APPETITESUPPRESSANTS, SYMPATHOMIMETIC (Systemic)
Some commonly used brand names are:
In the U.S.?
- Adipex-P 5
- Adipost 4
- Bontril PDM 4
- Bontril Slow-Release 4
- Didrex 1
- Fastin 5
- Ionamin 5
- Mazanor 3
- Melfiat 4
- Obenix 5
- Obezine 4
- Phendiet 4
- Phendiet-105 4
- Phentercot 5
- Phentride 5
- Plegine 4
- Prelu-2 4
- Pro-Fast 5
- PT 105 4
- Sanorex 3
- Tenuate 2
- Tenuate Dospan 2
- Tepanil Ten-Tab 2
- Teramine 5
- Zantryl 5
In Canada?
- Ionamin 5
- Sanorex 3
- Tenuate 2
- Tenuate Dospan 2
Other commonly used names are:
Note: | For quick reference, the following appetite suppressants are numberedto match the corresponding brand names. |
Category
- Appetitesuppressant?Benzphetamine; Diethylpropion; Mazindol; Phendimetrazine; Phentermine
Description
Sympathomimetic appetite suppressants are used in the short-termtreatment of obesity. Their appetite-reducing effect tends to decrease aftera few weeks. Because of this, these medicines are useful only during the firstfew weeks of a weight-loss program. The sympathomimetic appetite suppressantscan help you to lose weight while you are learning new ways to eat and toexercise. Changes in eating habits and activity level must be developed andcontinued long-term in order for you to continue losing weight and to keepthe lost weight from returning.
These medicines are available only with your doctor's prescription, inthe following dosage forms:
Oral- Benzphetamine
- Diethylpropion
- Tablets (U.S. and Canada)
- Extended-release tablets (U.S. and Canada)
- Mazindol
- Tablets (U.S. and Canada)
- Phendimetrazine
- Extended-release capsules (U.S.)
- Tablets (U.S.)
- Phentermine
- Capsules (U.S.)
- Resin capsules (U.S. and Canada)
- Tablets (U.S.)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it may do.This is a decision you and your doctor will make. For sympathomimetic appetitesuppressants, the following should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to this medicine or amphetamine, dextroamphetamine, ephedrine,epinephrine, isoproterenol, metaproterenol, methamphetamine, norepinephrine,phenylephrine, phenylpropanolamine, pseudoephedrine, terbutaline, or otherappetite suppressants. Also tell your health care professional if you areallergic to any other substances, such as foods, preservatives, or dyes.
Diet?You must follow a reduced-calorie diet whileusing an appetite suppressant in order to lose weight. Also, in order to keepthe lost weight from returning, changes in diet and exercise must be continuedafter the weight has been lost.
Pregnancy?If a pregnant woman takes this medicine in high dosesor more often than the doctor has directed, it may cause withdrawal symptomsin the newborn baby. Also, medicines similar to sympathomimetic appetite suppressantscan cause birth defects in the newborn baby if a pregnant woman takes themin high doses. Before taking this medicine, make sure your doctor knows ifyou are pregnant or if you may become pregnant.
Breast-feeding?Diethylpropion and benzphetamine pass into breastmilk. It is not known if other sympathomimetic appetite suppressants passinto breast milk. However, use of sympathomimetic appetite suppressants duringbreast-feeding is not recommended, because it may cause unwanted effects innursing babies.
Children?Studies on these medicines have been done only inadult patients, and there is no specific information comparing use of sympathomimeticappetite suppressants in children with use in other age groups. The use ofthese medicines by children younger than 16 years of age is not recommended.
Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults or if they cause different side effectsor problems in older people. There is no specific information comparing useof appetite suppressants in the elderly with use in other age groups.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingappetite suppressants, it is especially important that your health care professionalknow if you are taking any of the following:
- Amantadine (e.g., Symmetrel) or
- Amphetamines or
- Caffeine (e.g., NoDoz) or
- Chlophedianol (e.g., Ulone) or
- Cocaine or
- Medicine for asthma or other breathing problems or
- Medicine for colds, sinus problems, or hay fever or other allergies(including nose drops or sprays) or
- Methylphenidate (e.g., Ritalin) or
- Nabilone (e.g., Cesamet) or
- Pemoline (e.g., Cylert)?Using these medicines with sympathomimeticappetite suppressants may increase the central nervous system (CNS) stimulanteffects, such as irritability, nervousness, trembling or shaking, or troublein sleeping
- Appetite suppressants (diet pills), other or
- Selective serotonin reuptake inhibitors (citalopram [e.g., Celexa],fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil],sertraline [e.g., Zoloft])?It is not known whether using two differentappetite suppressants together or using a sympathomimetic appetite suppressantwith a selective serotonin reuptake inhibitor is safe and effective. Therehave been some serious unwanted effects on the hearts of people who used twodifferent appetite suppressants together
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g.,Marplan], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine[e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])?Do not take an appetite suppressant while you are taking orless than 14 days after taking a monoamine oxidase (MAO) inhibitor.If you do, you may develop sudden extremely high blood pressure
- Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine[e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane],doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g.,Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])?Usingthese medicines with sympathomimetic appetite suppressants may cause highblood pressure or irregular heartbeat
Other medical problems?The presence of other medicalproblems may affect the use of appetite suppressants. Make sure you tell yourdoctor if you have any other medical problems, especially:
- Alcohol abuse (or history of) or
- Drug abuse or dependence (or history of)?Dependence on appetitesuppressants may be more likely to develop
- Type 2 diabetes mellitus?The amount of insulin or oral antidiabeticmedicine that you need to take may change
- Epilepsy?Diethylpropion may increase the risk of having seizures
- Family history of mental illness?Mental depression or othermental illness may be more likely to occur
- Glaucoma or
- Heart or blood vessel disease or
- High blood pressure or
- Mental illness or
- Overactive thyroid?Appetite suppressants may make the conditionworse
- Kidney disease?Higher blood levels of the appetite suppressantmay occur, increasing the chance of serious side effects
Proper Use of This Medicine
In orderto prevent trouble in sleeping, if you are taking:
- One dose of this medicine a day, take it about 10 to 14 hours beforebedtime.
- More than one dose of this medicine a day, take the last dose ofthe day about 4 to 6 hours before bedtime.
For patients taking a long-acting form of thismedicine:
- Swallow these capsules or tablets whole. Do not break, crush, orchew before swallowing.
For patients taking mazindol:
- This medicine may be taken with food, if needed, to prevent stomachupset.
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not takeit for a longer time than your doctor ordered. If too much is taken, it maycause unwanted effects or become habit-forming.
If you think this medicine is not working properly after you have takenit for a few weeks, do not increase the dose.Instead, check with your doctor.
Dosing?The dose of appetite suppressants will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of appetite suppressants. If your doseis different, do not change it unless your doctor tells you to do so.
For benzphetamine- For oral dosage form (tablets):
- For appetite suppression:
- Adults?At first, 25 to 50 milligrams (mg) once a day, takenin midmorning or midafternoon. Your doctor may need to adjust your dose.
- Children up to 16 years of age?Use is not recommended.
For diethylpropion- For oral dosage form (tablets):
- For appetite suppression:
- Adults?25 milligrams (mg) three times a day, taken one hourbefore meals.
- Children up to 16 years of age?Use is not recommended.
- For long-acting oral dosage form (extended-releasetablets):
- For appetite suppression:
- Adults?75 mg once a day, taken in midmorning.
- Children up to 16 years of age?Use is not recommended.
For mazindol- For oral dosage form (tablets):
- For appetite suppression:
- Adults?At first, 1 milligram (mg) once a day. Your doctor mayneed to adjust your dose.
- Children up to 16 years of age?Use is not recommended.
For phendimetrazine- For long-acting oral dosage form (extended-releasecapsules):
- For appetite suppression:
- Adults?105 mg once a day, taken thirty to sixty minutes beforethe morning meal.
- Children up to 16 years of age?Use is not recommended.
- For oral dosage form (tablets):
- For appetite suppression:
- Adults?17.5 to 35 mg two or three times a day, taken one hourbefore meals.
- Children up to 16 years of age?Use is not recommended.
For phentermine- For oral dosage form (capsules):
- For appetite suppression:
- Adults?15 to 37.5 milligrams (mg) once a day, taken beforebreakfast or one to two hours after breakfast.
- Children up to 16 years of age?Use is not recommended.
- For oral dosage form (tablets):
- For appetite suppression:
- Adults?15 to 37.5 mg once a day, taken before breakfast orone to two hours after breakfast. Instead of taking it once a day, your doctormay tell you to take smaller doses thirty minutes before meals.
- Children up to 16 years of age?Use is not recommended.
- For oral resin dosage form (capsules):
- For appetite suppression:
- Adults?15 to 30 mg once a day, taken before breakfast.
- Children up to 16 years of age?Use is not recommended.
Missed dose?If you miss a dose of this medicine, skip the misseddose and continue with your regular dosing schedule. Do not double doses.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Yourdoctor should check your progress at regular visits to make sure that thismedicine does not cause unwanted effects.
