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Phentermine is still available by itself in most countries, including the U.S. However, because it is similar to the amphetamines, individuals may develop an addiction to it. Hence, it is classified as a controlled substance in many countries. Internationally, phentermine is a schedule IV drug under the Convention on Psychotropic Substances (PDF file). In the United States, it is classified as a Schedule IV controlled substance under the Controlled Substances Act.
Mechanism of action in Phentermine from Phentermine Man.com
Phentermine, as many other prescription drugs,
works with neurotransmitters in the brain. It is a centrally-acting stimulant
chemically related to the amphetamines. It stimulates neuron bundles to release
a particular group of neurotransmitters known as catecholamines; these include
dopamine, epinephrine (also known as adrenalin), and norepinephrine (noradrenaline).
The anorectic activity seen with these compounds would thus seem likely due to
this effect on Central Nervous System, which is consistent with current
knowledge about Central Nervous System systems and feeding behavior. This is the
same mechanism of action as other stimulant appetite suppresants such as
diethylpropion, and phendimetrazine.
The neurotransmitters signal a fight-or-flight response in the body which, in
turn, puts a halt to the hunger signal. As a result, it causes a loss in
appetite because the brain does not receive the hunger message.
Clinical use of Phentermine
Generally, it is recommended by the FDA that Phentermine should be used short-term (usually interpreted as 'up to 12 weeks'), while following nonpharmacological approaches to weight loss such as healthy dieting and exercise. However, recommendations limiting its use for short-term treatment may be controversial. One reason given behind limiting its use to 12 weeks is drug tolerance, whereby phentermine loses its appetite-suppressing effects after the body adjusts to the drug. On the contrary, it has been shown that Phentermine did not lose effectiveness in a 36-week trial (PMID 11054601). Due to the risk of insomnia, it is generally recommended that the drug be taken either before breakfast or 1-2 hours after breakfast.
Phentermine side effects
Generally, phentermine appears to be relatively well tolerated [1]. It can produce side effects consistent with its catecholaminereleasing properties, e.g., tachycardia, increased heart rate, increased alertness, but the incidence and magnitude of these appear to be less than with the amphetamines. Because phentermine acts through sympathomimetic pathways, the drug may increase blood pressure and heart rate. It may also cause palpitations, restlessness, and insomnia. Additionally, individuals taking this drug on a long-term basis may develop euphoria and a psychological addiction to it.
Contraindications in Phentermine
Phentermine should generally be
avoided in patients with:
Agitation
Allergy/Hypersensitivity to other sympathomimetic amines
Atherosclerosis
Cardiovascular disease
Glaucoma
High blood pressure
Hyperthyroidism
Previous history of drug abuse
Additionally, this drug should not be used at the same time or within 14 days
following the use of monoamine oxidase inhibitors.