Phentermine in the Modern Era of Obesity Pharmacotherapy: Does It Still Have a Role in Treatment?
Anti-obesity pharmacotherapy
Phentermine
Journal
Current obesity reports
ISSN: 2162-4968
Titre abrégé: Curr Obes Rep
Pays: United States
ID NLM: 101578283
Informations de publication
Date de publication:
03 Jan 2024
03 Jan 2024
Historique:
accepted:
02
12
2023
medline:
4
1
2024
pubmed:
4
1
2024
entrez:
3
1
2024
Statut:
aheadofprint
Résumé
This review provides an overview of the history, mechanism of action, and expected treatment effects of the anti-obesity medication (AOM), phentermine. It also includes a summary of recent research and practical guidance for prescribing clinicians. Recent research on phentermine is sparse and consists primarily of observational studies with methodologic limitations. These studies suggest that phentermine use is associated with clinically significant weight loss in adults and that the medication is generally well tolerated. Large-scale observational studies evaluating phentermine's safety have not identified an increased risk of cardiovascular events or elevations in blood pressure. There is no data to support the notion that phentermine is addictive. Although it remains the most commonly prescribed AOM in the USA, phentermine has little rigorous research to support its efficacy and safety in long-term treatment, which creates a dilemma with guideline-recommended chronic use of AOMs. While we await forthcoming conclusive data on this front, clinicians may consider using phentermine long-term in selected patients, if such prescribing is consistent with local regulatory statutes.
Identifiants
pubmed: 38172485
doi: 10.1007/s13679-023-00546-9
pii: 10.1007/s13679-023-00546-9
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989.
pubmed: 33567185
doi: 10.1056/NEJMoa2032183
Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–16.
pubmed: 35658024
doi: 10.1056/NEJMoa2206038
Zoler M. Wegovy U.S. Supply shortage strikes again. WebMD Health News. 2023 May 5 2023.
Colman E. Anorectics on trial: a half century of federal regulation of prescription appetite suppressants. Ann Intern Med. 2005;143(5):380–5.
pubmed: 16144896
doi: 10.7326/0003-4819-143-5-200509060-00013
Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62.
pubmed: 25590212
doi: 10.1210/jc.2014-3415
Patel D. Pharmacotherapy for the management of obesity. Metabolism. 2015;64(11):1376–85.
pubmed: 26342499
doi: 10.1016/j.metabol.2015.08.001
Bray GA, Greenway FL. Pharmacological treatment of the overweight patient. Pharmacol Rev. 2007;59(2):151–84.
pubmed: 17540905
doi: 10.1124/pr.59.2.2
Nelson DL, Gehlert DR. Central nervous system biogenic amine targets for control of appetite and energy expenditure. Endocrine. 2006;29(1):49–60.
pubmed: 16622292
doi: 10.1385/ENDO:29:1:49
Introduction WM. Clin Pharmacol Ther. 1992;51(5):581–5.
doi: 10.1038/clpt.1992.68
Weintraub M. Long-term weight control study: conclusions. Clin Pharmacol Ther. 1992;51(5):642–6.
pubmed: 1587079
doi: 10.1038/clpt.1992.76
Weintraub M, Sundaresan PR, Madan M, Schuster B, Balder A, Lasagna L, et al. Long-term weight control study I (weeks 0 to 34). Clin Pharmacol Ther. 1992;51(5):586–94.
pubmed: 1587072
doi: 10.1038/clpt.1992.69
Murali S. Knowledge gaps in long-term phentermine use: making the case for maintenance. Obesity (Silver Spring). 2019;27(8):1219.
pubmed: 31241252
doi: 10.1002/oby.22516
Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: an Endocrine Society scientific statement. Endocr Rev. 2018;39(2):79–132.
pubmed: 29518206
pmcid: 5888222
doi: 10.1210/er.2017-00253
Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association Of Clinical Endocrinologists and American College Of Endocrinology Comprehensive Clinical Practice Guidelines for medical care of patients with obesity. Executive Summary Complete Guidelines available at https://www.aace.com/publications/guidelines . Endocr Pract. 2016;22(7):842–84.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2013.
Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, et al. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163(5):1198–225.
pubmed: 36273831
doi: 10.1053/j.gastro.2022.08.045
Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–91.
pubmed: 32753461
pmcid: 7828878
doi: 10.1503/cmaj.191707
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020;360:1–8.
Saxon DR, Iwamoto SJ, Mettenbrink CJ, McCormick E, Arterburn D, Daley MF, et al. Antiobesity medication use in 2.2 million adults across eight large health care organizations: 2009–2015. Obesity (Silver Spring). 2019;27(12):1975–81.
Almazan E, Schwartz JL, Gudzune KA. Use of medications associated with weight change among participants in the All of Us research programme. Clin Obes. 2023:e12609.
Elangovan A, Shah R, Smith ZL. Pharmacotherapy for obesity-trends using a population level national database. Obes Surg. 2021;31(3):1105–12.
pubmed: 32986169
doi: 10.1007/s11695-020-04987-2
Lewis KH, Fischer H, Ard J, Barton L, Bessesen DH, Daley MF, et al. Safety and effectiveness of longer-term phentermine use: clinical outcomes from an electronic health record cohort. Obesity (Silver Spring). 2019;27(4):591–602.
pubmed: 30900410
doi: 10.1002/oby.22430
Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64.
pubmed: 35441470
pmcid: 9542252
doi: 10.1111/dom.14725
Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414–25.
pubmed: 33755728
doi: 10.1001/jama.2021.3224
Shibuya K, Ali KF, Ji X, Milinoivh A, Bauman J, Kattan MW, et al. The benefit of short-term weight loss with anti-obesity medications in real-world clinical practice. Endocr Pract. 2019;25(10):1022–8.
pubmed: 31241358
doi: 10.4158/EP-2019-0081
Grabarczyk TR. Observational comparative effectiveness of pharmaceutical treatments for obesity within the veterans health administration. Pharmacotherapy. 2018;38(1):19–28.
pubmed: 29044720
doi: 10.1002/phar.2048
Tchang BG, Aras M, Wu A, Aronne LJ, Shukla AP. Long-term weight loss maintenance with obesity pharmacotherapy: a retrospective cohort study. Obes Sci Pract. 2022;8(3):320–7.
pubmed: 35664243
doi: 10.1002/osp4.575
Cunningham JG, Szoka N, Tabone LE, Cox S, Aylward L, Abunnaja S. Preoperative and early adjuvant weight loss medications in bariatric surgery patients with body mass index over 60 or suboptimal initial response to surgery. Surg Obes Relat Dis: official journal of the American Society for Bariatric Surgery. 2023.
Griebeler ML, Butsch WS, Rodriguez P, Lomeli L, Kampert M, Makin V, et al. The use of virtual visits for obesity pharmacotherapy in patients with overweight or obesity compared with in-person encounters. Obesity (Silver Spring). 2022;30(11):2194–203.
pubmed: 36156456
doi: 10.1002/oby.23548
Rocha-Gonzalez HI, De la Cruz-Alvarez LE, Kammar-Garcia A, Canizales-Quinteros S, Huerta-Cruz JC, Barranco-Garduno LM, et al. Weight loss at first month and development of tolerance as possible predictors of 30 mg phentermine efficacy at 6 months. J Pers Med. 2021;11(12).
