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Withdrawal Not a Problem with Phentermine

May 20, 2013

Trigger warning: Discussion of the diet drug phentermine.

Another one of my MedPage Today articles caught my eye. This time, the headline read, “Withdrawal Not A Problem With Phentermine.”

Phentermine, a common diet drug that has been on the U.S. market since 1959, is pharmacologically similar to amphetamine. It’s often prescribed long-term to help patients lose weight.

Given its similarity to the stimulant amphetamine, some researchers have suspected that phentermine may also lead to withdrawal once it’s stopped.

Because phentermine acts like, and is similar to, amphetamine, doctors have worried about withdrawal effects on patients. I noticed that phentermine has been available and prescribed since 1959, and some patients have been on it as long as eight years. So doctors are worried about withdrawal symptoms/effects, but they’re still prescribing it without knowing if those effects exist or what their severity is. Why do I get the feeling this kind of thing really isn’t about health, but is about aesthetics?

But only the hyperphagia score was significantly different across groups, rising from 0.77 on-drug to 1.16 the first day off the drug and 1.03 on the second day (P=0.027).

Hyperphagia is defined as abnormally increased appetite for consumption of food.

PhentermineWhat these researchers found is that the day after phentermine is abruptly stopped, appetite increases (no shit, Sherlock). The researchers also say that this effect goes away after a couple of days, but they don’t say how they know this as the questionnaire they gave to participants only covered the time while they were taking the drug and the two days after it was stopped. They don’t say if there was any further follow-up to see if patients’ appetites were still increased after that.

Thus, after hyperphagia score was removed from the total, the remaining scores based on 9 items were not significantly different across days, the researchers reported (P=0.084).

Hendricks and colleagues noted that these scores are far lower than scores achieved on the amphetamine withdrawal questionnaire.

He also added that phentermine is not available in Europe: “Worldwide usage of phentermine has been curtailed because of persistent fears that the drug might induce addiction and that it might induce cardiovascular harm. However, this study suggests fears of causing addiction with long-term phentermine prescribing are exaggerated and present a needless barrier to better care for overweight and obese patients worldwide,” he said in a statement.

Right, because even the risk of cardiovascular harm is better than being fat (/sarcasm).

So, the researchers found that phentermine is not addictive, but it’s not available in Europe because of the fear of addiction, and the fear that “it might induce cardiovascular harm” (phen-fen, anyone?). We don’t have to worry about becoming addicted to phentermine, but the researchers don’t address the fears about it causing cardiovascular harm. I guess that’s a risk they’re willing for fat people to take in order to try and become thin. I don’t even know what to say about people who think like this (well, I do, but I don’t think anyone wants to read a long string of swear words).

Even if phentermine isn’t addictive, the cardiovascular issues just isn’t a risk I would be willing to take now that I know it exists (I didn’t know about the risk back in 1996 when I took phen-fen for six months, right before it was taken off the market).

The drug’s structural similarity to amphetamine “has led many to presume that phentermine should have the same adverse effects as crystal methamphetamine,” Hendricks said. “No evidence supporting such presumptions is to be found.”

“On the contrary,” he added, “the evidence strongly suggests phentermine is far safer than is commonly assumed. It is indeed unfortunate that these misconceptions hinder the availability of an effective, affordable medicine for treating obesity.”

Safer because it’s not addictive? Safer because you don’t know the risks of cardiovascular harm? *headdesk*

It’s worth noting that the results of the yet-to-be-published study were reported at the European Congress on Obesity (ECO) in Liverpool, England by lead author Dr. Ed Hendricks of the Center for Weight Management in California, which is a a non-public fee-for-support health-related practice specializing in weight problems drugs or bariatric medication. ECO is an annual meeting of the European Association for the Study of Obesity. ECO is sponsored by corporates sponsors involved in biomedical research, the treatment of obesity-related diseases, and, of course, weight loss companies like Eurodiet, Pronokal, Cambridge Weight Plan, Slimming World, LighterLife, Weight Watchers, and Nestlé.

