects include a fast heart beat, high blood pressure, trouble sleeping, dizziness, and restlessness.^[3] Serious side effects may include abuse but do not include pulmonary hypertension, valvular heart disease as the latter were caused by the fenfluramine component of the fen/phen drug combination.^[3] Use is not recommended during pregnancy or breastfeeding.^[6] Use is not recommended together with SSRIs or MAO inhibitors.^[3] It works as an appetite suppressant likely as a result of being a CNS stimulant.^[3] Chemically, phentermine is a substituted amphetamine.^[7]

Phentermine was approved for medical use in the United States in 1959.^[3] It is available as a generic medication.^[3] In 2018, it was the 168th most commonly prescribed medication in the United States, with more than 3 million prescriptions.^[8][9] Phentermine was withdrawn from the market in the United Kingdom in 2000 while the combination medication fen-phen, of which it was a part, was withdrawn from the market in 1997 due to side effects of fenfluramine which caused increased levels of circulating of serotonin which stimulated serotonin receptors on heart valves and thus causing valve insufficiency and leading to primary pulmonary hypertension (PPH). According to the NIH (National Institutes of Health) there is no evidence that phentermine causes PPH

Medical uses

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Phentermine is used for a short period of time to promote weight loss, if exercise and calorie reduction are not sufficient, and in addition to exercise and calorie reduction.^[4][11]

Phentermine is approved for up to 12 weeks of use and most weight loss occurs in the first weeks.^[11] However, significant loss continues through the sixth month and has been shown to continue at a slower rate through the ninth month.^[12]

Contraindications

Phentermine use is contraindicated in those who:^[4][11]

• have a history of drug abuse.
• are allergic to sympathomimetic amine drugs.
• are taking a monoamine oxidase inhibitor (MAOI) or have taken one within the last 14 days.
• have cardiovascular disease, hyperthyroidism, or glaucoma.
• are pregnant, planning to become pregnant, or breast-feeding.

Adverse effects

Tolerance usually occurs; however, risks of dependence and addiction are considered negligible.^[12][13] People taking phentermine may be impaired when driving or operating machinery.^[11] Consumption of alcohol with phentermine may produce adverse effects.^[11]

There is currently no evidence regarding whether or not phentermine is safe for women who are pregnant.^[4][11]

Other adverse effects include:^[4][11]

• Cardiovascular effects like palpitations, tachycardia, high blood pressure, precordial pain; rare cases of stroke, angina, myocardial infarction, cardiac failure and cardiac arrest have been reported.
• Central nervous system effects like overstimulation, restlessness, nervousness, insomnia, tremor, dizziness and headache; there are rare reports of euphoria followed by fatigue and depression, and very rarely, psychotic episodes and hallucinations.
• Gastrointestinal effects include nausea, vomiting, dry mouth, cramps, unpleasant taste, diarrhea, and constipation.
• Other adverse effects include trouble urinating, rash, impotence, changes in libido, and facial swelling.

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Dizziness, dry mouth, difficulty sleeping, irritability, nausea, vomiting, diarrhea, or constipation may occur. If these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if any of these unlikely but serious side effects occur: fast/irregular/pounding heartbeat, mental/mood changes (e.g., agitation, uncontrolled anger, hallucinations, nervousness), uncontrolled muscle movements, change in sexual ability/interest.

Stop taking this medication and seek immediate medical attention if any of these rare but very serious side effects occur: severe headache, slurred speech, seizure, weakness on one side of the body, vision changes (e.g., blurred vision).

This drug may rarely cause serious (sometimes fatal) lung or heart problems (pulmonary hypertension, heart valve problems). The risk increases with longer use of this medication and use of this drug along with other appetite-suppressant drugs/herbal products. If you notice any of the following unlikely but very serious side effects, stop taking this medication and consult your doctor or pharmacist right away: chest pain, difficulty breathing with exercise, decreased ability to exercise, fainting, swelling of the legs/ankles/feet.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.