Moldovan CP, Weldon AJ, Daher NS, Schneider LE, Bellinger DL, Berk LS, et al. Effects of a meal replacement system alone or in combination with phentermine on weight loss and food cravings. Obesity (Silver Spring). 2016;24(11):2344–50.
pubmed: 27664021
doi: 10.1002/oby.21649
Thomas DD, Waring ME, Ameli O, Reisman JI, Vimalananda VG. Patient characteristics associated with receipt of prescription weight-management medications among veterans participating in MOVE! Obesity (Silver Spring). 2019;27(7):1168–76.
pubmed: 31090207
doi: 10.1002/oby.22503
Acosta A, Camilleri M, Abu Dayyeh B, Calderon G, Gonzalez D, McRae A, et al. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity (Silver Spring). 2021;29(4):662–71.
pubmed: 33759389
doi: 10.1002/oby.23120
U.S. Department of Health and Human Services FaDA, Center for drug evaluation and research. Guidance for industry: developing products for weight management. 2007.
Marquez-Cruz M, Kammar-Garcia A, Huerta-Cruz JC, Carrasco-Portugal MDC, Barranco-Garduno LM, Rodriguez-Silverio J, et al. Three- and six-month efficacy and safety of phentermine in a Mexican obese population. Int J Clin Pharmacol Ther. 2021;59(8):539–48.
pubmed: 34236303
pmcid: 8295716
doi: 10.5414/CP203943
Perez-Cruz E, Guevara-Cruz M, Ortiz-Gutierrez S, Luna-Camacho Y, Guzman-Aguilar R, Briceno-Saenz G, et al. Effect of phentermine on hepatic steatosis in bariatric surgery: a pilot study. Med Princ Pract. 2022;31(3):254–61.
pubmed: 35526530
pmcid: 9275005
doi: 10.1159/000524805
Kim HO, Lee JA, Suh HW, Kim YS, Kim BS, Ahn ES, et al. Postmarketing surveillance study of the efficacy and safety of phentermine in patients with obesity. Korean J Fam Med. 2013;34(5):298–306.
pubmed: 24106582
pmcid: 3791337
doi: 10.4082/kjfm.2013.34.5.298
Lexicomp. Phentermine: drug information: Topic 9765 Version 211.0 2018 [Available from: Available at: https://www.uptodate.com/contents/phentermine-drug-information?search=phentermine&source=search_result&selectedTitle=1~13&usage_type=default&display_rank=1#F209150 .
Lexicomp. Phentermine and topiramate: drug information (Topic 85870 Version 263.0) 2023 [Available at: https://www-uptodate-com.wake.idm.oclc.org/contents/phentermine-and-topiramate-drug-information?search=qsymia:%20drug%20information&source=panel_search_result&selectedTitle=1~6&usage_type=panel&kp_tab=drug_general&display_rank=1#references ].
Lexicomp. Semaglutide: drug information (Topic 115980 Version 217.0) 2023 [Available at: https://www-uptodate-com.wake.idm.oclc.org/contents/semaglutide-drug-information?source=auto_suggest&selectedTitle=1~1---1~4---semaglu&search=semaglutide ].
Lee M, Lauren BN, Zhan T, Choi J, Klebanoff M, Abu Dayyeh B, et al. The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. Obes Sci Pract. 2020;6(2):162–70.
pubmed: 32313674
doi: 10.1002/osp4.390
Elhag W, El Ansari W, Abdulrazzaq S, Elsherif M, Mustafa I. Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: anthropometric, glycemic, lipid, safety and cost outcomes. Ann Med Surg (Lond). 2019;45:75–81.
Gorelik E, Gorelik B, Masarwa R, Perlman A, Hirsh-Raccah B, Matok I. The cardiovascular safety of antiobesity drugs-analysis of signals in the FDA Adverse Event Report System Database. Int J Obes (Lond). 2020;44(5):1021–7.
pubmed: 32152496
doi: 10.1038/s41366-020-0544-4
Thomas EA, McNair B, Bechtell JL, Ferland A, Cornier MA, Eckel RH. Greater hunger and less restraint predict weight loss success with phentermine treatment. Obesity (Silver Spring). 2016;24(1):37–43.
pubmed: 26584649
doi: 10.1002/oby.21244
Rothman RB, Elmer GI, Shippenberg TS, Rea W, Baumann MH. Phentermine and fenfluramine: preclinical studies in animal models of cocaine addiction. Ann N Y Acad Sci. 2006;844(1):59–74.