Even more interesting is that the study was supported by the American Society of Bariatric Physicians, and lead author Hendricks  received honoraria from Akramax, Eurodrug Laboratories, Citius, and Vivus, all of which manufacture phentermine products. Coauthor Dr. Frank Greenway reported relationships with Baronova, Basic Research, Diabetic Living, Eisai, GNC, Jenny Craig, Lithera, Merck, Naturalpha, Nume Health, Orexigen, Plensat, Takeda, Thetis, Unigene, and Zafgen.

I’m sure none of these conflicts of interest had any influence on the final outcome.


8 Comments leave one →
  1. May 20, 2013 10:40 am

    I don’t even know what to say about people who think like this (well, I do, but I don’t think anyone wants to read a long string of swear words).

    Oh, I don’t know. Maybe I would like to read that in correlation to weight loss drugs. 🙂

    *sarcasm* It’s good to know that my fat is obviously a more pressing matter than potential addiction or cardiovascular risks. Or that it’s okay to make fatties of the world the guinea pigs of the world for big pharma. *end sarcasm*

  2. Duckie permalink
    May 20, 2013 11:33 am

    To be fair, and thinking about this with the scientific mind, the stated purpose was to discuss the addiction/withdrawal concerns related to the drug. There was never any stated intent to discuss any cardiovascular or other side effects and they don’t deny that the side effects exist (based on the info you provide here). Though they did give a nod to the side effects, they could have left that out entirely and still had a focused research report on addictive qualities.

    I’m willing to entertain the idea that maybe there’s something about this drug that is not physically addictive. That’s not to say I’m gullible enough to believe that there are no side effects or potential for psychological addiction.

    • Purple peonies permalink
      May 20, 2013 12:51 pm

      Withdrawal problems can happen for more than 2 days after the fact though, and may involve long term CV risks. I think this study was purely to make the drug look more appealing.

      Big Pharma is well known now for cherry picking data, and this study REEKS of that. A withdrawal study that only looks 2 days beyond cessation? We already know stuff like SSRI’s can take WEEKS to withdraw after sudden stopping. Opiates can take many days. A 2 day survey Raises more questions than it answers.

      • May 20, 2013 1:04 pm

        Excellent point! I take Paxil for ADD (long story) and have for over a decade. When I stop taking Paxil abruptly, it’s no big deal until about four days later when I start getting these (for lack of a better term) electrical impulses in my brain that become increasingly intense with each passing day. I would love to see the actual content of this study to see their methodology, but it hasn’t been published yet. 😦


        • Elizabeth permalink
          May 20, 2013 1:45 pm

          Shannon, my GP prescribed Paxil to me when 1) I was in severe pain, 2) my kitchen was completely torn up, and 3) my furnace had just been condemned, in January. She diagnosed me as depressed but didn’t tell me she did so. After two months, I had gained 20 pounds and slept all the time. A friend asked me, “Why are you taking that shit?” and I stopped. And found out that Paxil is the SSRI most difficult to stop. I carefully weaned myself and had no problems other than jumpiness.

          I don’t mean people shouldn’t take drugs they feel they need, but they should be told of all the drug’s effects and how difficult it may be to stop taking.

    • May 20, 2013 1:05 pm

      True. But it does still dismiss the cardiovascular problems rather glibly, don’t you think?


  3. Purple peonies permalink
    May 20, 2013 12:47 pm

    I can’t get a box of freaking sudafed during allergy season without practically being fingerprinted and pardoned due to to ability to turn it into methamphetamine by way of a dirty complex dangerous process, but let’s just go ahead and make an ACTUAL amphetamine more appealing to people who hate fat people. Brilliant.

    Glad you pointed out the financial ties. This is really the heart of the issue IMO.

  4. Dizzyd permalink
    May 20, 2013 6:34 pm

    So there they go again prescribing phentamine (which of course is part of the dastardly duo fen/phen). I had a rotten feeling they would do that. If they can suggest glibly – not too long ago – that yo-yo dieting is actually OKAY and NOT harmful at all, I was sitting there thinking when reading that that it won’t be long before they start bringing back the worst drug combo ever and claim that it’s as harmless as popping Flintstones Chewables. Hey, fatties! We hate your guts, but we won’t come right out and say it, so here – take these pills we tried to foist on you before until we were called out on its bad side effects, but we’re hoping you have a short memory and are totally stupid so you’ll take it again! Cuz we need money!

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