If you think this medicine is not working properly after you have takenit for a few weeks, do not increase the dose.Instead, check with your doctor.
Do not take an appetite suppressant with or less than14 days after taking a monoamine oxidase (MAO) inhibitor. If you do,you may very suddenly develop extremely high blood pressure.
Taking a sympathomimetic appetite suppressant may cause a positive resultin urine screening tests for amphetamines.
Sympathomimetic appetite suppressants may cause dryness of the mouth. Fortemporary relief, use sugarless candy or gum, melt bits of ice in your mouth,or use a saliva substitute. However, if your mouth continues to feel dry formore than 2 weeks, check with your medical doctor or dentist. Continuing drynessof the mouth may increase the chance of developing dental disease, includingtooth decay, gum disease, and fungus infections.
This medicine may cause some people to feel a false sense of well-beingor to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine beforeyou drive, use machines, or do anything else that could be dangerous if youare dizzy or are not alert.
Before having any kind of surgery, dental treatment,or emergency treatment, tell the medical doctor or dentist in charge thatyou are using this medicine. Taking appetite suppressants togetherwith medicines that are used during surgery or dental or emergency treatmentsmay cause serious side effects.
Check with your doctor immediately if you notice adecrease in your ability to exercise, if you faint, or if you have chest pain,swelling of your feet or lower legs, or trouble in breathing. Thesemay be symptoms of very serious heart or lung problems.
If you have been taking this medicine for a long time or in large dosesand you think you may have become mentally or physicallydependent on it, check with your doctor.
- Some signs of dependence on appetite suppressants are:
- a strong desire or need to continue taking the medicine.
- a need to increase the dose to receive the effects of the medicine.
- withdrawal side effects (for example, mental depression, nausea orvomiting, stomach cramps or pain, trembling, unusual tiredness or weakness)when you stop taking the medicine.
For patients with diabetes:
- This medicine may affect blood sugar levels. If you notice a changein the results of your urine or blood sugar test or if you have any questions,check with your doctor.
If you have been taking this medicine in large doses or for a long time, do not stop taking it without first checking with yourdoctor. Your doctor may want you to reduce gradually the amount youare taking before stopping completely. This will help prevent withdrawal sideeffects.
Side Effects of This Medicine
Appetite suppressants maycause some serious side effects, including heart and lung problems. You and your doctor should discuss the good this medicine maydo as well as the risks of taking it.
Along with its needed effects, a medicine maycause some unwanted effects. Although not all of these side effects may occur,if they do occur they may need medical attention.
Check withyour doctor as soon as possible if any of the following side effects occur:
Less common or rare
Difficult or painful urination; fastor irregular heartbeat; feeling that others can hearyour thoughts; feeling that others are watching youor controlling your behavior; hallucinations (feeling,seeing, or hearing things that are not there); headache(severe); mental depression; numbness, especially on one side of the face or body; skin rash or hives; sore throat and fever (with diethylpropion); talking, feeling, and acting with excitement andactivity you cannot control; unusual bleeding orbruising (with diethylpropion)
Symptoms of overdose
Abdominal or stomach cramps; coma; confusion; convulsions (seizures); diarrhea (severe); dizziness, lightheadedness,or fainting; fast breathing; feeling of panic; fever; hallucinations (seeing, hearing or feeling things that are not there); high or low blood pressure; hostilitywith urge to attack; irregular heartbeat; nausea or vomiting (severe); overactivereflexes; restlessness; trembling or shaking; tiredness, weakness, and mentaldepression following effects of excitement
Abuse of a sympathomimetic appetite suppressant(taking the medicine in larger doses or taking it more frequently or for alonger time than the doctor ordered) can cause the following side effects:
Changes in personality; excessive, excitedactivity; irritability (severe); mental illness (severe), similar to schizophrenia; skin disease; trouble in sleeping (severe)
Other side effects may occur that usually do not need medical attention.These side effects may go away during treatment as your body adjusts to themedicine. However, check with your doctor if any of the following side effectscontinue or are bothersome:
Although notall of the side effects listed above have been reported for all of these medicines,they have been reported for at least one of them. However, since all of thesympathomimetic appetite suppressants are similar, any of the above side effectsmay occur with any of these medicines.
After you stop using thismedicine, your body may need time to adjust. The length of time this takesdepends on the amount of medicine you were using and how long you used it.During this time check with your doctor if you notice any of the followingside effects:
Extreme tiredness or weakness; mentaldepression; nausea or vomiting; stomach cramps or pain; trembling; trouble in sleeping or nightmares
Otherside effects not listed above may also occur in some patients. If you noticeany other effects, check with your doctor.
Revised: 04/26/1999