Hendricks EJ, Srisurapanont M, Schmidt SL, Haggard M, Souter S, Mitchell CL, et al. Addiction potential of phentermine prescribed during long-term treatment of obesity. Int J Obes (Lond). 2014;38(2):292–8.
pubmed: 23736363
doi: 10.1038/ijo.2013.74
Force USPST, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive services task force recommendation statement. JAMA. 2018;320(11):1163–71.
O’Malley PG. What does off-label prescribing really mean? Arch Intern Med. 2012;172(10):759–60.
pubmed: 22507697
Eguale T, Buckeridge DL, Winslade NE, Benedetti A, Hanley JA, Tamblyn R. Drug, patient, and physician characteristics associated with off-label prescribing in primary care. Arch Intern Med. 2012;172(10):781–8.
pubmed: 22507695
doi: 10.1001/archinternmed.2012.340
Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med. 2006;166(9):1021–6.
pubmed: 16682577
doi: 10.1001/archinte.166.9.1021
Good CB, Gellad WF. Off-label drug use and adverse drug events: turning up the heat on off-label prescribing. JAMA Intern Med. 2016;176(1):63–4.
pubmed: 26524668
doi: 10.1001/jamainternmed.2015.6068
Diversion Control Division UD. Controlled substance schedules 2023 [Available from: https://www.deadiversion.usdoj.gov/schedules/ .
Gabay M. Federal controlled substances act: controlled substances prescriptions. Hosp Pharm. 2013;48(8):644–5.
pubmed: 24421533
pmcid: 3847977
doi: 10.1310/hpj4808-644
Administration UFaD. Code of Federal Regulations Title 21: Chapter II, Part 1306, Prescriptions 2023 [Available from: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=1306.22 .
Services UDoHaH. Prescribing controlled substances via telehealth 2023 [Available from: https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth .
Agency UDE. Dea’s proposed telemedicine regulations: highlights for medical practitioners 2023 [Available from: https://www.dea.gov/sites/default/files/2023-03/Telehealth_Practitioner_Narrative_312023.pdf .
Pharmacy KBo. Frequently asked questions [Available from: https://pharmacy.ks.gov/resources-consumer-info-2/faq/lists/listsProvider10/weight-loss/can-a-controlled-substance-be-prescribed-to-treat-weight-loss .
Commission OLS. Rule 4731–11–04: Controlled substances for the treatment of obesity 2023 [Available from: https://codes.ohio.gov/ohio-administrative-code/rule-4731-11-04 .
Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74–86.
pubmed: 24231879
pmcid: 3928674
doi: 10.1001/jama.2013.281361
Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. Br Med J. 1968;1(5588):352–4.
pubmed: 15508204
pmcid: 1984840
doi: 10.1136/bmj.1.5588.352
Chai ST MN. SAT-LB022 Effects of intermittent versus continuous phentermine therapy on weight reduction and inflammatory markers in obese non-diabetic patients. J Endocr Soc. 2019;3(Suppl 1).
Busetto L, Bettini S, Makaronidis J, Roberts CA, Halford JCG, Batterham RL. Mechanisms of weight regain. Eur J Intern Med. 2021;93:3–7.
pubmed: 33461826
doi: 10.1016/j.ejim.2021.01.002
Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010;363(3):245–56.
pubmed: 20647200
doi: 10.1056/NEJMoa0909809
Jastreboff AM, Kaplan LM, Frias JP, Wu Q, Du Y, Gurbuz S, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 trial. N Engl J Med. 2023.
Hudak J WG. How to reschedule marijuana, and why it’s unlikely anytime soon 2015 [Available from: https://www.brookings.edu/articles/how-to-reschedule-marijuana-and-why-its-unlikely-anytime-soon/ .