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Introduction to Phentermine

Phentermine is a prescription medication that is primarily used for short-term weight loss treatment. It is part of a class of drugs called sympathomimetic amines, which work by stimulating the central nervous system to increase heart rate and blood pressure while also suppressing appetite. 

Phentermine works by increasing the levels of certain neurotransmitters in the brain, such as norepinephrine, that signal fullness and satiety. This helps patients feel less hungry while strictly controlling their calorie intake. When combined with lifestyle changes, phentermine can be an effective short-term treatment for clinically obese patients. However, it is not a standalone solution and requires dedication from the patient to modify behaviors for lasting weight loss success.

 Medical Uses

1. Phentermine is primarily used for weight loss in people who are obese or overweight. It is intended for short-term use of a few weeks as part of an overall weight loss program that also includes diet, exercise, and counseling. 
2. Phentermine works by decreasing appetite and boosting energy expenditure. This helps people eat less and have more energy to exercise, leading to weight loss.
3. Phentermine is sometimes prescribed off-label for ADHD. It is similar in structure and effects to amphetamine stimulants used for ADHD like Adderall. Phentermine may help increase focus and concentration in those with ADHD. However, it has a high abuse potential and there are safer FDA-approved options for treating ADHD. Phentermine use for ADHD is controversial.

Mechanism of Action 

It stimulates the central nervous system (CNS), which increases heart rate and blood pressure while also decreasing appetite. 

• The exact mechanisms behind phentermine’s appetite-suppressing effects are not fully understood. However, it is thought to work by increasing levels of norepinephrine and dopamine in the brain. This triggers a fight-or-flight response, which suppresses hunger. 
• Additionally, phentermine is chemically similar to amphetamine. It is believed to stimulate the release of norepinephrine in the hypothalamus region of the brain. The hypothalamus helps control appetite and energy expenditure. Higher levels of norepinephrine in this region are associated with decreased hunger.

Dosage   

Phentermine is typically prescribed in doses ranging from Phentermine  15 to Phentermine  37.5 mg per day. It is most commonly prescribed at a dose of 37.5 mg per day. However, lower doses such as 15 or 30 mg may be prescribed, especially for patients who experience side effects at higher doses. 

The dosing schedule depends on the formulation:

• Immediate release tablets or capsules are usually taken once daily in the morning before breakfast or 1-2 hours after breakfast.
• Extended release capsules can be taken once daily in the morning.
• Orally disintegrating tablets are dissolved in the mouth in the morning.

The dosage may be adjusted during treatment depending on effectiveness and tolerability. Patients should follow their prescribing doctor’s instructions for when and how to take phentermine, and should not increase or alter the dosage without medical consultation.

Side Effects

Phentermine is generally well tolerated, but may cause some side effects. The most common side effects are:

• Dry mouth
• Unpleasant taste in mouth  
• Diarrhea or constipation
• Headache  
• Dizziness
• Trouble sleeping
• Irritability
• Nausea
• Vomiting
• Tremors
• Increased blood pressure
• Increased heart rate

More serious side effects may include:

• Heart palpitations
• Shortness of breath
• Swelling of feet or ankles  
• Hallucinations
• Aggressive behavior
• Mania
• Paranoia 

Precautions  

Caution should be used when prescribing phentermine to patients with even mild hypertension, diabetes, or a history of substance abuse. The least amount feasible should be prescribed for the shortest period needed to achieve acceptable weight loss.

The effect of long-term use of phentermine is unknown. Tolerance to the anorectic effect usually develops within a few weeks, meaning the drug loses effectiveness over time. Phentermine should be discontinued in patients who fail to lose weight during the first month of therapy.

Withdrawal following chronic use may include extreme fatigue, mental depression, anxiety, and changes in libido.

Conclusion

Phentermine is a stimulant medication that is used for short-term treatment of obesity. It increases energy expenditure while decreasing appetite. When used appropriately under medical supervision, phentermine can be an effective component of a weight loss regimen. However, it does have the potential for side effects and abuse. Key points to understand about phentermine include:

• It is a Schedule IV controlled substance due to its abuse potential and side effects. It should only be used short-term.
• It works by increasing levels of norepinephrine, dopamine, and serotonin in the brain which suppresses appetite and increases metabolism and energy levels.
• Common side effects include increased heart rate and blood pressure, insomnia, dry mouth, constipation, and headaches. More serious side effects are possible. 
• It can interact with many other medications including antidepressants, so other medications should be reviewed before starting phentermine.
• It should not be taken by those with heart disease, hyperthyroidism, glaucoma, or a history of drug abuse.
• While it can help with short-term weight loss, it does not teach long-term healthy lifestyle changes. Lifestyle modification is still required for sustained weight loss.
• It has a high potential for abuse and addiction and should be taken exactly as prescribed.

In summary, phentermine is a potentially useful short-term obesity treatment under medical supervision, but also carries risks. Patients should be monitored closely and use it appropriately as part of an overall weight loss program.